Summary about Disease
Fecal incontinence, also known as bowel incontinence, is the inability to control bowel movements, resulting in unintentional leakage of stool from the rectum. The severity can range from occasionally leaking a small amount of stool or gas to complete loss of bowel control. It can significantly impact a person's quality of life, leading to embarrassment, social isolation, and depression. It is more common in older adults, but can affect people of all ages. It is often a symptom of an underlying problem, not a disease in itself.
Symptoms
Inability to delay a bowel movement.
Leaking stool when passing gas.
Accidental bowel movements without warning.
Feeling the need to have a bowel movement but being unable to reach a toilet in time.
Soiling of underwear.
Skin irritation and itching around the anus.
Emotional distress, such as embarrassment, anxiety, and depression.
Weakness or lack of feeling in the rectum and anus.
Causes
Muscle Damage: Damage to the anal sphincter muscles (muscles that control bowel movements) due to childbirth, surgery, or trauma.
Nerve Damage: Damage to the nerves that control the anal sphincter or sense the presence of stool in the rectum. This can be caused by diabetes, stroke, multiple sclerosis, spinal cord injury, or long-term straining during bowel movements.
Constipation: Chronic constipation can lead to weakened rectal muscles and stool impaction, causing leakage.
Diarrhea: Loose stools can be harder to control than solid stools.
Hemorrhoids: Hemorrhoids can prevent the complete closing of the anus.
Rectal Prolapse: When the rectum slips out of place, it can weaken the anal sphincter.
Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause frequent diarrhea and urgency.
Irritable Bowel Syndrome (IBS): IBS can cause diarrhea, constipation, and abdominal cramping, which can contribute to fecal incontinence.
Aging: As people age, their muscles and nerves can weaken, making it more difficult to control bowel movements.
Cognitive Impairment: Conditions like dementia can make it difficult for people to recognize the need to have a bowel movement or to reach a toilet in time.
Medicine Used
Medications used to manage fecal incontinence depend on the underlying cause and symptoms. Common options include:
Anti-diarrheals: Loperamide (Imodium) and diphenoxylate/atropine (Lomotil) can help to slow down bowel movements and reduce the frequency of diarrhea.
Bulk-forming agents: Psyllium (Metamucil) and methylcellulose (Citrucel) can add bulk to the stool, making it more solid and easier to control. They are useful for individuals with loose stool or diarrhea.
Laxatives: For constipation-related fecal incontinence, laxatives such as polyethylene glycol (Miralax) or docusate sodium (Colace) may be prescribed to soften the stool and promote regular bowel movements.
Bile acid sequestrants: Cholestyramine (Questran) or colestipol (Colestid) can bind to bile acids in the intestine and reduce diarrhea in individuals with bile acid malabsorption.
Topical creams: Barrier creams such as zinc oxide or petroleum jelly can be applied to the skin around the anus to protect it from irritation caused by fecal leakage.
Other medications: Depending on the underlying cause of fecal incontinence, other medications may be prescribed, such as antibiotics for infections or anti-inflammatory drugs for inflammatory bowel disease.
Sacral Nerve Stimulation (SNS): This involves implanting a device that sends mild electrical impulses to the sacral nerves, which control bowel function.
Is Communicable
Fecal incontinence itself is not communicable. It is not an infectious disease that can be spread from person to person. However, if the incontinence is due to an infectious agent (like a virus causing diarrhea), the infection itself is communicable, though the incontinence is just a symptom of that infection.
Precautions
Maintain good hygiene: Clean the anal area thoroughly with mild soap and water after each bowel movement.
Use barrier creams: Apply barrier creams to protect the skin from irritation.
Wear absorbent pads or underwear: These can help to absorb leakage and prevent soiling of clothing.
Dietary modifications:
Avoid foods that trigger diarrhea, such as caffeine, alcohol, spicy foods, and dairy products.
Increase fiber intake to help bulk up the stool.
Drink plenty of fluids to prevent constipation.
Regular bowel habits: Try to establish a regular bowel routine by going to the toilet at the same time each day.
Pelvic floor exercises (Kegel exercises): These can help to strengthen the muscles that control bowel movements.
Biofeedback therapy: This can help to improve awareness and control of the anal sphincter muscles.
Avoid straining during bowel movements: This can weaken the pelvic floor muscles and increase the risk of fecal incontinence.
Promptly treat constipation or diarrhea: Addressing these issues can help to prevent fecal incontinence.
How long does an outbreak last?
Because fecal incontinence is a symptom and not a disease itself, the duration is dependent on the underlying cause.
Acute Causes (like infections): Incontinence due to a temporary condition such as a bout of diarrhea from a viral infection will typically resolve within a few days to a week as the infection clears.
Chronic Conditions: Incontinence due to chronic conditions like nerve damage, muscle damage, or inflammatory bowel disease, can be ongoing and may require long-term management.
Post-Surgery: If the incontinence is a result of surgery, the duration can vary. Some individuals may regain control within a few weeks or months, while others may experience long-term issues.
How is it diagnosed?
Medical history and physical exam: The doctor will ask about your symptoms, bowel habits, medical history, and medications. A physical exam will include a rectal exam to assess muscle tone and identify any abnormalities.
Stool tests: These tests can help to rule out infections or other underlying causes of fecal incontinence.
Anorectal manometry: This test measures the strength of the anal sphincter muscles and the sensitivity of the rectum.
Anal ultrasound: This imaging test can help to visualize the anal sphincter muscles and identify any damage.
Proctography (defecography): This X-ray test can help to evaluate the function of the rectum and anus during bowel movements.
Colonoscopy or sigmoidoscopy: These procedures involve inserting a flexible tube with a camera into the colon to visualize the lining and identify any abnormalities, such as inflammation, polyps, or tumors.
Nerve conduction studies: These tests can help to assess the function of the nerves that control the anal sphincter.
Timeline of Symptoms
The onset and progression of symptoms vary based on the underlying cause:
Sudden Onset: Often associated with acute diarrhea, infections, or certain medications. Symptoms appear rapidly and may resolve quickly as the underlying issue clears.
Gradual Onset: This is more common with chronic conditions like muscle weakening due to aging, nerve damage from diabetes, or progressive conditions such as inflammatory bowel disease. Symptoms start subtly and worsen over time.
Post-Surgical: Symptoms may appear immediately after surgery affecting the anal sphincter or rectum, or they may develop gradually as scar tissue forms or nerve function recovers (or fails to recover).
Intermittent: Some individuals experience fecal incontinence only occasionally, triggered by specific foods, stress, or other factors. The timeline is episodic.
Progressive: In conditions such as neurological disorders or progressive muscle weakness, the frequency and severity of incontinence may increase over time.
Important Considerations
Seek medical attention: It's important to see a doctor to determine the underlying cause of fecal incontinence and to develop a treatment plan.
Don't be embarrassed: Fecal incontinence is a common problem, and healthcare providers are experienced in treating it.
Impact on quality of life: Fecal incontinence can significantly impact a person's quality of life, leading to embarrassment, social isolation, and depression. It's important to address the emotional and psychological effects of the condition.
Personalized treatment: Treatment for fecal incontinence is individualized and depends on the underlying cause and severity of symptoms.
Combination of therapies: A combination of dietary changes, medications, pelvic floor exercises, biofeedback, and surgery may be necessary to manage fecal incontinence.
Long-term management: Fecal incontinence may require long-term management and follow-up care.
Skin care: Proper skin care is essential to prevent irritation and infection.
Support groups: Joining a support group can provide emotional support and practical advice.