Dr. Ertan Beyatlı

Stool Incontinence Causes and Treatment

(Update: ) - Digestive System Diseases

What is Fecal Incontinence?

Incontinence or in medical language "Fecal incontinenceThe disease known as ”means involuntary and untimely defecation. In short, it is the inability to hold stool.

This inconvenience common in society It can manifest itself at many different levels as it does. The spectrum opens between occasional brief involuntary flatulence and almost daily even multiple involuntary and unexpected fecal incontinence.

Regardless of the cause, incontinence can sometimes be seriously embarrassing and uncomfortable.

Do not let this situation prevent you from being examined, because there are various treatment methods for stool incontinence and it is possible to lead a better quality of life with these methods.

Although the discomfort caused by this disease varies according to the standards of social traditions and customs, it seriously affects patients in advanced stages and can even lead to asocial tendencies.

Various terms are used to describe the disease among the people. Incontinence of stool, involuntary defecation, incontinence, incontinence of ablution, defecation .., etc.

Causes of Stool Incontinence

  • Diarrhea (diarrhea). Soft and watery stools from the anus it is easier to exit than hard and solid stool.
  • Constipation (constipation). In cases of constipation that continues for a long time, a hard and solid stool mass occurs in the anorectal region and over time, excessively stretching the anal muscles causes these muscles to weaken and weaken. Thus, the relatively watery stool from the upper parts of the large intestine slips around the hard stool mass and comes out involuntarily. In addition, chronic constipation can cause fecal incontinence by damaging the nerve tissue in the area.
  • Muscle and Nerve Damage. It can be caused by muscle and nerve damage, especially during birth and during episiotomy. Diabetes (diabetes DM) and multiple sclerosis MS can also damage the nerve tissue and cause fecal incontinence. In addition, spinal cord injuries and surgical procedures performed in the anorectal area (such as hemorrhoid surgery, anal fissure ve fistula surgery, perianal abscess surgery) can also cause iatrogenic anal ring muscle (internal sphincter) and nerve injury.
  • Aging. With the advancement of age, atrophy of the muscles in the anus region, diabetes, inactivity and constipation due to bowel laziness can cause stool incontinence.
  • Storage capacity decreases. It allows stool storage by stretching the muscles in the anus region. This mechanism works in coordination with anal sphincter activity. In some cases, this tensile capacity may be lost, such as chronic inflammatory bowel diseases (IBS), bowel inflammation due to radiation therapy (radial colitis), anorectal cancer, etc.
  • Other. Protrusion of the rectum (rectal prolapse) or herniation of the vagina (rectocele)

Symptoms of Stool Incontinence

In many adults, especially in cases of diarrhea, occasional temporary and uncomfortable stool or gas leakage may occur. However, some people have recurrent stool incontinence, and in these cases:

  • Unable to control bowel movements, involuntary gas or stool outflow from the anus
  • it may not be possible to reach the toilet in time

In some people, especially in infants and childrenThis may not be uncomfortable and may be soiling of diapers or underwear but unfortunately, it can be completely disappointing in some adults.

Stool incontinence may accompany other bowel problems such as diarrhea, constipation and gas and bloating.

When should I go to the doctor?

in you or your child repetitive stool incontinence If there is an event, it is useful to see a doctor without disturbing you further. The treatment chance of fecal incontinence is proportional to early diagnosis. It is possible to achieve more successful and satisfying results with early diagnosis and early treatment.

Effects of Stool Incontinence

  • lack of people's defecation control to frustration, anger, and depression may cause. To prevent this situation, patients adopt an asocial lifestyle.
  • Skin Irritation. The skin in the rectal area is very sensitive and when it constantly comes into contact with feces, it may cause various irritations in the area. ulcers and abscesses may occur.

Diagnosis and Treatment

The most important diagnostic tool for fecal incontinence made in the clinic physical digital breech examination. There are many tests available to determine the severity of the disease and determine the underlying pathology, such as MRI, colonoscopy, rectosigmoidoscopy, anasocopy, anal manometry, anal ultrasound (3D Endoanal Ultrasound), proctography, defecography and anal electromyography.

Anal Manometry
Anal Manometry

During the diagnosis process, your doctor may ask you some important questions, so you should be prepared in advance:

  • When did the symptoms start?
  • Are the symptoms constant or do they occur from time to time?
  • How serious are the symptoms?
  • What activity do you take to prevent symptoms?
  • Which way do you go to reduce or prevent symptoms?
  • In what situations do the symptoms increase?
  • Do you have a disease such as diabetes, multiple sclerosis or chronic constipation?
  • Do you have diarrhea?
  • Have you been diagnosed with ulcerative colitis or Crohn's disease (IBS)?
  • Have you ever had radiation therapy to the pelvic area?
  • Used forceps or was an episiotomy performed during delivery?
  • Also do you have urinary incontinence?

Stool incontinence is treated according to its cause. The treatment option consists of two parts as Medical and Surgical.

Medical and Palliative Therapy

  • Medicines: Anti-diarrhea drugs, Laxatives and some drugs that reduce and regulate the spontaneous movement of the intestines.
  • Diet: Depending on the condition of diarrhea and constipation, various diets can be arranged according to the liquid and fiber ratio in the foods. For example, in cases of constipation, it may be advisable to drink plenty of fluids and consume foods rich in fiber.
  • Exercise and other methods: These methods can be applied by experienced physiotherapists. The aim of the methods is to strengthen the anal muscles and increase impulse awareness. For example, biofeedback, Kegel exercises, bowel training and sacral nerve stimulation.

Surgical Option

Surgery may be required to correct the muscle or nerve damage that caused the disease.

  • Sphincteroplasty: In this method, the damaged ring muscle (sphincter) of the anus is freed from the surrounding tissues and stitched on top of it with surgical sutures. In cases of tissue loss, an artificial synthetic patch (mesh) can be placed between the muscles.
  • Rectal prolapse, rectocele or treatment of hemorrhoid disease.
  • Sphincter repair: Recovery of anal sphincter tone with a muscle taken from the thigh.
  • Sphincter replacement: An artificial anal sphincter, which can be controlled manually, is placed in the breech area. With the help of a pump placed outside, the sphincter in the anus region is inflated and defecation is controlled.
  • Colostomy: This method is applied in advanced situations. The large intestine is cut, the front wall of the abdomen is mouthed and stitched. Adhesive and replaceable colostomy bags are placed in the area. The breech area is completely stitched and canceled. (see. What is a colostomy and why is it opened?)

Can Stool Incontinence Be Prevented?

Depending on the cause, it is possible to prevent stool incontinence. These actions can help you:

  • Check for constipation. Exercise. Consume higher fiber foods and drink plenty of fluids to reduce chronic constipation.
  • Check for diarrhea.
  • Don't worry. Strain during bowel movements can weaken the anal sphincter muscles or cause nerve damage.
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