Bowel or fecal incontinence is the loss of voluntary control of bowel movements or fecal material. This condition can range from being minor , in which a person loses control of gas or only a small amount of stool, to major, where complete control of bowel movements is lost.
Fecal incontinence is one of the most emotionally devastating of all nonfatal conditions. Many patients do not respond satisfactorily to conservative measures, and there is a need for new and effective strategies when medical therapy fails. The development of sacral nerve stimulation and other forms of neuromodulation and the injection of biologically compatible substances into the anal sphincter complex have brought renewed enthusiasm for using these novel treatments in this underserved population.
Bowel incontinence affects more than 2% of the U.S. population. Both men and women suffer from this problem, and it may be more common in women because of injury to the anal muscles or nerves that can occur during childbirth. There are several risk factors for bowel incontinence, with advancing age being the most important since the muscles that control bowel movements (anal sphincter muscles) weaken over time. Other contributing risk factors include poor overall health, physical limitations that prevent ready access to the restroom, diabetes, urinary incontinence, irritable bowel syndrome, and prior bowel surgery (such as colon removal).
Often, embarrassment and the stigma associated with incontinence prevent people from seeking treatment, even when incontinence affects quality of life. Many people resort to altering their social and physical activities, even their employment, to cope with the problem. In addition, some people with bowel incontinence do not see a doctor because they do not realize that their problem can be effectively treated. It is important to understand that bowel incontinence is not uncommon and can be successfully treated.
What causes bowel incontinence?
Normal control of bowel movements depends on a number of factors, including the amount and consistency of stool, as well as proper functioning of the colon, rectum, muscles surrounding the anus (anal sphincter muscles), and nervous system (brain and spinal cord).
There are many causes of bowel incontinence. More than one problem can contribute, including:
• Damage or injury to the anal sphincter muscles or surrounding nerves
• Anal surgery for another condition such as hemorrhoids or fistulas
• Certain medications, such as antibiotics or Neurontin
• Improper diet
• Conditions associated with chronic diarrhea or constipation
• Systemic (whole body) diseases such as diabetes or scleroderma
• Radiation treatment to the lower pelvic region
• Conditions that can impair mental function, such as stroke
• Conditions that affect the nerves, including spinal cord injury
What can I do if I have bowel incontinence?
See your doctor to determine what tests are needed to evaluate your incontinence. Tests to determine the cause for incontinence can be performed during an outpatient appointment.
Once these tests have confirmed the cause of your incontinence, your doctor can make specific recommendations for treatment, many of which do not require surgery.
No matter how serious the problem seems, incontinence is a condition that can be significantly helped and, in many cases, cured.
How is bowel incontinence diagnosed?
Your doctor will obtain a history from you, as well as examine you to gain insight into the reason for your bowel incontinence. The physical exam will likely include a rectal examination to exclude an obvious cause, such as a mass or fecal impaction, and to gauge the function of the anal muscles. Based on the history and physical exam findings, your doctor will determine what tests are needed for further evaluation.
These tests include:
• Manometry. This test measures the pressure and strength of the anal muscles and can determine if they are too weak to function properly.
• Rectal ultrasound (endosonography). This is a minimally invasive test that can identify patients with sphincter injury, since it can locate the exact position of a tear in a muscle.
• Flexible sigmoidoscopy. By using a thin, flexible, lighted tube called an endoscope, your doctor can examine the lining of the lower digestive tract.
• MRI: Magnetic resonance imaging identifies areas of weakness in the sphincter muscle or rectal wall.
• Nerve studies. These tests check for nerve damage to determine if the nerves that communicate with the sphincter muscles are working properly.
How is bowel incontinence treated?
Once the underlying cause of bowel incontinence has been identified, most people with this condition can be cured or the condition can be significantly improved. However, the method of treatment depends on the cause of the incontinence.
Sometimes simple changes in diet or eliminating certain medications can be effective in helping patients regain bowel control. More frequently, treatment involves a combination of medication, biofeedback, and exercise.
• Medication. Sometimes taking medications to change the consistency of the stool can provide relief, since a person can usually control stool better when it is firm rather than loose or liquid form. Stool consistency can be improved by using bulking agents such as fiber supplements (Citrucel, Metamucil). Stool frequency can be decreased with over-the-counter anti-diarrheal medications including Imodium.
• Biofeedback. Patients with bowel incontinence related to physical limitations or change in mental function will likely benefit from scheduled or timed trips to the restroom. Furthermore, biofeedback training for bowel incontinence involves putting a pressure probe in the anus and a sensing electrode on the abdomen. These devices are attached to a visual or sound display to tell the patient when the proper anal muscles are being used. Biofeedback helps a patient improve the strength and coordination of the anal muscles that help control bowel movements, and heightens the sensation related to the rectum filling with stool.
• Exercise. Muscle-strengthening exercises (called Kegel exercises or pelvic floor exercises) can be very helpful in treating bowel incontinence. To do Kegel exercises, contract the muscles of the anus, buttocks, and pelvis, hold as hard as possible for a slow count of five, and then relax. Imagine you are trying to stop the flow of stool or trying not to pass gas. A series of 30 of these exercises should be done three times daily. In a few weeks, the pelvic floor muscles will be stronger and often the incontinence improves or resolves.
• Surgery. Patients who continue to experience bowel incontinence despite other treatments may require surgery to regain control. Surgery may especially be needed for patients who have experienced anal muscle injuries (as can occur during childbirth).
What surgical procedures are used to treat bowel incontinence?
Surgical options include:
• Sphincteroplasty. Rectal sphincter repair is the most common procedure used to correct a defect in the sphincter muscles. There are two anal muscles that control bowel movements, similar to two round doughnuts, one inside the other. If a defect exists in the complete circle of muscle, the problem can be corrected with this surgery. During the sphincteroplasty, the two ends of the muscle are cut and overlapped onto one another, then sewn in place to restore the complete circle of muscle.
• Muscle transfer. During this procedure, gluteal (buttock) or gracilis (inner thigh) muscles are used to encircle and strengthen the anal canal. When the inner thigh muscle is used, pacemaker-like electrodes are implanted into the grafted muscle to train it to remain contracted. When the buttock muscle is used, the lower portion of this muscle is freed from the tailbone region and wrapped around the anus to construct a new anus. The buttock muscle transposition does not require the use of a pacemaker. This procedure is an option for the small percentage of patients whose condition cannot be successfully treated with sphincteroplasty.
• Colostomy. In rare and very difficult cases, the only alternative may be a colostomy, a surgically created opening in the abdominal wall through which the colon passes, and where a bag is fitted to collect stool.
There are a number of other treatment modalities still being studied, including sacral nerve stimulation, radiofrequency, anal plugs, and injection of materials to improve anal sphincter function. In addition, an artificial bowel sphincter, called The Acticon Neosphincter, may be an option if conservative treatment or surgical repair of the anal sphincter fails to improve symptoms. The Acticon Neosphincter is a circular plastic device implanted around the anus that can be inflated like a balloon to prevent the passage of stool, and deflated for stool passage.
Can bowel incontinence be prevented?
Since fecal incontinence in women is often caused by anal muscle or nerve damage that occurred during childbirth, prevention is not always possible. However, if the use of forceps can be avoided during childbirth, the period of labor not prolonged, and the baby not delivered too rapidly, injury to the pelvic muscles and nerves can be avoided.
Also, chronic constipation may result in incontinence. Getting sufficient water, fiber, and exercise can be effective in treating constipation.
If symptoms persist call Gastrocure in West Orange, NJ at 973-736-1112 to schedule an appointment