Fecal Incontinence Treatment
Fecal incontinence is the loss of bowel control leading to involuntary or inappropriately passing stool. Fecal incontinence ranges from occasionally leaking a small amount of stool and passing gas to a complete loss of bowel movements. Nearly 18 million adults in the U.S. have fecal incontinence and it is more common among older adults. Fecal incontinence can be embarrassing and upsetting, but your surgeon is experienced in talking about this condition so you should discuss this with him or her. Fecal incontinence is frequently caused by a medical problem and treatment is available.
Fecal incontinence has a number of causes including diarrhea, constipation, muscle damage or weakness, nerve damage due to disease or injury, overall poor health or chronic conditions, loss of stretch in the rectum, hemorrhoids, and difficult childbirth with injuries to the pelvic floor. (The pelvic floor contains muscle fibers that support organs in the pelvic region (e.g., bladder, intestines, uterus in females)).
Fecal incontinence is diagnosed based on your medical history, physical examination, and tests that provide objective measurement of rectal and anal function. Your physician may recommend one or more of the following tests:
- Digital rectal exam: Your physician uses a gloved and lubricated finger inserted into your rectum to check the strength of your sphincter muscles and for any abnormalities of the rectal area.
- Sigmoidoscopy: allows your surgeon to directly view the lower part of the colon using a flexible tube with a small camera attached
- Colonoscopy: allows your surgeon to directly view the upper and lower parts of the colon
- Anoscopy: allows your surgeon to directly view the anal canal
- Anal Manometry: this test measures the sensitivity and function of the rectum. In addition, it determines tightness of anal sphincter muscles and their ability to respond to nerve signals, which is needed for normal bowel movements.
- Magnetic Resonance Imaging (MRI): The MRI uses radio waves and magnets (instead of x-rays) to create pictures of anal sphincter muscles for your surgeon to evaluate.
- Anorectal Ultrasonography: This test uses ultrasound to create an image of the anal sphincter muscles so that your surgeon can assess the structures for a defect.
- Defecography or Proctography: This test uses x-rays to show how the rectum and anal canal change during a bowel movement. It is used to evaluate for bowel problems that may not be evident by other tests such as colonoscopy or sigmoidoscopy.
- Proctosigmoidoscopy: This test allows your surgeon to look for problems related to fecal incontinence including inflammation, tumors, and scar tissue by examining the lining of the distal sigmoid colon (the last part of the colon before the rectum begins), rectum, and anal canal.
- Anal Electromyography: This test uses an electrical recording of muscle activity that allows your surgeon to assess problems including pelvic floor and rectal muscle and nerve damage.
Surgical and Non-Surgical Treatments
Once the cause of fecal incontinence is identified, most people can be cured or their condition can be improved significantly. The treatment that is recommended depends upon the cause and severity of the problem. Essentially, treatment falls into four categories: changes in diet, medication, bowel training - all non-surgical treatments - and surgery.
There are a number of treatments to conservatively manage fecal incontinence including:
- Diet: Decreasing or eliminating alcohol and caffeine, which may cause diarrhea and incontinence in some people may be recommended. Since dairy products may also cause diarrhea in those patients unable to digest lactose, reducing or eliminating this food source may be suggested. Adding certain foods adds fiber and bulk to your diet, which thicken and decrease the amount of stool giving you better control. Fiber is found in many foods including fruits, vegetables, whole grains, and beans. Patients being fed through a feed tube may also need bulk agents added to their formula.
- Medication: Over-the-counter or prescription anti-diarrhea medications that change the consistency of stool can provide relief since it is easier to control stool when it is firm. If constipation is the cause of your fecal incontinence, laxatives or stool softeners may be recommended.
- Bowel Training: Getting on a regular schedule of bowel movements may help improve fecal incontinence. Bowel training means attempting to have bowel movements at certain times like after eating a meal. This helps you gain more control since it helps you predict when you need to move your bowels. Over a period of time your body becomes accustomed to a pattern. However, the process of achieving a regular pattern can take weeks or months.
- Biofeedback: This is another form of bowel training to strengthen your rectal muscles.. A pressure sensitive probe is inserted into your anus which measures the strength and activity of your anal sphincter. By viewing the readout on the scale, you can practice sphincter contractions and strengthen those muscles.
- Exercise: You can also strengthen your pelvic floor muscles through exercises by contracting muscles of the anus, buttocks, and pelvis. Hold as hard as you can for about five seconds and then relax. Pretend you are attempting to stop the flow of urine, stool, or gas. It is recommended this be done 50 to 100 times a day. Your physician can give you additional details about how to perform these exercises using the proper technique.
If conservative management fails and you continue to experience fecal incontinence, you may require surgery to gain control. Surgery includes the following options:
- Sphincteroplasty: This is the most common procedure used to repair a defect in the rectal sphincter muscles. By re-attaching these muscles the sphincter becomes tighter and helps the anus close more completely which gives you better control.
- Muscle Transposition: This procedure may be performed if there is a loss of nerve function in the anal sphincter. During this procedure muscles of the inner thigh are used to strengthen the anal canal and provide sphincter muscle tone.
- Sphincter Replacement: This procedure uses an artificial anal sphincter device to replace the sphincter function. The device, an inflatable cuff, is implanted around the anal canal. By keeping the cuff inflated, the anal sphincter remains closed which prevents leakage. When you are ready to move your bowels, you use a small external pump to deflate the cuff and pass stool. The device automatically re-inflates itself.
- Injecting Bulking Agents: These materials are injected into the anal sphincter to increase muscle mass of the anal sphincter, which may improve incontinence.
- Colostomy: This procedure is usually used to control incontinence after all other treatments have failed. The procedure diverts stool through an opening in the abdomen (belly) where a special bag is attached to collect stool.
Sacral Nerve Stimulator/Interstim
Sacral Nerve Stimulation (Also known as Electrical Stimulation): This procedure involves implanting a device to deliver electrical stimulation to the nerves controlling the bladder, sphincter, and pelvic floor muscles. The stimulation causes changes in how the bladder, sphincter, and pelvic floor muscles function. The product used for this procedure is InterStim®. It is made up of a thin wire lead and an implanted device that functions similar to a pacemaker by using mild electrical stimulation to the nerves that affect pelvic muscles and the bowel. In a prospective, multi-center study with 120 patients sponsored by Medtronic, the company that developed the InterStim® device, significant improvement was demonstrated in fecal incontinence symptoms and quality of life. 41% achieved complete continence, 84% achieved 50% or greater reduction in incontinence episodes per week, and overall quality-of-life scores improved significantly.