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'''Fecal incontinence''' is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected.
'''Fecal incontinence''' is the loss of regular control of the [[bowels]]. Involuntary excretion and leaking are common occurrences for those affected.
Subjects relating to defecation are often socially unacceptable, thus those affected are often beset by feelings of shame and humiliation. Some refuse to seek medical help, and instead attempt to self-manage the problem. This can lead to social withdrawal and [[isolation]], which can turn into cases of [[agoraphobia]]. Such effects may be reduced by undergoing prescribed treatment, taking prescribed medicine and making dietery changes.
Subjects relating to [[defecation]] are often socially unacceptable, thus those affected are often beset by feelings of shame and humiliation. Some refuse to seek medical help, and instead attempt to self-manage the problem. This can lead to social withdrawal and [[Solitude|isolation]], which can turn into cases of [[agoraphobia]]. Such effects may be reduced by undergoing prescribed treatment, taking prescribed medicine and making dietary changes.


==Prevalence==
==Prevalence==
Line 11: Line 11:


==Causes==
==Causes==
Fecal incontinence can have several causes:
===Constipation===


* [[diarrhea]]
Constipation is the most common cause of fecal incontinence. Constipation causes prolonged muscle stretching and leads to weakness of the intestinal muscles. After a certain point, the rectum will no longer close tightly enough to prevent stool loss, resulting in incontinence.<ref name=medlineFI>{{cite url|title=NIH MedlinePlus - Bowel Incontinence|url=http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003135.htm|accessdate=2008-08-08}}</ref>
* [[pelvic floor]] dysfunction
* [[fecal impaction]]
* severe muscular strain in the abdominal area, particularly when giving [[childbirth|birth]]
* [[episiotomy]] complications
* damage to the muscles or nerves of the [[anal sphincter]]s
* damage to the muscles or nerves of the [[rectum]]
* loss of storage capacity in the rectum, e.g. due to [[surgery]]
* [[Spinal cord injury]]
* Various [[medication]]s, particularly [[stimulant]]s.
 
or a combination thereof.


===Muscle damage===
===Muscle damage===
Fecal incontinence is most often caused by injury to one or both of the ring-like muscles at the end of the rectum called the internal and external anal sphincters. During normal function, these sphincters help retain [[stool]]. When damaged, the operation of the muscles is compromised, and leaks may occur. In women, the damage often happens when giving birth. The risk of injury is greatest when the doctor uses forceps to help the delivery or does an [[episiotomy]]. [[Hemorrhoid]] surgery can damage the sphincters as well.
Fecal incontinence can be caused by injury to one or both of the ring-like muscles at the end of the rectum called the internal and external anal sphincters. During normal function, these sphincters help retain [[Human feces|stool]]. In women, damage can occur during [[childbirth]]. The risk of injury is greatest when the [[birth attendant]] uses [[Forceps in childbirth|forceps]] to help the delivery or does an [[episiotomy]].{{Fact|date=August 2008}} [[Hemorrhoid]] surgery can damage the sphincters as well.{{Fact|date=August 2008}} A [[pelvic tumor]] that grows in or becomes attached to the [[rectum]] or [[anus]] also can cause muscle damage, as can surgery to remove the tumor.{{Fact|date=August 2008}} Although [[anal sex]] resulting in repeated injury to the internal anal sphincter can lead to incontinence, the threat is relatively small.<ref name=duke_analsex>{{cite url|title=Duke Student Health Center - Anal Stimulation and Intercourse |url=http://healthydevil.studentaffairs.duke.edu/health_info/Anal%20Stimulation%20and%20Intercourse.html|accessdate=2008-08-08}}</ref> One study among 14 anoreceptive homosexual men and ten non-anoreceptive heterosexual men showed that anoreceptive homosexual men have decreased anal canal resting pressure relative to non-anoreceptive heterosexual men and no associated fecal incontinence.<ref name=pmid9068471>{{cite url|title=Anal sphincter structure and function in homosexual males engaging in anoreceptive intercourse.|url=http://www.ncbi.nlm.nih.gov/pubmed/9068471 |accessdate=2008-08-08}}</ref>  Another study among forty anoreceptive homosexual men and ten non-anoreceptive heterosexual men found a very significant increase in fecal incontinence (fourteen, or 35% amongst the anoreceptive men, and one, or 10% in the non-anoreceptive sample) amongst the the anoreceptive sample.<ref name=pmid8459377>{{cite url|title=Effect of anoreceptive intercourse on anorectal function.|url=http://www.ncbi.nlm.nih.gov/pubmed/8459377 |accessdate=2008-08-31}}</ref>


