Fecal Incontinence: Managing the Embarrassment

What can be more embarrassing than losing control of your bowels while out in public? Now you need to get out without being seen or having someone notice the odor. Fecal incontinence is devastating to someone struggling with this condition. It affects one’s social life, work life and emotional well-being. There are many causes and even more management strategies. It is a good idea to seek evaluation from your doctor.

Fecal incontinence is the loss of control for eliminating stool. It can be as simple as the inability to hold the stool until you get to a bathroom, occasional leakage of stool while passing gas or complete loss of control. Some feel an urgent need to go and cannot hold it while others have no sensation to have a bowel movement (BM) and pass it without knowing.

Parts of the lower pelvis control proper bowel function. The pelvic muscles should be toned, the rectum compliant with capacity to hold stool and the anal sphincter muscles (internal and external) need good resting tone as well as squeeze ability. The nervous system must be intact to control these muscles. One must have the physical and mental ability to recognize the urge to have a BM. Damage to any of these can result in fecal incontinence.

Common causes of Fecal Incontinence

  • Diarrhea or loose stools are hard to hold on to.
  • Hemorrhoids can prevent the anal sphincter from closing tightly, allowing loose stool or mucus to leak out.
  • Fecal impaction (stool bocks the pathway) can cause seepage of liquid stool around the blockage. Chronic constipation can stretch and weaken the sphincter muscles.
  • Muscle or nerve damage to the sphincter muscle can prevent proper functioning. Causes of nerve damage include childbirth, chronic constipation and straining, stroke, multiple sclerosis (MS), and diabetes mellitus (DM).
  • Pelvic floor dysfunction can present years after pregnancy and giving birth. The weakening of these muscles can allow prolapse of the rectum from the anus. A rectocele can occur. This is when the rectum pushes into the vaginal canal during BMs. Men can also develop pelvic floor dysfunction.
  • Radiation treatment or Crohn’s disease can thicken the rectal wall, damaging the rectal capacity to hold stool.

Diagnosing Fecal Incontinence

Diagnosing fecal incontinence begins with a questionnaire about accidents or incidents of loss of stool. How often does it occur? How much stool is lost? Do you have the sensation or urge to have a BM? What is the consistency of the stool? Do you feel the stool pass? A digital rectal or finger examination is done to evaluate muscle tone and squeeze strength. Another testing may be ordered which include:

  1. Anal manometry: A short flexible tube is placed in the anus and rectum. It measures the rectal sensation and strength of the anal sphincter.
  2. Anorectal ultrasound: A small balloon-tipped probe is placed into the rectum that photographs the anal sphincter as it is removed.
  3. Defecography: Defecography is a barium enema given via the rectum. A video will be taken while sitting on a special toilet. You will be asked to cough and squeeze your pelvic muscles. Then you will release the barium contents by bearing down.
  4. MRI imaging: MRI imaging is similar to defecography using a different method of imaging.
  5. Rigid sigmoidoscopy: Rigid sigmoidoscopy is a long, thin scope placed in the rectum. This allows the physician to evaluate the rectum and sigmoid colon for inflammation, scarring or tumors.

Treatment of Fecal Incontinence

Treating fecal incontinence varies depending on the cause. Starting with diet, foods that cause diarrhea or constipation should be avoided. If you struggle with constipation, taking stool softeners and increasing fluid intake is important. If you suffer with diarrhea, increased fiber in your diet will be helpful. You may be given an antidiarrheal medication such as Imodium.

Bowel retraining can help regulate a normal bowel schedule. To do this you will need to toilet at regular times. Some may need to use a rectal suppository to stimulate a bowel movement at certain times.

Products to manage fecal incontinence are available in disposable and reusable forms. Abena Abri-San Special Fecal Incontinence Pads are disposable, have a cotton feel and an odor system to minimize the unpleasant odors. For those who are incontinent of gas, Flat-D Flatulence Reusable Deodorizer Pad can be placed in the underwear. These pads have activated charcoal that absorbs odor. Also, consider Parthenon Devrom Internal Deodorant Tablets. They are available in capsule or chewable form. These tablets neutralize internal odor.

Kegel exercises can help strengthen pelvic floor muscles. By tightening the pelvic floor muscles (try stopping the flow of urine to know you’re doing it correctly) multiple times a day, they become stronger and help improve both fecal and urinary incontinence.

Biofeedback is a technique that assists with learning how to strengthen and control the sphincter muscles. Sensors that test the sphincter strength are placed in the rectum and anus.

Solesta is a gel that is injected into the anus, providing bulk in the rectal tissue. This treatment is a non-surgical office procedure that does not require sedation and for those who fail conservative treatments. It is effective in reducing fecal incontinent episodes and provides improvement in quality of life. Recovery time is minimal.

Surgical Treatment Options for Fecal Incontinence

Surgery may not always be an option to correct or improve the problem. If the sphincter muscle is damaged, a sphincteroplasty can be done. The torn sphincter muscle is sutured together, tightening it to control incontinence.

A muscle from the inner thigh, called the gracilis muscle, can be sutured around the anal sphincter to strengthen and support it.

A ring made of silicone can be placed or implanted around the anus, an artificial sphincter. This ring is controlled by the patient and inflated to close the anus, preventing leakage. It is then opened or deflated to allow elimination.

Sacral nerve stimulation (SNS) is a less invasive option for fecal incontinence. A surgically implanted device delivers a low voltage electrical impulse to the sacral nerve roots that control bowel function. If this option is appropriate for you, a trial is done, known as stage 1. The lead is placed while under sedation with an external unit. The trial period can be 1-2 weeks. If it proves to be effective, the implanted device is placed, known as stage 2. It is battery powdered and the setting can be adjusted based on individual needs. The impulses do not cause pain.

Last, is the option of a diverting colostomy. During this surgery, the end of the large intestine (colon) is brought out through the abdomen and sutured in place. This is called a stoma. Waste (stool) travels out through the stoma. A disposable pouch is placed around the soma to collect stool, which is then discarded or emptied.

Coping Strategies of Faecal Incontinence

Coping with fecal incontinence is difficult. It is hard to leave the house because of fear, shame, and embarrassment. Here is a list of helpful tips to reduce the fear:

  • Before leaving the house, use the bathroom
  • If you’re worried, wear a pad or disposable garment
  • Bring supplies for cleaning and a change of clothes with you
  • Search out restrooms before needing to use one
  • Consider internal deodorants and biologic odor air fresheners
  • Avoid foods that trigger symptoms (diary, fatty foods, etc)
  • If appropriate, try Imodium (antidiarrheal)
  • Use a barrier cream to protect skin from moisture

If you struggle with fecal incontinence, don’t be afraid to discuss it with your health care professional. Small changes in diet, medications, bowel training, and muscle strengthening can provide improvement, if not resolution of your symptoms. Products to help manage your symptoms can be purchased online. Remember fecal incontinence is a medical problem that can often be treated. It doesn’t resolve without help. You are not alone!

 

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