Bowel Leakage (Fecal Incontinence)
What is Fecal Incontinence?
Bowel leakage or fecal incontinence is the inability to control passage of liquid or solid stool from the rectum. This condition affects 2-15 percent of all adults in the United States. Because people are embarrassed to talk about their symptoms, many people go untreated. There are effective treatments that can help, or even cure, the problem.
How Your Bowels Should Work
- The rectum is the lowest part of the large intestine that ends just before the anus. Stool can be stored here until it is ready to be eliminated.
- The anus is the opening of the lower intestine where solid waste is eliminated. Just on the inside of the anus are two rings of muscle around the anus or exit from the bowel. These two rings of muscle form the anal sphincter and are designed to hold in the bowel contents at all times except when you are trying to empty the bowel.
- The external anal sphincter is the muscle that you use to hold on when the rectum is full and you feel that you need to empty the bowel.
- The internal anal sphincter is an internal muscle responsible for keeping the anal canal closed at all times except when there is an urge to empty the bowel. You do not have to think about keeping this muscle closed, it happens automatically.
For the mechanism to work properly you need several things:
- The nerves of the rectum and anus need to be sending the right messages to your brain so you can feel when stool or gas arrives in the rectum, sending messages to the muscles to wait.
- The internal and external anal sphincters need to be undamaged and working properly.
- The stool should not be too soft or loose so that the sphincter can cope with holding on, but not so hard so that they're difficult to pass.
Different Types of Fecal Incontinence
- Flatal incontinence: the inability to control the passage of gas from the rectum.
- Fecal incontinence: the inability to control the passage of liquid or solid stool from the rectum.
- Double incontinence: the inability to control both the passage of stool and urine.
- Rectovaginal fistula: when a connection develops between the vagina and rectum and results in stool being passed uncontrollably through the vagina.
Typical Causes of Fecal Incontinence
There are many causes of fecal incontinence, including:
Birth trauma is the most common cause of fecal incontinence in young women. During a very difficult vaginal delivery or during a delivery that requires use of forceps, vacuum or episiotomy, a partial tear in the muscles of the anal sphincter can happen. If this tear doesn’t heal properly, it can cause incontinence. This is called a chronic third/fourth degree laceration. This tear may also cause a rectovaginal fistula and causes incontinence because stool can pass inadvertently from the rectum into the vagina.
Aging has the greatest impact on bowel control in women over the age of 40.
Certain surgeries place you at risk for developing fecal incontinence. Most of these surgeries involve manipulation of the muscles in the pelvis or the sphincter itself. They include:
- Internal sphincterotomy
- Low anterior resection
Chronic diarrhea can cause fecal incontinence. Often, your doctor may try to control your diarrhea first to see if this helps in your bowel control. Inflammatory bowel disease is a disease can cause alternating constipation and diarrhea. Often, if your diarrhea can be controlled with medication or dietary changes, and bowel control can improve.
Laxatives containing Senna can damage your bowels and cause fecal incontinence.
This is a temporary condition that may be caused by a virus or bacteria. Treatment with antibiotics often improves your bowel control.
Some diseases affect the nerves in the pelvis that help you control your bowel movements; if these nerves are damaged, fecal incontinence occurs.
Diseases that can cause nerve damage include:
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury
- Diabetic neuropathy
Diagnosing Fecal Incontinence
You may also have:
Your doctor will ask for your health history. Some questions you may be asked include:
- Did your symptoms begin after a surgery such as a hysterectomy or surgery for your hemorrhoids?
- Do your symptoms relate to when you had children?
- How fast did your symptoms get worse?
- Do you feel the need to have a bowel movement, or does it just happen without your awareness?
- Do you feel like you completely empty your rectum after a bowel movement, or do you feel like your bowel movements are incomplete?
- Do you ever have to use your hand to help the bowel movement come out by either pressing on the inside or outside of the vagina?
- How are your symptoms affecting your quality of life?
- Are your symptoms affecting your ability to be intimate with your partner?
- Are you having any problems with low back pain or loss of sensation in your legs?
Your doctor will perform a pelvic exam to see how well your pelvic organs are supported and check the strength of your rectum muscles and your ability to squeeze those muscles. He/she will conduct a digital examination of your rectum and anus to look for hemorrhoids and prior scarring.
A probe is placed into your rectum. It's about the size of a finger and should not be uncomfortable. The ultrasound allows your doctor to see the anal sphincter, which is the muscle that allows you to control your bowel movements.
This radiology test allows your doctor to look at your pelvic floor muscles, which help you to control your bowel movements and also the nerves in your back which are important to bowel control.
This test allows your doctor to see with X-ray what is happening during a bowel movement. It allows your doctor to see if there are blockages or pelvic organ prolapse. During this exam, barium paste is placed into your rectum and vagina.
This test allows your doctor to see if the muscles of the rectum are strong and able to function properly. A small air-filled balloon is inserted into your rectum, which allows your doctor to determine if the muscles react properly to different pressures.
Treatment For Fecal Incontinence
UVA offers a number of treatment options, including medications and/or:
- Strengthening and retraining pelvis and sphincter muscles - A physical therapist can teach you how to correctly perform pelvic floor muscle contractions (kegel exercises), which are designed to strengthen the pelvic floor muscles. This can aid in preventing leakage of urine or feces when coughing, sneezing, lifting, or other stressful movements. Other benefits include enhanced sexual function, conditioned muscles to make childbirth easier, decrease and/or prevent pelvic organ prolapse and improve the ability to pass stool.
- Biofeedback therapy involves using a machine to show you how your muscles are working and how well you can coordinate the use of these muscles with a full bowel to teach you improved control. Biofeedback can teach you how to empty the bowel effectively while improving symptoms.
- Electrical Stimulation can help strengthen your muscles as part of your treatment plan. You can either purchase or rent one of these devices to use at home.
Surgical Treatment for Fecal Incontinence
Anal sphincteroplasty can repair injured or separated sphincter muscles. An opening in the skin is made between the vagina and anus where the separated muscles are stitched back together.
Rectovaginal fistula is a procedure in which the tract connecting the vagina and rectum are separated, and the area between these openings is closed in multiple tissue layers. An incision is either made between the vaginal and anus or just inside the vagina to separate the tissues.
A seton is a ribbon of material that is placed in a fistula to aid in healing. Thread, wire, rubber, or medicated suture can be used as a seton. A seton works by draining the fistula tract in order to prevent bacteria from collecting and eroding more deeply into the patient’s tissues. With drainage, the infection will pass allowing operation at the site of origin.
DO YOU HAVE A BOWEL LEAKAGE?
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