===Nerve damage===
===Nerve damage===
Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that detect stool in the rectum. Damage to the nerves controlling the sphincter muscles will render the muscles unable to work effectively and incontinence may occur. If the sensory nerves are damaged, detection of stool in the rectum is disabled, and one will not feel the need to defecate until too late. Nerve damage can be caused by childbirth, long-term [[constipation]], [[stroke]], and diseases that cause [[nerve]] degeneration, such as [[diabetes]] and [[multiple sclerosis]].
Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that detect stool in the rectum. Damage to the nerves controlling the sphincter muscles may render the muscles unable to work effectively. If the sensory nerves are damaged, detection of stool in the rectum is disabled, and one will not feel the need to defecate until too late. Nerve damage can be caused by childbirth, long-term [[constipation]], [[stroke]], and diseases that cause [[nerve]] degeneration, such as [[diabetes]] and [[multiple sclerosis]].


===Loss of storage capacity===
===Loss of storage capacity===
Normally, the rectum stretches to hold stool until it is voluntarily released. But rectal surgery, [[radiation]] treatment, and [[inflammatory bowel disease]] can cause scarring, which may result in the walls of the rectum becoming stiff and less elastic. The rectum walls are unable to stretch as much and are unable to accommodate as much stool, resulting in '''fecal incontinence'''. Inflammatory bowel disease also can make rectal walls very irritated and thereby unable to contain stool.
Normally, the rectum stretches to hold stool until it is voluntarily released. But rectal surgery, [[radiation]] treatment, and [[inflammatory bowel disease]] can cause scarring, which may result in the walls of the rectum becoming stiff and less elastic. The rectum walls are unable to stretch as much and are unable to accommodate as much stool. Inflammatory bowel disease also can make rectal walls very irritated and thereby unable to contain stool.


===Diarrhea===
===Diarrhea===
{{main|Diarrhea}}
{{main|Diarrhea}}
[[Diarrhea]], or loose stool, is more difficult to control than solid stool that is formed. For people who are normally unaffected by fecal incontinence, this can manifest itself as a temporary form.
[[Diarrhea]], or loose stool, is more difficult to control than solid stool that is formed. Where diarrhea is caused by temporary problems such as mild infections or food reactions, incontinence tends to last for a period of days. Chronic conditions, such as [[Irritable Bowel Syndrome]], or [[Crohn's disease]] can cause severe diarrhea lasting for weeks or months until successful treatment can be found.


===Pelvic floor dysfunction===
===Pelvic floor dysfunction===
{{main|Pelvic floor}}
Abnormalities of the [[pelvic floor]] can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum ([[rectal prolapse]]), protrusion of the rectum through the vagina ([[rectocele]]), and generalized weakness and sagging of the pelvic floor.
Abnormalities of the [[pelvic floor]] can lead to '''fecal incontinence'''. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum ([[rectal prolapse]]), protrusion of the rectum through the vagina ([[rectocele]]), and generalized weakness and sagging of the [[pelvic floor]]. Often the cause of pelvic floor dysfunction is childbirth, and incontinence does not show up until the midforties or later.{{Fact|date=September 2007}}
 
