Fecal incontinence or anal incontinence, in the technical term anorectal incontinence, is the inability to control bowel movements or intestinal gases that occurs in all age groups and leads to spontaneous, involuntary bowel movements. This disease, which can occur in three degrees of severity, is associated with high psychosocial stress and requires extensive therapeutic measures.
What is fecal incontinence?
Anorectal incontinence is divided into three degrees of severity: In the first degree, the mild stage, intestinal wind is released uncontrollably. For what is the definition of radiculopathy, please visit healthknowing.com.
Those affected in the second, middle, degree cannot hold any thin intestinal contents and in the third, the severe, stage there is a complete loss of control over bowel movements, even solid stool can no longer be held back.
The classification into degrees of severity neglects important aspects of fecal incontinence such as the frequency of uncontrolled defecation and social problems of those affected. So far, no precise classification has been made that takes these aspects into account.
About three percent of the German population of all ages suffer from fecal incontinence, with a clear increase in age and among women. A related childhood disease is encopresis, repeated, voluntary or involuntary defecating from the age of four.
Causes
Fecal incontinence has numerous causative factors, several of which must come together to trigger the disease. If only one mechanism controlling bowel movements fails, the body has sufficient compensatory mechanisms to prevent fecal incontinence.
The most common causes are:
Damage to the sphincter muscle on the anus, for example due to a perineal tear, after surgical interventions, for example fistula or haemorrhoid operations, and when the anal canal or rectum “slips out” from its natural position. Pelvic floor weakness can also be one of the causes. This is caused by severe obesity, muscle and connective tissue weakness and can occur after childbirth. Intestinal diseases, such as Crohn’s disease, can also trigger anorectal incontinence.
Fecal incontinence can also occur with nerve damage from strokes, major pelvic operations, herniated discs, paraplegia or medication.
A rare cause is psychological problems such as traumatic experiences and psychosis. Laxative abuse can also cause fecal incontinence. Finally, patients with dementia are often affected by this burden.
Symptoms, Ailments & Signs
The main symptom of fecal incontinence is an inability to keep gas and stool in the rectum voluntarily. Characteristic signs of the disease include repeated involuntary loss of stools (“stool accidents”), underwear soiled by feces, a general inability to control the passage of gas, and uncontrolled opening of the bowel.
Depending on the specific form of fecal incontinence, the disease can manifest itself in different ways. In the case of sensory fecal incontinence, those affected do not notice the urge to defecate. People with urge incontinence notice the urge to defecate but are unable to control it and must rush to make it to a toilet in time.
The consistency of the stool is often the decisive factor. Around half of those affected can only hold soft and mushy stools. In a third, this inability also occurs when the stool is firm. In many cases, fecal incontinence occurs in combination with constipation.
Those affected also often suffer from severe abdominal pain, flatulence and bowel movements, which can take a long time. Overflow incontinence, in which those affected suffer from constipation but nevertheless have diarrhea that pushes past the hard stool, also rarely occurs.
Diagnosis & History
The diagnosis of fecal incontinence is carried out by a proctologist in a detailed anamnesis at the beginning of the complaint, accompanying circumstances and existing diseases. This is followed by a rectal examination of the rectum in order to be able to identify any changes.
If further examination is required, the proctologist arranges a proctoscopy of the anal canal or rectoscopy of the rectum. The endoscopy of the entire intestine, the colonoscopy, can also be necessary, but is rarely used due to the high effort involved.
During the reflections, the doctor can take tissue samples from the intestinal mucosa and/or swabs from the anal mucosa and assess them under a microscope. The sphincter function can be determined electronically with a pressure measurement. Imaging tests can be useful, including x-rays of the rectum under contrast media.
Complications
Fecal incontinence leads to complications, especially on a psychological level. The unwanted discharge of intestinal wind and feces often leads to those affected socially isolating themselves. They no longer participate in activities and avoid social events. At the same time, many of those affected hide their suffering from those around them or from their doctor, which in the case of organic causes can mean that a possible treatment is no longer effective at a certain point.
If there are haemorrhoids, colitis or other infections and abscesses in the corresponding area as the cause of fecal incontinence, delaying can lead to an expansion of the inflammation and can even lead to the complete destruction of the tissue. Surgical measures to treat fecal incontinence involve the usual risks of complications during or after an operation.
It should also be mentioned that measures aimed at surgically modifying the anus (using autologous tissue or a “STARR” implant, for example) can lead to pain and inflammation of the anus or intestines. Bleeding can also occur. Further complications associated with fecal incontinence result from the large number of possible conditions that can be the cause. Here is the relevant disease to look at.
