Fecal Incontinence - Symptoms, causes and treatment

Fecal incontinence or vaginal incontinence is a condition when the body is unable to control bowel movements. This condition causes the stool to come out suddenly, without the sufferer realizing it. Fecal incontinence is influenced by the end of the intestine (rectum), anus (rectum), and the nervous system that does not function normally. This condition can be experienced by the elderly (over 65 years) and women undergoing normal delivery.

Causes of Fecal Incontinence

Fecal incontinence can be caused by several things, including:

  • anal sphincter damage, the ring of muscle located at the end of the anal canal (anus). This condition can be caused by an episiotomy or a vaginal surgical procedure performed after a normal delivery.
  • Damage to the nerves that control the anal sphincter. This condition can result from childbirth, excessive stretching during bowel movements, or spinal cord injury. Medical conditions, such as diabetes and multiple sclerosis, It can also impair nerve function and cause fecal incontinence.
  • Surgical action. Surgical procedures to treat hemorrhoids or other conditions related to the anus or rectum carry the risk of nerve damage.
  • rectal prolapse, This is a condition when the rectum descends to the anus.
  • rectocele, which is a condition when the rectum protrudes outward to the vaginal area in women.
  • Limited space in the rectum to accommodate feces. This condition occurs due to scar tissue on the rectal wall, so the flexibility of the rectum is reduced.
  • Chronic constipation. This condition causes the stool to harden, making it difficult for it to move through the rectum and be expelled from the body. This condition can cause nerve and muscle damage that triggers fecal incontinence.
  • Diarrhea. Diarrhea causes more watery stools, which can worsen fecal incontinence.
  • Use of laxatives in the long run.
  • other medical conditions, such as stroke, dementia, and Alzheimer's disease.

Symptoms of Fecal Incontinence

Symptoms are generally different, depending on the type of fecal incontinence experienced by the patient. Urgent incontinence (urge incontinence) is characterized when the patient feels a sudden urge to defecate and is difficult to control. Meanwhile, passive fecal incontinence is characterized by passing stools without realizing it or without an urge to defecate. Sometimes, feces also come out when the sufferer has a bowel movement.

Other symptoms that people with fecal incontinence may experience are:

  • Abdominal pain or cramps
  • Bloated
  • Constipation
  • Diarrhea
  • Anus feels itchy or irritated
  • Urinary incontinence.

Call your doctor immediately if bleeding or blood spots appear. This condition may show symptoms of inflammation within the colon and rectum, such as ulcerative colitis, Crohn's disease, or a rectal tumor.

Diagnosis of Fecal Incontinence

As a first step in the diagnosis, the doctor will perform a medical history examination. The doctor will ask questions about the frequency of bowel movements, complaints and symptoms, the type of food or drink consumed, and the drugs being consumed.

Next, the doctor will perform a physical examination by directly examining the condition of the patient's anus, including a digital rectal examination to check the strength of the anal sphincter muscle. During a digital rectal examination, the doctor will also instruct the patient to strain to see if the rectum is descending (rectal prolapse).

If necessary, the doctor will perform further examinations to confirm the diagnosis, including:

  • stool culture, namely a laboratory examination procedure through a stool sample to detect any infection that causes diarrhea and incontinence.
  • anorectal ultrasound, namely examination of the anal sphincter structure using a stick-like instrument that is inserted into the anus and rectum.
  • MRI, to obtain detailed images of the condition of the anal sphincter and see the condition of the anal muscles.
  • barium enema, namely examination using X-rays and barium fluid to examine the lower digestive tract, including the large intestine and rectum.
  • proctography, namely an examination to measure the amount of feces that the body can expel and measure the strength of the rectum to hold feces from seeping. This test uses X-rays to produce a series of moving images, and is performed while the patient is defecating in a special toilet.
  • Electromyography (EMG), to check the function and coordination of the muscles and nerves around the anus and rectum.
  • colonoscopy, to examine the entire intestine using a flexible tube with a camera that is inserted through the anus.

Fecal Incontinence Treatment

The method of treating fecal incontinence is determined based on the cause. There are several treatment steps that can be taken, namely:

  • Changes in diet. If fecal incontinence is caused by diarrhea or constipation, dietary changes will need to be made to restore function and control bowel movements. The doctor will advise the patient to increase the consumption of high-fiber foods (20-30 grams per day) so that stools are denser and easier to control, and increase fluid consumption.
  • Drug therapy. Some types of drugs that doctors can give to people with fecal incontinence are:
  • antidiarrheal drugs, as loperamide.
  • laxatives or laxatives, with lactulose content. This type of drug is usually given for fecal incontinence caused by chronic constipation.
  • fiber supplements, to treat constipation.