===Other causes===
Fecal incontinence can have other causes including one or a combination of the following:
* [[excretion|Excretory problems]]
* [[Fecal impaction]]
* Diseases, drugs, and indigestible dietary fats that interfere with the [[intestine]]al absorption. Respective examples include [[cystic fibrosis]], [[orlistat]], and [[olestra]].
* [[Lateral internal sphincterotomy]] (Surgical procedure for helping [[Anal fissure]]s heal)
* Seizure


==Diagnosis==
==Diagnosis==
The doctor will ask health-related questions and do a physical exam and possibly other medical tests.
===Severity scales===
The [[Cleveland Clinic]] Incontinence Score is widely used because it is practical and easy to use and interpret. The score takes into account the frequency of incontinence and the use of pads and lifestyle alteration. A Fecal Incontinence Severity Index<ref name="pmid10613469">{{cite journal
| author = Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC
| title = Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index.
| journal = Dis. Colon Rectum
| volume = 42
| issue = 12
| pages = 1525–32
| year = 1999
| pmid = 10613469
| doi =
| issn =
}}</ref> is based on a type-by-frequency matrix with four types of leakage (gas, mucus, liquid stool, solid stool) and five frequencies (one to three times per month, once per week, twice per week, once per day, twice or more per day).
 
Other tests include: AMS, Pescatori, Williams score, Kirwan, Miller score, Parks criteria, and the Vaizey scale.


* [[Anal manometry]] checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum.
===Tests===
* [[Anorectal ultrasonography]] evaluates the structure of the anal sphincters.
[[Anal manometry]] checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum. [[Anorectal ultrasonography]] evaluates the structure of the anal sphincters. [[Proctography]], also known as defecography, shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can evacuate the stool. [[Proctosigmoidoscopy]] allows doctors to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors, or scar tissue. [[Anal electromyography]] tests for nerve damage, which is often associated with obstetric injury.
* [[Proctography]], also known as defecography, shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can evacuate the stool.
* [[Proctosigmoidoscopy]] allows doctors to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors, or scar tissue.
* [[Anal electromyography]] tests for nerve damage, which is often associated with obstetric injury.


==Treatment==
==Treatment==
Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary as some forms of fecal incontinence can be rather complicated.
Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary because some forms of fecal incontinence can be rather complicated.  Most physicians that specialize in [[gastroenterology]], rehabilitative medicine, neurotrauma, and pediatric surgery have experience with bowel management programs. "Social continence" may be achievable for some people using a bowel management program that cleans out the colon daily.


There are several devices and medications available to combat fecal incontinence.
There are several devices and medications available to combat fecal incontinence. One method of relatively easy treatment is the use of diapers. Both cloth and disposable diapers are available for fecal incontinence. Pull-up type diapers are not recommended for fecal incontinence. Thicker-type diapers are generally seen as the best method of treating fecal incontinence, since these diapers are thicker and have inner linings to help control fecal matter better.


===Dietary changes===
===Dietary changes===
Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, decreasing the water content of the feces and making it firmer.  Also, avoid foods and/or drinks that contribute to the problem. They include foods and drinks containing caffeine, like coffee, tea, and chocolate, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly.
Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, decreasing the water content of the feces and making it firmer.  Also, avoidance of foods and drinks such as those containing caffeine, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly. Foods to be avoided also include those that typically cause diarrhea, such as [[Curing (food preservation)|cured]] or [[Smoking (food)|smoked]] [[meat]]; [[spice|spicy]] foods; [[alcohol]]; [[dairy products]]; fatty and greasy foods; and artificial [[sweeteners]].


Individuals affected with fecal incontinence can make dietary adjustments to assist in management of the condition.  
===Medication===
Medication consists primarily of [[antipropulsive]] drugs.