When should you go to the doctor?
In the case of persistent or recurring problems with bowel movements, a doctor should be consulted. If constipation, diarrhea or blood in the stool occurs, action is required. If the bowel movements cannot be regulated at will, there is a disorder that should be investigated and treated. A diagnosis is necessary so that an individual treatment plan can be drawn up. If there is spontaneous bowel movement during the day or during sleep at night, a doctor’s visit is advisable.
If the causes lie in an incorrect diet, the intake of medication or if the person concerned suffers from a strong experience of stress, the observations should be discussed with a doctor. Abnormalities and peculiarities that take place immediately before the sudden defecation should be documented and presented to the doctor. A decrease in well-being and an increase in mental resilience are signs of health impairment. If the symptoms persist for several weeks or months, the person concerned needs a medical examination.
Reduced sexual activity, interpersonal problems or withdrawal behavior on the part of the person concerned are indications of irregularities. There may be physical illnesses that need to be clarified. Bloating or unpleasant body odors are other signs that should be investigated. If severe abdominal pain or abdominal discomfort occurs, a doctor’s visit is also necessary.
Treatment & Therapy
The cause of anorectal incontinence determines its therapy. A healthy diet with regulation of bowel movements is also advisable to regain control through regular bowel movements. At this point, the administration of laxatives at a certain time and toilet training also take effect. This is carried out over several weeks and with the help of a stool diary and is intended to get the bowel and patient used to regular, controllable bowel movements.
If the sphincter is incapable of functioning, operations may be necessary. Either the patient is given an artificial or endogenous sphincter replacement or an artificial anus is placed.
Modern sacral nerve stimulation is promising for neuronal causes. Here, the sphincter muscle is stimulated by a pacemaker in such a way that it contracts and holds back the stool and evacuations only take place at the appropriate times.
The therapy also includes incontinence care with aids that are intended to prevent soiling of laundry and clothing. According to individual criteria and requirements, diapers, incontinence pants, anal tampons or chair bags are used for immobile patients, for example.
Prevention
There are few preventive measures against fecal incontinence. Pelvic floor exercises are not only useful during and after pregnancy and childbirth, they are generally recommended regardless of gender. On the one hand, it has a preventive effect, but on the other hand, it can also counteract functional causes of fecal incontinence.
Aftercare
Fecal incontinence can be counteracted effectively with pelvic floor exercises – the muscles in the anal and pelvic area can be specifically strengthened with pelvic floor exercises. The pelvic floor training shows good results, especially in patients with connective tissue weakness, but also in women after several births. Vaginal cones can be used to train the pelvic floor muscles.
A change in toilet habits, so-called toilet training, can also bring relief – with specific behavioral therapy techniques, for example by introducing regular times when going to the toilet. In addition, biofeedback is an effective measure in the fight against faecal incontinence: Here the affected person learns to consciously perceive their sphincter muscle tension and to control it accordingly.
A small balloon is placed in the anal canal. This causes the patient to tighten the sphincter muscle. A signal indicates as soon as a certain pinching pressure has been reached. Biofeedback training is based on an individually designed exercise plan and helps many patients. Another method is electrostimulation: Here, a weak current flow, a stimulation current, helps to stimulate the sphincter muscle – the latter is passively tensed in this way.
However, noticeable effects only appear after a few weeks. This means that the patients need stamina. And last but not least, in many cases a change in diet helps, for example the increased intake of high-fiber foods. This increases the stool volume and normalizes the stool consistency.
You can do that yourself
Pelvic floor exercises are recommended for faecal incontinence. Daily training of the pelvic floor muscles strengthens the connective tissue and muscles. At best, this improves the ability to retain stool.
Good “toilet training” also includes introducing regular toilet times. If the patient knows when he feels the urge, he can adjust his everyday life accordingly. With biofeedback, the patient is aware of his sphincter muscle tension. The individually defined exercise plan can be carried out by the patients at home. In addition, electrostimulation of the sphincter function is possible. A weak current flow stimulates the tension in the sphincter muscle.
Immediately after an operation on the sphincter, rest and protection apply. Surgeries such as colostomy or prolapse surgery put a greater strain on the body and especially on the gastrointestinal tract. The patient should stick to the prescribed diet and not subject the sphincter to unnecessary stress until the symptoms have been completely cured. Finally, patients must follow the measures prescribed by the doctor and carefully monitor the symptoms. The more comprehensively the disease is studied, the more specifically the patient can take action against it himself.
