Fecal Incontinence involves the involuntary loss of gas, liquid stool, or solid stool, and symptoms of fecal urgency and soiling.
It occurs in 7 to 16% of healthy adults and two-thirds of affected individuals are women whom have had children. The emotional, psychological and social problems associated with anal incontinence are significant but there are treatment options.
Causes of Fecal Incontinence include:
- Childbirth resulting partial or complete disruption of the anal sphincter muscle and/or damage to the nerve that controls the muscle.
- Surgery, Hemorrhoidectomy
- Pelvic Floor Muscle Denervation from rectal prolapse, chronic straining, fecal impaction
- Neurological Disorders, Stroke, Spinal cord injury, Multiple Sclerosis
- Diarrheal States, Irritable Bowel Syndrome, Inflammatory Bowel Disease (Crohn’s disease, Ulcerative Colitis), Radiation treatments
- Diagnosis of Anal Incontinence and Rectal Prolapse is by History, Ultrasound Imaging, and Physical exam.
Treatment Options for Fecal Incontinence
- Dietary Changes such as High Fiber Diets, Food Avoidance, Fiber Supplements
- Medications such as Loperamide (Imodium), Diphenoxylate (Lomotil)
- Bowel Management by scheduled defecation
- Surgical Management of Fecal Incontinence
Reconstruction of the Anal Sphincter (Sphincteroplasty):
This is surgery to repair a damaged or weakened anal sphincter. In this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscle, tightening the sphincter.
Fecal Incontinence with Rectal Prolapse
Rectal prolapse, a condition in which a portion of your rectum protrudes through your anus, weakens the anal sphincter. In certain circumstances, such as chronic constipation and straining, the ligaments to the rectum can become stretched and lose their ability to hold the rectum in place.
Surgical correction of the rectal prolapse may be needed along with sphincter muscle repair. This may be accomplished through a vaginal approach or done through the anus called a STARR Procedure.
Prolapsed internal hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence. Hemorrhoids may be near the upper part or beginning of the anal canal (internal hemorrhoids) or at the lower portion or anal opening (external hemorrhoids). Hemorrhoids can be treated by conventional hemorrhoidectomy, a surgical procedure to remove the hemorrhoidal tissue.