* A good approach is a food diary. Such a diary can document what is being eaten, how much has been eaten, and records each incontinent episode. After a few days, a pattern between certain foods and incontinence could be detected. After problem foods are identified  cutting back on them could lead to an improvement in the incontinence. Foods that typically cause diarrhea, and so should probably be avoided, include
===Surgery===
** [[caffeine]]
[[surgery|Surgical]] procedures used to treat otherwise intractable [[fecal incontinence]] include:
** [[Curing|cured]] or [[Smoking (food)|smoked]] [[meat]] like sausage, ham, or turkey
** [[spice|spicy]] foods
** [[alcohol]]
** [[dairy products]] like milk, cheese, and ice cream
** [[fruit]]s like apples, peaches, or pears
** fatty and greasy foods
** [[sweeteners]], such as [[sorbitol]], [[xylitol]], [[mannitol]], [[aspartame]] and [[fructose]], which are found in diet drinks, sugarless gum and candy, chocolate, and fruit juices


==Sacral Neuromodulation (SNM) ==
*[[Colostomy]]
Recently, electrical stimulation of sacral nerves has been used to treat fecal incontinence, mainly of neurogenic origin, in order to obtain a “modulation” effect on neural activities, by supplying additional electrical stimulation to both pelvic floor muscles, and sensitive neurological pathways. This therapeutic approach is referred to as Sacral Neuromodulation (SNM).


See: [http://www.pelviperineology.org/pelvic_floor/sacral_neuromodulation_in_treatment_fecal_incontinence.html Sacral Neuromodulation in fecal incontinence.] Full Journal article.
*Stimulated graciloplasty creates a new [[anal sphincter]], using [[gracilis muscle]] from the [[thigh]] and a temporary electric device to retrain the muscle for its new function.


==References==
*Artificial anal sphincter (also known as "artificial bowel sphincter" and "neosphincter").<ref name="pmid17062108">{{cite journal
This article is based largely on public domain text from the U.S. government. See:
| author = Schrag HJ, Ruthmann O, Doll A, Goldschmidtböing F, Woias P, Hopt UT
*http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/
| title = Development of a novel, remote-controlled artificial bowel sphincter through microsystems technology.
| journal = Artif Organs
| volume = 30
| issue = 11
| pages = 855–62
| year = 2006
| pmid = 17062108
| doi = 10.1111/j.1525-1594.2006.00312.x
| url = http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0160-564X&date=2006&volume=30&issue=11&spage=855
}}</ref>  The usual surgical approach is through the [[perineum]] but because in many cases of fecal incontinence the perineum is damaged, for women an alternative approach is through the [[vagina]].<ref name="pmid17665251">{{cite journal
| author = Michot F, Tuech JJ, Lefebure B, Bridoux V, Denis P
| title = A new implantation procedure of artificial sphincter for anal incontinence: the transvaginal approach.
| journal = Dis. Colon Rectum
| volume = 50
| issue = 9
| pages = 1401–4
| year = 2007
| pmid = 17665251
| doi = 10.1007/s10350-007-0314-6
}}</ref>
 
*Temperature-controlled radiofrequency energy (SECCA)<ref name="pmid17556904">{{cite journal
| author = Felt-Bersma RJ, Szojda MM, Mulder CJ
| title = Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement.
| journal = Eur J Gastroenterol Hepatol
| volume = 19
| issue = 7
| pages = 575–80
| year = 2007
| pmid = 17556904
| doi = 10.1097/MEG.0b013e32811ec010
| url = http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00042737-200707000-00010
}}</ref>
 
*Antegrade continent enema stoma. This procedure is often necessary in addition to others when fecal incontinence is complicated by [[neuropathy]] and/or an incomplete internal anal sphincter.
 