If laxatives or supplements don't help with constipation, your doctor may prescribe a type of medication that's inserted through your rectum.

  • Physical therapy. Physical therapy is done to restore the strength of the rectum muscles, so as to improve anal sphincter control and the sensation to defecate. Some methods of physical therapy that may be done, including:
    • Biofeedback. Simple exercise movements to increase the strength of the rectal muscles, pelvic floor muscles, muscle contractions while urinating, and the sensation of the urge to pass stool. This therapy is generally performed with the help of anal manometry or rectal balloons.
    • Vaginal balloon. A pump-like device that is inserted into the vagina to apply pressure to the rectal area.
    • Kegel exercises. Exercises to reduce fecal incontinence and strengthen the pelvic floor muscles that play a role in the performance of the urinary tract, digestive tract, and muscles in the uterus of women. Kegel movements are done by holding and letting urine out to produce muscle contractions. Do the exercise to tighten the muscles for 5-10 seconds, then relax. Repeat the contraction exercise 10-20 times, at least 3 times a day.
  • Bowel or gastrointestinal exercises. Exercises to improve control over the rectum and anus muscles by doing activities that are done regularly, such as:
    • Defecate regularly according to a prescribed schedule, for example after eating.
    • Stimulate the anal sphincter muscle with a lubricated finger.
    • Using suppositories (drugs that are inserted through the rectum or vagina) to stimulate bowel movements.
  • Operation.If drug and physical therapy are ineffective, surgical procedures may be performed to treat fecal incontinence. Surgery is generally tailored to the patient's overall condition and the cause of fecal incontinence. Some of the types of surgery that can be performed are:
    • sphincteroplasty, which is a surgical procedure to repair weak or damaged rectal muscles. This procedure is generally performed on fecal incontinence patients who have undergone labor.
    • colostomy, is the procedure of making a hole in the abdominal wall to divert and remove feces (feces). Dirt that comes out of the hole will be accommodated in a special bag attached to the hole.
    • correction surgery, This is a procedure to repair damaged anal and rectal muscles. This procedure is performed to treat rectal prolapse, rectocele, and hemorrhoids, which cause fecal incontinence.
    • muscle transplant gracilis. This procedure is generally performed on patients who have lost nerve function in the anal sphincter. This action is done by taking a muscle from the upper thigh to be placed around the sphincter muscle to strengthen the muscle.
    • Nerve stimulation. The doctor will place a device in the body that will stimulate the nerves and control the anal muscles so that they can function normally.

Fecal Incontinence Prevention

Fecal incontinence is a condition that cannot be prevented easily because it is determined by the cause. However, the following steps can be taken to prevent fecal incontinence or reduce the symptoms experienced. Among others are:

  • Eat foods high in fiber and drink plenty of fluids to reduce the risk of constipation.
  • Exercise regularly.
  • Not straining when defecating. Straining can weaken the rectal muscles or damage nerves, leading to fecal incontinence.
  • Avoid the causes of diarrhea by maintaining hand hygiene before and after eating, as well as the cleanliness of the food consumed.
  • Using cotton underwear so that airflow is maintained and does not cause irritation.

People with fecal incontinence usually have problems with self-confidence and difficulty when they are outside the home. Here are some things that people with fecal incontinence can do to maintain comfort and increase self-confidence regarding their condition.

  • Defecate before traveling.
  • Use sanitary napkins or adult diapers when traveling long distances.
  • Don't forget to prepare cleaning tools and spare change of clothes as needed.
  • Immediately find the location of the toilet when you arrive at your destination.
  • Use deodorizing pills (fecal deodorant) to reduce the unpleasant odor of feces or gas (farts).

Complications of Fecal Incontinence

There are several complications that can be experienced by patients if fecal incontinence is not treated immediately, namely:

  • Emotional disturbance. Fecal incontinence can cause embarrassment, frustration, and depression in sufferers. This condition also causes sufferers to distance themselves from social life.
  • Skin irritation. The skin around the anus is very sensitive. When there is repeated contact with feces, the skin will become irritated and cause pain and itching. If not treated immediately, ulcers can appear that require medical treatment.