Stool incontinence is the most common problem for older people, but it can occur at any age, including in children. The causes of fecal incontinence vary. These can be hemorrhoids, i.e. anal varices. Faecal incontinence can also occur after childbirth. Check what other causes of fecal incontinence are and what is the treatment.

Stool incontinenceis a problem with controlling defecation (defecation) and the escape of gases from the gastrointestinal tract. According to available statistics, fecal incontinence is a problem of 2-3% worldwide. people. Some patients withfaecal incontinenceavoid talking to doctors about their problem, probably out of embarrassment, and therefore it is believed that the estimated frequency of this condition is actually underestimated.

Faecal incontinence is an important problem because it can lead to irritation of the anal area (this area of ​​the body may become infected and develop chronic, difficult-to-heal wounds), as well as to significant psychological disorders. A patient who loses control of one such basic physiological activity as defecation may experience a significant decrease in self-esteem, and may eventually simply start to isolate himself from others. Such complications can be prevented bytreatment of fecal incontinence- both non-surgical methods and surgical treatment are available for patients.

Stool incontinence - causes

Stool incontinence can occur in a patient from birth - this is the case with children who have defects in the structure of the anus and in children with defects in the spinal cord.

Stool incontinence can also be an acquired condition. Generally speaking, thecauses of fecal incontinenceinclude any conditions that lead to the weakening of the anal sphincters or damage to the nerves involved in defecation. These disorders can be caused by such states as:

  • pelvic injuries
  • diabetes
  • multiple sclerosis
  • childbirth
  • chronic constipation
  • stroke
  • spinal cord injuries
  • diarrhea
  • occurrence of complications from other surgical treatmentdiseases (e.g. haemorrhoids)
  • undergoing pelvic radiotherapy
  • inflammatory bowel diseases (e.g. Crohn's disease)
  • rectal prolapse
  • irritable bowel syndrome

Some of the factors mentioned (e.g. episodes of diarrhea) may lead to temporary fecal incontinence, while others (e.g. spinal cord injury) may result in permanent defecation disorders.

Stool incontinence is most common in the elderly, but in fact, it can appear at any age - even in a newborn.

Stool incontinence: symptoms

Faecal incontinence may differ from patient to patient. Some sufferers only experience loss of control over the escape of gases from the gastrointestinal tract. In others, the above disorder occurs, as well as involuntary passing of loose stools. In the most severe forms of fecal incontinence, the patient is unable to control either the escape of gas from the gastrointestinal tract or the excretion of loose or dense stools.

Stool incontinence can be urgent, i.e. when the patient suddenly feels the need to defecate - it can be so strong that the patient will not be able to reach the toilet in time. Another form of the disease is the one in which the patient passes the stool completely unconsciously - because the patient does not feel the pressure on the stool, the bowel movement occurs spontaneously.

Worth knowing

There are certain groups of patients at increased risk of fecal incontinence. Elderly people can be mentioned here, because the disease is most common in them. Women are also at risk of fecal incontinence, as they have a risk factor specific to them only, i.e. childbirth. The very mere birth of a child by force of nature may result in defecation disorders, but they can also appear as a result of complications after the perineal incision or as a complication after childbirth with the use of forceps. Still other conditions in which the risk of fecal incontinence is increased include dementia, states of motor disabilities, and the long history of certain chronic conditions (such as diabetes).

Stool incontinence: diagnosis

In the case of a patient with fecal incontinence, a number of different tests are performed, the main purpose of which is to find out the cause of the disorder. One of the first tests that can be performed in any doctor's office,there is a rectal examination that allows you to initially check the tension of the anal sphincter. The more specialized tests for the diagnosis of fecal incontinence are:

  • anorectal manometry
  • transrectal ultrasound
  • pelvic magnetic resonance imaging
  • defecography (X-ray examination performed during defecation)
  • endoscopic examinations (such as colonoscopy)
  • electrophysiological tests (assessing the functioning of the nerves involved in stool excretion)

Faecal incontinence: treatment

Patients with fecal incontinence can be treated both conservatively and surgically. The first of these treatments can be used in those patients who have low bowel movements. Conservative management is based primarily on changing the diet - you need to reduce the risk of constipation. Patients may also be advised to use various medications, mainly the anti-diarrheal loperamide. Rectal cleansing infusions are also sometimes recommended.

In faecal incontinence, behavioral training (biofeedback) is sometimes used. In this case, these are exercises based on repeated attempts to tighten the anal sphincter muscles. During such exercises, an electrode is inserted into the patient's anus, which is responsible for recording the electrical activity of the rectal muscles. The results of the measurements are displayed on monitors, so that the patient can find out how tightly his muscles are tightened and whether he is performing the exercises correctly. Behavioral training in fecal incontinence aims to increase the degree of control of the sphincter muscles, as well as increase the resting tone of the anal sphincters.

Another treatment method for fecal incontinence is transrectal electrostimulation. It consists in the fact that an electrode placed in the anus generates impulses that stimulate the muscles of the anal sphincters to contract. Repeated repetition of the electrostimulation procedure is expected to lead, as in the case of bio-fencing, to increasing the resting tension of the anal sphincters.

If patients do not improve their bowel movements after several months of non-surgical treatment, there is a possibility of using more invasive treatment. Various types of operations are used, such asanal sphincter plastic surgeryor implantation of an anal sphincter prosthesis. In a situation where all treatments fail or patients are unable to control stools at all, a stoma may be performed,(i.e. the formation of an intestinal fistula, leading to the fact that the mouth of the large intestine is located within the skin of the abdomen, and the feces accumulate in the so-called ostomy bags).

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