*Sacral nerve stimulation, the newest of these surgical procedures, involves implanting an electric device that may enable control of the anal sphincter and restore a patient's continence.[http://www.pelviperineology.org/pelvic_floor/sacral_neuromodulation_in_treatment_fecal_incontinence.html]
 
Graciloplasty and artificial anal sphincter both significantly improve continence, with artificial anal sphincter being superior,<ref name="pmid16896900">{{cite journal
| author = Ruthmann O, Fischer A, Hopt UT, Schrag HJ
| title = [Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence]
| language = German
| journal = Chirurg
| volume = 77
| issue = 10
| pages = 926–38
| year = 2006
| pmid = 16896900
| doi = 10.1007/s00104-006-1217-0
}}</ref> however both methods have high rates of complications.<ref name="pmid16896900">{{cite journal
| author = Ruthmann O, Fischer A, Hopt UT, Schrag HJ
| title = [Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence]
| language = German
| journal = Chirurg
| volume = 77
| issue = 10
| pages = 926–38
| year = 2006
| pmid = 16896900
| doi = 10.1007/s00104-006-1217-0
}}</ref><ref name="pmid16554983">{{cite journal
| author = Belyaev O, Müller C, Uhl W
| title = Neosphincter surgery for fecal incontinence: a critical and unbiased review of the relevant literature.
| journal = Surg. Today
| volume = 36
| issue = 4
| pages = 295–303
| year = 2006
| pmid = 16554983
| doi = 10.1007/s00595-005-3159-4
}}</ref>
 
===Kegel Exercises===
 
[[Kegel exercise|Appropriate exercise]] of the sphincter muscles can help restore muscle tone, and reduce or even eliminate anal incontinence<ref>{{cite web|url=http://www.continence-foundation.org.uk/publications/pdfs/Sphincter%20Exercises%209.PDF|title=The Continence Foundation - Sphincter Exercises to Aid Bowel Control|accessdate=2008-05-14}}</ref>.


==See also==
==See also==
* [[Anal leakage]]
* [[Steatorrhea]]
* [[Encopresis]]
* [[Encopresis]]
* [[Soiling]]
* [[Soiling]]


{{Symptoms and signs}}
==References==
{{reflist|2}}
 
==External links==
*[http://www.colorep.it/Rivista%20CEC/consensus_conference.htm Consensus Conference: Treatment Options for Fecal Incontinence. Saint Vincent Oct 2002]
*[http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/ http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/]
*[http://www.spinalcord.ar.gov/Publications/FactSheets/sheets6-10/fact10.html http://www.spinalcord.ar.gov/Publications/FactSheets/sheets6-10/fact10.html]
*[[National Institute for Health and Clinical Excellence|NICE]] guidance IPG159:  [http://www.nice.org.uk/page.redirect?o=IP_19 Stimulated graciloplasty for faecal incontinence]
*[[National Institute for Health and Clinical Excellence|NICE]] guidance IPG099: [http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11079 Sacral nerve stimulation for faecal incontinence]
 
{{Digestive system and abdomen symptoms and signs}}
{{Antidiarrheals, intestinal anti-inflammatory/anti-infective agents}}


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Symptoms]]


[[cs:Fekální inkontinence]]
[[cs:Fekální inkontinence]]
[[de:Stuhlinkontinenz]]
[[de:Stuhlinkontinenz]]
[[fr:Incontinence fécale]]
[[fr:Incontinence fécale]]
[[it:Incontinenza fecale]]
[[nl:Ontlastingincontinentie]]
[[nl:Ontlastingincontinentie]]
[[pt:Incontinência fecal]]
[[pt:Incontinência fecal]]
[[sk:Fekálna inkontinencia]]
[[sk:Fekálna inkontinencia]]
{{WikiDoc Sources}}
[[fi:Ulosteinkontinenssi]]

Revision as of 16:12, 13 April 2009

Template:SignSymptom infobox Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected are often beset by feelings of shame and humiliation. Some refuse to seek medical help, and instead attempt to self-manage the problem. This can lead to social withdrawal and isolation, which can turn into cases of agoraphobia. Such effects may be reduced by undergoing prescribed treatment, taking prescribed medicine and making dietary changes.

