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Fecal Incontinence

Introduction

  • Fecal (stool) incontinence means uncontrolled passage of bowel movements.
  • Losing control over bowel movements and becoming incontinent is humiliating for most older people.
  • Older people who become incontinent of feces (stool) often fear that others will view them as helpless and dependent.
  • Fortunately, fecal incontinence can often be cured or controlled with treatment.

Causes

  • Fecal incontinence has a variety of causes.
  • Some causes e.g. sudden diarrhea from an infection, stroke and injuries to the anus or spinal cord can suddenly turn a continent person into an incontinent person.
  • Other causes e.g. constipation with stool impaction, rectal prolapse (protrusion of the inside lining of the rectum through the anus), dementia and damage to nerves from diabetes, can interfere with control of bowel movements and incontinence develops.
  • Once incontinence develops, it may resolve completely, persist but occur sporadically or persist and occur frequently depending on the underlying cause.

Sign and Symptoms

  • Fecal incontinence can range from a small amount of staining on underclothing to loss of a large amount of stool.
  • When stool is lost, it may be entirely liquid, entirely solid, or a mixture of both.

Diagnosis

  • A doctor examines the anus and rectum, checking the extent of sensation of the skin around the anus and how tightly the anus closes.
  • The doctor usually examines the inside of the anus and rectum using either a very short rigid viewing tube (proctoscopy) or a longer flexible viewing tube (sigmoidoscopy).
  • If the cause remains unclear, more specialized tests may be needed. These tests include x-rays to determine how the rectum functions after a barium dye is instilled into it or measurements of nerve and muscle function of the anus and rectum (manometry).

Complications

  • If the older people continue to have fecal incontinence, they may become undernourished and dehydrated, may lead to low self-esteem, social isolation and depression.

Treatment

  • If fecal incontinence is caused by impacted stool in the rectum due to constipation, the impaction must be removed by using enemas or manual removal with a gloved finger.
  • Effective treatment enables a person to eat enough types of foods in order to get a well-balanced and adequate diet.
  • Treatment of fecal incontinence involves establishing a regular pattern of bowel movements that results in well-formed stools.
  • Dietary changes may help. In people without stool impaction, adding foods with a high fiber content to the diet increases the bulk of stools and the regularity of bowel movements. It is important that high fiber diet is accompanied by adequate fluid intake.
  • If fecal incontinence is due to persistent diarrhea, the cause of the diarrhea should be identified and treated.
  • A drug that slows bowel movements, such as loperamide, may be helpful.
  • Exercising the circular muscle that keeps the anus closed (anal sphincter) by squeezing and releasing it increases its tone and strength and helps prevent fecal incontinence from recurring.
  • Surgery may benefit a small number of people e.g. when the cause is an injury to the anal sphincter.
  • As a last resort, a colostomy (the surgical creation of an opening between the large intestine and the abdominal wall) may be performed. The bowel movements are diverted into a removable bag attached to an opening in the abdominal wall. A colostomy does not always have to be permanent, depending on the underlying cause of fecal incontinence.
Last Review : 14 June 2011
Writer : Dr. Ho Bee Kiau
Reviewed : Dr. Ho Bee Kiau