Fecal Incontinence

What is Anal Incontinence?

You can see that it is defined by names such as fecal incontinence, fecal incontinence, fecal incontinence, encopresis. If there is only gaseous or liquid escape, it is called minor incontinence , while solid fecal incontinence is called major incontinence . It is a condition that affects 2 to 7% of the population. The real rates may be higher than many people hide because they are psychologically affected by this situation.

While minor incontinence affects men and women at the same rate, major incontinence is 2 times more common in women. Fecal incontinence problems are more common in older adults.
The problem of fecal incontinence causes anxiety such as losing self-confidence and causes the person to be socially isolated. Considering these results, it will be understood that fecal incontinence is a condition that needs to be treated.

Fecal incontinence, that is, fecal incontinence, is a treatable condition. In some of the cases, complaints can be reduced or often treated.

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What are the Causes of Anal Incontinence?

The ability to hold the stool at any time and to do it at any time depends on the proper functioning of the muscles in the breech area and the nerve structures that manage them. Any disorder that disrupts the structure of the muscles and prevents nerve conduction can cause fecal incontinence.

  1. Anal sphincter injuries; The most common causes are vaginal births and anal region surgeries.
  2. Neurological causes; diabetes, multiple sclerosis, spinal cord damage. Conditions that cause problems in the nerves that govern the external anal sphincter and puborectalis muscles, which are important in keeping stool in the system, especially in the last part of the intestines, cause fecal incontinence.
  3. Decreased expandability of the rectum; inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease, radiation-induced rectingitis. When this feature is lost, the rectum cannot hold much stool when needed, which may cause incontinence.
  4. Petrified feces ;In this case, which is also called fecal impaction in elderly patients, the stool hardens in the form of a voluminous stone in the rectum area. This petrified stool relaxes the internal anal sphincter in the anal area and causes fecal leaks in the form of liquid.
  5.  Severe diarrhea  irritable bowel syndrome, active inflammatory bowel diseases, and acute gastroenteritis may cause fecal incontinence during the severe period of diarrhea. This condition will improve when diarrhea is treated

How is Fecal Incontinence diagnosed?

The cause of fecal incontinence should be found and diagnosed with history, physical examination and some diagnostic tests.

Diagnostic tests

Colonoscopy

With colonoscopy, the entire intestine is examined. It can be diagnosed if there is an inflammation, tumor or other ailments on the intestine that may be the cause of fecal incontinence.

Anorectal manometer

With anorectal manometry, it will be understood whether the muscles in the last part of the large intestine work at appropriate pressures and show inappropriate contractions. For example, in case of sphincter damage that may occur during vaginal delivery, the resting pressures in the anal sphincter will be low or the external sphincter pressure expected to occur with voluntary breech squeezing will not occur.

Anorectal endosonography or pelvic MRI

With these imaging methods, the structural condition of the anal sphincter structure, rectal walls and pelvic region muscles that contribute to defecation are evaluated. Especially with anorectal endoscopic ultrasound, traumatic tears in the inner anal sphincter and external anal sphincter muscles are visualized very well. The video below is taken from our YouTube channel and an elderly female patient with fecal incontinence has a tear in the external anal sphincter with anorectal endoscopic ultrasound.

Stool tests

In cases of fecal incontinence due to severe diarrhea, tests to be performed for the cause of diarrhea. These tests include fecal occult blood, parasite examination, calprotectin and lactoferrin levels, and stool culture.

How Is Fecal Incontinence (Anal Incontinence) Treated?

-Medical treatments
Medical treatments are methods that try to prevent the frequency of fecal incontinence and the formation of petrified stools, thus trying to correct the conditions that cause leaks in the form of transport diarrhea with drugs.

  • Drugs that increase the volume of the stool
  • Drugs that reduce the frequency of defecation
  • Anticholinergic drugs
  • Treatment of petrified feces
  • Forming the habit of going to the toilet regularly
-Biofeedback therapy

-Other methods

  • Anal plugs
  • Sacral nerve stimulants
  • Anal electrical impulses
  • Filler injection under the mucosa of the anal canal

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