This refers to accidental loss of fecal material or stool. Some may have a more minor version of this problem whereby they only lose control of gas or small amounts of stool. Others may experience complete loss of control of bowel movements. Incontinence is more prevalent among women than men.
A significant problem affecting these individuals is the embarrassment and the stigma associated with incontinence which prevents them from seeking treatment even when incontinence affects their quality of life. Many people alter their physical and social activities or even employment in order to deal with their problems.
As providers, our biggest challenge is to encourage our patients to seek treatment and create an open and comfortable environment where patients can discuss these issues without shame or embarrassment.
There are several causes of incontinence. Sometimes more than one cause may apply.
Damage to anal sphincter muscle and nerves during childbirth
Surgeries like hemorrhoidectomy, fistula treatment or removal of part of the colon.
Medications like antibiotics and chronic laxative use
Chemotherapy or radiation therapy
Diet poor in fiber
Diseases that cause chronic diarrhea
Diseases that affect general health by diabetes and obesity
Conditions that impair mental function like stroke.
Spinal cord injury.
Limited mobility and difficult access to a restroom.
Typically, a thorough history and physical exam is good enough to get you started. Sometimes, additional testing may be required such as one of the following:
Anal manometry: Study of pressures within the anal canal.
Endoanal ultrasound: Ultrasound study of the anal sphincter.
Flexible sigmoidoscopy, colonoscopy: Placement of a thin flexible camera tube to study the walls of the colon.
Nerve studies: Check the normal functioning of the nerves that supply the anal canal.
Start by discussing this problem with your primary care doctor or your OB/GYN. Your doctor may recommend some preliminary stool testing and may further refer you to a specialist based upon your individual needs. Depending upon your individual need you may need to be referred to Female Pelvic Medicine and Reconstructive Surgeons also know as Urogynecologist, Gastroenterologist or Colorectal Surgeons. The most important thing to remember is that no matter how bad the problem seems to you, there is very likely to be a treatment option that may either improve or cure your condition completely.
Treatment options range from conservative therapies to medical or surgical treatments. Everybody’s needs are different; however the following are a few treatment options that your doctor may discuss with you:
Diet modifications
Medications: These include fiber or anti-diarrhea medications.
Biofeedback: This requires the use of a device that helps retrain your bowels to function properly.
Physical therapy: This is geared towards strengthening the muscles that’s around the anal canal.
Anal bulking agents: Some patients may benefit injection of soft biological materials that act like a cushion around the anal canal and improve the seal of the anal opening.
Sacral Neuromodulation: Recently, sacral neuromodulation has demonstrated a significant amount of success in treatment of bowel incontinence. This is a small outpatient procedure that improves the regulation of bowel function. Before the actual procedure is performed most patients have the benefit of going through a trial phase.
Surgeries: While several surgeries have been described they have variable success rates and carry a high risk of complication.