Fecal incontinence

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Overview

Fecal incontinence (FI) is the involuntary passage of fecal matter through anus or inability to control the discharge of bowel contents. Its severity can range from an involuntary passage of flatus to complete evacuation of fecal matter. Depending on the severity of the disease, it has a significant impact on a patient’s quality of life.

Patients with fecal incontinence have an unintentional loss of liquid or solid stool. In true anal incontinence, there is loss of control of the anal sphincter which leads to the untimely release of feces. On the other hand, fecal incontinence can also result from enlarged skin tags, poor hygiene, hemorrhoids, rectal prolapse and fistula in ano. Other common causes include the use of laxatives, inflammatory bowel disease, and parasitic infections.

Symptoms

Fecal incontinence may occur temporarily during an occasional bout of diarrhea, but for some people, fecal incontinence is chronic or recurring. People with this condition may be unable to stop the urge to defecate, which comes on so suddenly that they don't make it to the toilet in time. This is called urge incontinence.


Another type of fecal incontinence occurs in people who are not aware of the need to pass stool. This is called passive incontinence.


Fecal incontinence may be accompanied by other bowel problems, such as:


Diarrhea

Constipation

Gas and bloating

Causes

Frequent diarrhea or constipation. These conditions cause the muscles in the rectum and anus to weaken. When these muscles weaken, the ability to hold stool within the body also weakens.

Muscle damage. Muscle damage can occur during a difficult vaginal childbirth, when doctors have to use forceps or make a small cut (an episiotomy) to make a larger opening. Muscle damage can also result from anal or rectal surgery.

Older age. Muscles in the rectum and anus naturally weaken with age. Other nearby structures in the pelvis area also loosen with age. This adds to the general weakness seen in that area of the body, leading to problems with stool control. Loose stool is more difficult to control than solid stool. When a large amount of loose stool arrives rapidly in the rectum, there may not be enough warning to reach the bathroom in time.

Damage to nerves. If the nerves that control the ability of the rectum and anus muscles to contract are damaged, incontinence can result. Nerves that control "rectal sensation" can also lead to incontinence if they are damaged. Nerve damage can happen during a difficult vaginal delivery, anal surgery, constipation (resulting in bouts of frequent and severe straining), or the presence of certain health conditions (such as diabetes, multiple sclerosis, stroke or a spinal tumor).

Inability of the rectum to stretch. If the muscles of the rectum are not as elastic as they should be, excess stool that builds up can leak out. Inflammatory bowel disease (such as Crohn's disease) can also affect the rectum's ability to stretch. The scars resulting from surgery and radiation therapy can also stiffen the muscles of the rectum.

Other medical conditions. Certain medical conditions, such as rectal prolapse (the rectum falls down into the anus) or rectocele (the rectum pushes into the vagina), or chronic constipation where stool leaks around a large stool ball, can lead to fecal incontinence.

Other causes: Laxative abuse, radiation treatments, certain nervous system and congenital (inherited) defects, inflammation (swelling), and inflammatory bowel disease may affect the ability to control stool.


Risk factors

Age. Although fecal incontinence can occur at any age, it's more common in adults over 65.

Being female. Fecal incontinence can be a complication of childbirth. ...

Nerve damage. ...

Dementia. ...

Physical disability.

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Complications

Complications of fecal incontinence may include: Emotional distress. The loss of dignity associated with losing control over one's bodily functions can lead to embarrassment, shame, frustration and depression. It's common for people with fecal incontinence to try to hide the problem or to avoid social engagements.

Prevention

Depending on the cause, it may be possible to improve or prevent fecal incontinence. These actions may help:


Reduce constipation. Increase your exercise, eat more high-fiber foods and drink plenty of fluids.

Control diarrhea. Treating or eliminating the cause of the diarrhea, such as an intestinal infection, may help you avoid fecal incontinence.

Avoid straining. Straining during bowel movements can eventually weaken anal sphincter muscles or damage nerves, possibly leading to fecal incontinence.