Prevalence

Fecal incontinence affects people of all ages. Fecal incontinence is more common in women than in men, and more in older adults than in younger adults. It is not, however, a normal part of aging.

Causes

Constipation

Constipation is the most common cause of fecal incontinence. Constipation causes prolonged muscle stretching and leads to weakness of the intestinal muscles. After a certain point, the rectum will no longer close tightly enough to prevent stool loss, resulting in incontinence.[1]

Muscle damage

Fecal incontinence can be caused by injury to one or both of the ring-like muscles at the end of the rectum called the internal and external anal sphincters. During normal function, these sphincters help retain stool. In women, damage can occur during childbirth. The risk of injury is greatest when the birth attendant uses forceps to help the delivery or does an episiotomy.[citation needed] Hemorrhoid surgery can damage the sphincters as well.[citation needed] A pelvic tumor that grows in or becomes attached to the rectum or anus also can cause muscle damage, as can surgery to remove the tumor.[citation needed] Although anal sex resulting in repeated injury to the internal anal sphincter can lead to incontinence, the threat is relatively small.[2] One study among 14 anoreceptive homosexual men and ten non-anoreceptive heterosexual men showed that anoreceptive homosexual men have decreased anal canal resting pressure relative to non-anoreceptive heterosexual men and no associated fecal incontinence.[3] Another study among forty anoreceptive homosexual men and ten non-anoreceptive heterosexual men found a very significant increase in fecal incontinence (fourteen, or 35% amongst the anoreceptive men, and one, or 10% in the non-anoreceptive sample) amongst the the anoreceptive sample.[4]

Nerve damage

Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that detect stool in the rectum. Damage to the nerves controlling the sphincter muscles may render the muscles unable to work effectively. If the sensory nerves are damaged, detection of stool in the rectum is disabled, and one will not feel the need to defecate until too late. Nerve damage can be caused by childbirth, long-term constipation, stroke, and diseases that cause nerve degeneration, such as diabetes and multiple sclerosis.

Loss of storage capacity

Normally, the rectum stretches to hold stool until it is voluntarily released. But rectal surgery, radiation treatment, and inflammatory bowel disease can cause scarring, which may result in the walls of the rectum becoming stiff and less elastic. The rectum walls are unable to stretch as much and are unable to accommodate as much stool. Inflammatory bowel disease also can make rectal walls very irritated and thereby unable to contain stool.

Diarrhea

Main article: Diarrhea

Diarrhea, or loose stool, is more difficult to control than solid stool that is formed. Where diarrhea is caused by temporary problems such as mild infections or food reactions, incontinence tends to last for a period of days. Chronic conditions, such as Irritable Bowel Syndrome, or Crohn's disease can cause severe diarrhea lasting for weeks or months until successful treatment can be found.

Pelvic floor dysfunction

Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocele), and generalized weakness and sagging of the pelvic floor.

Other causes

Fecal incontinence can have other causes including one or a combination of the following:

Diagnosis

Severity scales

The Cleveland Clinic Incontinence Score is widely used because it is practical and easy to use and interpret. The score takes into account the frequency of incontinence and the use of pads and lifestyle alteration. A Fecal Incontinence Severity Index[5] is based on a type-by-frequency matrix with four types of leakage (gas, mucus, liquid stool, solid stool) and five frequencies (one to three times per month, once per week, twice per week, once per day, twice or more per day).

Other tests include: AMS, Pescatori, Williams score, Kirwan, Miller score, Parks criteria, and the Vaizey scale.

Tests

Anal manometry checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum. Anorectal ultrasonography evaluates the structure of the anal sphincters. Proctography, also known as defecography, shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can evacuate the stool. Proctosigmoidoscopy allows doctors to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors, or scar tissue. Anal electromyography tests for nerve damage, which is often associated with obstetric injury.

