The inability to control the passing of the stools or gas is fecal incontinence. This can vary from a small leak to a control loss.
There are several mechanisms in the body which help in storing and evacuation of stools on time. Rectum is the part of intestine where stools are stored. There are two sphincters – internal and external sphincter. Internal sphincter is ring like structure in the anal canal which tightens a point in the anal canal, hence, helps in retaining the stools. The internal sphincter cannot be controlled by self, it is controlled by the body without our knowledge. But the external sphincter is something that we control whenever we feel the urge to pass stools.
Causes of Fecal incontinence
When the function of the sphincter gets impaired it leads to fecal incontinence. Below listed are the several causes :
Injury During Childbirth
The most common cause for fecal incontinence is injury to the muscles in the sphincter. Among these, injury during childbirth is high in number. Hence, women are affected more than men in total.
Spinal cord injury
Any injury to the spinal cord that is in the back bone of the body, may also result as loss of control of the nerves that control the stools exit from the spinal cord.
Any surgery in the anal region has a chance of damage to the nerves. If this occurs, the function of sphincter stops, leading to incontinence.
Crohns Disease/ Ulcerative Colitis
In conditions where there is inflammation in the intestines like crohn’s disease and ulcerative colitis, fecal incontinence may also be associated with it.
Symptoms of Fecal Incontinence
Symptoms may differ from person to person.
- Some may have urgency to pass stool , but some may not even feel like like passing stools.
- Due to weak or non acting muscles that guard the stools from passing out, the patient would not have much time between feeling of passing stools and actually passing stools. Hence they may pass then and there itself.
- In some people, they pass stools without even realizing it.
Diagnosing Fecal Incontinence
Digital Rectal Examination
The Doctor will insert his finger with a glove inside the patient’s rectum to feel any abnormality, presence of stools, and strength of the sphincters. More..
A probe will be inserted inside the anus till the rectum. The patient will be then asked to tightly close the anus, and the pressure is recorded. There will be a balloon in the end of the probe, it will be dilated and hence the internal sphincter function also is noted. More..
An ultrasound probe will be inserted through the anus and radiological images will be taken which can be manifested by a doctor. He can assess the structures around and find out any structural abnormalities present. More..
Proctosigmoidoscopy or Colonoscopy
A camera fitted tube can be inserted through the anus and a complete visual impression of the whole intestines can be obtained. This is a very helpful investigation as it can give direct pictures of the internal surface. More..
Treatments for Fecal Incontinence
Medical Treatments & Lifestyle modification
Anti diarrheal medications would help temporarily by slowing down the bowel movements.
Medicines and foods that increase the bulk of the stools and soften will be helpful in people having incontinence due to not passing stools for a long time. That is also by increasing fiber rich foods in the daily diet.
Exercises to strengthen the anal muscles will be helpful to regain the control.
Above method of treatments are effective on a low basis. The biggest problem in such patience is losing self confidence. Surgery gives a complete assurance so it is the preferred treatment. There are several type of surgeries available.
- The surgeon identifies the anal sphincter, then catches the weak spot or damaged spot in the muscles. He will then separate it from the neighboring structures. He will then pull the both ends and overlap them and sew it. This would tighten the sphincter. This is known as Sphincteroplasty.
- The surgeon will operate and remove the damaged sphincter. He will then keep an artificial sphincter in place. this will act as sphincter controlled manually by a inflating balloon. This is known as Sphincter replacement.
- If nothing works out, the surgeon would make an opening in the abdominal wall. Then he would cut the end of intestine and join it to the opening. Other ending of the opening will be attached to a bag which will collect the stool. This is known as colostomy.
- There is a specific device, which emits electrical impulses. When is implanted inside, these send impulses which is received by the sacral nerves (the structures those are responsible for the message to transfer so that the muscles could act) and the function is retained. This is known as sacral nerve stimulation. Keep in mind that this method will be helpful where the reason of incontinence would be damage do the nerves.
- At times, when the anal sphincter is completely destroyed, a total reconstruction of the anus is done, by a procedure known as Graciloplasty.
Fecal Incontinence Specialists
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. R. Prabhakaran
Consultant Surgical Gastroenterology
M.B.B.S., M.S. (GENERAL SURGERY), M.Ch. (SGE), DLAP, FACRASI
Dr. S. Akbar
Consultant General and Laparoscopic Surgery
M.B.B.S., M.S (GENERAL SURGERY), D.MAS, F.MAS.