Fecal incontinence

An 82-year-old elderly man noticed that he was unable to control his stools. Even before he could reach the toilet, the bed sheets would get soiled. He was embarrassed to discuss this problem with his family. This is a common problem seen in the elderly and it is known as fecal incontinence.

About Fecal Incontinence

The inability to control bowel movements leading to leakage of feces through the rectum is known as fecal incontinence. This is commonly seen in elderly people. Effective treatments are available for this problem.

Fecal incontinence can cause embarrassment. The elderly may try to avoid discussing the problem and also avoid going to any social gatherings. This can cause anger and depression as well. Repeated contact with the stools can irritate the skin around the anus leading to itching, pain and ulcer formation in the area.

Causes

A muscle known as anal sphincter muscle that prevents the leakage of stools controls the bowels. The rectum can hold the stools for sometime due to its stretching and holding capacity which is known as rectal storage capacity.

If the anal sphincter muscle gets damaged fecal inconsistency occurs. The causes for the anal sphincter muscle damage include:

  • Child delivery with forceps
  • Episiotomy (cut made to enlarge vagina for easy delivery)
  • Constipation
  • Rectal surgery for hemorrhoids (piles)
  • Perirectal abscess
  • Inflammatory bowel disease
  • Reduction in elasticity of muscles
  • Radiation injury
  • Damage to nerves that control the anal sphincter muscle due to multiple sclerosis (nervous system disease), spinal cord tumors, and diabetes
  • Symptoms

    There are a few signs and symptoms of fecal incontinence listed below:

    • Abdominal cramping
    • Diarrhea
    • Flatulence
    • Bloating
    • Abdominal pain
    • Itchy anus
     

    Diagnosis

    A physical examination of the area between the anus and genitals is done to check for any infection or hemorrhoids. Blood tests and stool culture is recommended by the doctor. Various medical tests are done that include:

    • Digital rectal exam is done to check for abnormalities in rectum
    • Anal manometry is done to know the tightness of sphincter muscle
    • Anorectal ultrasonography which is done to evaluate structure of sphincter muscle
    • Proctography is done to evaluate the stool holding capacity of rectum
    • Proctosigmoidoscopy is done to check for swelling, infection, tumors and scar tissue
    • Anal electromyography is done to check for nerve damage in the anus

    Treatment

    Fecal incontinence treatments include medications, dietary changes, special exercises, and surgery are available for.

    The doctors prescribe an anti diarrheal drug called ioperamide (Imodium) to stop diarrhea. If the patient is suffering from constipation, the doctor prescribes milk of magnesia which is a mild laxative. Stool softening medications also may be prescribed to prevent stool hardening.

    In dietary changes, the doctor prescribes high fiber diet and plenty of fluids to relieve chronic constipation. It is better to avoid caffeine and alcohol as they add to fecal incontinence. In case of diarrhea also the doctor prescribes high fiber foods in order to increase bulk of stools. The foods that help in adding bulk to the stools include whole wheat grain, bran, rice, cheese, and yogurt.

    Bowel incontinence training is given by the doctor if there is no control of the anal sphincter muscle. The doctor will ask the patient to go to the toilet at a specific period of time daily. This will enable the bowel movements to occur only during that time. In biofeedback program, a probe is placed into the anus to check the anal sphincter muscle strength. The patient is made to practice anal sphincter muscle contractions and will learn to strengthen the muscles in the area.

    Surgical procedures are recommended in some patients that include

    • Sphincteroplasty helps in strengthening anal sphincter muscle
    • Surgical correction of protrusion of rectum through anus (rectal prolapsed)
    • Surgical correction of hemorrhoids
    • Repair of sphincter
    • Replacement with artificial anal sphincter
    • Injection of biomaterials to increase size of anal sphincter muscle
    • Colostomy is done to divert stools through an opening in the abdomen

    Give support

    The elderly with fecal incontinence feel depressed about their situation. The other family members need to understand this and try to help them. The more one panics the more worse the situation will look. When going out it is advised that the elderly use a disposable undergarment or pad and always carry change of clothing. The elderly must understand that fecal incontinence is a part of aging and there are effective treatments available for it.