Treatment

Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary because some forms of fecal incontinence can be rather complicated. Most physicians that specialize in gastroenterology, rehabilitative medicine, neurotrauma, and pediatric surgery have experience with bowel management programs. "Social continence" may be achievable for some people using a bowel management program that cleans out the colon daily.

There are several devices and medications available to combat fecal incontinence. One method of relatively easy treatment is the use of diapers. Both cloth and disposable diapers are available for fecal incontinence. Pull-up type diapers are not recommended for fecal incontinence. Thicker-type diapers are generally seen as the best method of treating fecal incontinence, since these diapers are thicker and have inner linings to help control fecal matter better.

Dietary changes

Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, decreasing the water content of the feces and making it firmer. Also, avoidance of foods and drinks such as those containing caffeine, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly. Foods to be avoided also include those that typically cause diarrhea, such as cured or smoked meat; spicy foods; alcohol; dairy products; fatty and greasy foods; and artificial sweeteners.

Medication

Medication consists primarily of antipropulsive drugs.

Surgery

Surgical procedures used to treat otherwise intractable fecal incontinence include:

  • Artificial anal sphincter (also known as "artificial bowel sphincter" and "neosphincter").[6] The usual surgical approach is through the perineum but because in many cases of fecal incontinence the perineum is damaged, for women an alternative approach is through the vagina.[7]
  • Temperature-controlled radiofrequency energy (SECCA)[8]
  • Antegrade continent enema stoma. This procedure is often necessary in addition to others when fecal incontinence is complicated by neuropathy and/or an incomplete internal anal sphincter.
  • Sacral nerve stimulation, the newest of these surgical procedures, involves implanting an electric device that may enable control of the anal sphincter and restore a patient's continence.[1]

Graciloplasty and artificial anal sphincter both significantly improve continence, with artificial anal sphincter being superior,[9] however both methods have high rates of complications.[9][10]

Kegel Exercises

Appropriate exercise of the sphincter muscles can help restore muscle tone, and reduce or even eliminate anal incontinence[11].

See also

References

  1. ↑
  2. ↑
  3. ↑
  4. ↑
  5. ↑ Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (1999). "Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index". Dis. Colon Rectum. 42 (12): 1525–32. PMID 10613469.
  6. ↑ Schrag HJ, Ruthmann O, Doll A, Goldschmidtböing F, Woias P, Hopt UT (2006). "Development of a novel, remote-controlled artificial bowel sphincter through microsystems technology". Artif Organs. 30 (11): 855–62. doi:10.1111/j.1525-1594.2006.00312.x. PMID 17062108.
  7. ↑ Michot F, Tuech JJ, Lefebure B, Bridoux V, Denis P (2007). "A new implantation procedure of artificial sphincter for anal incontinence: the transvaginal approach". Dis. Colon Rectum. 50 (9): 1401–4. doi:10.1007/s10350-007-0314-6. PMID 17665251.
  8. ↑ Felt-Bersma RJ, Szojda MM, Mulder CJ (2007). "Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement". Eur J Gastroenterol Hepatol. 19 (7): 575–80. doi:10.1097/MEG.0b013e32811ec010. PMID 17556904.
  9. ↑ 9.0 9.1 Ruthmann O, Fischer A, Hopt UT, Schrag HJ (2006). "[Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence]". Chirurg (in German). 77 (10): 926–38. doi:10.1007/s00104-006-1217-0. PMID 16896900.
  10. ↑ Belyaev O, Müller C, Uhl W (2006). "Neosphincter surgery for fecal incontinence: a critical and unbiased review of the relevant literature". Surg. Today. 36 (4): 295–303. doi:10.1007/s00595-005-3159-4. PMID 16554983.
  11. ↑ "The Continence Foundation - Sphincter Exercises to Aid Bowel Control" (PDF). Retrieved 2008-05-14.

External links

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cs:Fekální inkontinence de:Stuhlinkontinenz it:Incontinenza fecale nl:Ontlastingincontinentie sk:Fekálna inkontinencia fi:Ulosteinkontinenssi

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