PELVIC FLOOR DISORDERS
FECAL INCONTINENCE
Fecal Incontinence (FI) is a common disorder in which a loss of bowel control leads to unintended stool leakages from the rectum. There are different degrees of fecal incontinence (occasional, mild to complete). Several underlying causes can give rise to loss of bowel control and involuntary bowel movements. For instance, chronic digestive issues, diarrhea and constipation can cause fecal incontinence. Similarly, FI can be caused by nerve or muscle trauma to the rectal area and especially the anal sphincter. Often, such trauma is the result of giving birth, but it can also be the result of injuries or damage sustained during abdominal or pelvic surgeries (such as, for instance, a hysterectomy).
Risk Factors
-
Increased age
-
Female gender
-
Number of (natural) births
-
Chronic neurological conditions
-
Physical disability or paralysis (spinal cord injuries)
Causes
-
Muscle Damage: If the muscles in the rectum, and specifically the anal sphincter (the outermost ring of muscles at the end the rectum surrounding the anus) are damaged, they cannot open and contract properly to release or retain stool. Damaged muscles often lose tone (weaken), as a result causing uncontrolled discharge of stool from the rectum. Anal sphincter muscles can become damaged as a result of chronic conditions (such as hemorrhoids, irritable bowel syndrome or constipation) or trauma (such as childbirth, surgeries, or rectal prolapse).
-
Nerve Damage: Similarly, nerve damage can also lead to fecal incontinence. Anal sphincter muscles open and contract (thereby releasing and retaining bowl content) upon electrical stimulation from nerve endings. If the nerves are damaged - either because of trauma (such as spinal cord injury or paralysis) or chronic dysfunction (such as dementia, multiple sclerosis or amyotrophic lateral sclerosis) - they cannot pass on signals to the anal sphincter
muscles, thereby also causing a loss of muscle tone and fecal incontinence.
Diagnosis
-
Medical history and physical exam.
-
Regular imaging: Such as X-Ray, ultrasound, MRI.
-
Defectography/Proctography: Fluoroscopic X-Ray video imaging on a specifically designed seat to measure bowel movement while it occurs.
-
Colonoscopy: Imaging of the entire colon with small video camera.
-
Anal manometry: Insertion of a small catheter into the rectum. Inside the anal sphincter, a balloon is deployed, causing the anus to contract. The strength of the contraction can be used to measure anal sphincter muscle strength.
Treatments
-
Physical therapy: Physical therapy, such as biofeedback or Kegel exercises, can be used to retrain and strengthen the anal sphincter muscles.
-
Medications: Depending on the individual case, either anti-diarrheal drugs or laxatives can help manage fecal incontinence.
-
Nerve stimulations: Certain types of nerve stimulations, such as sacral nerve stimulation, can help increase muscle tone and thereby improve anal sphincter muscle function.
-
Anal sphincter repair surgery: In severe cases, when there is significant damage (such as tearing or scarring) to the anal sphincter, anal sphincter repair surgery (sphincteroplasty) can help reduce fecal incontinence (although regaining complete muscle and nerve function as a result of surgery is rare). If sphincteroplasty is not possible, for instance because damage is too extensive, a colostomy my have to be inserted (temporarily) to collect bowel content and avoid fecal incontinence.