Discharge of feces after defecation. We train the intimate muscles of the pelvic floor, Kegel exercises. Fecal incontinence: types
Fecal incontinence is a loss of control over bowel movements caused by various disorders and injuries.
Causes of fecal incontinence
The main cause of fecal incontinence is a disruption in the functioning of the muscle sphincter and the inability to retain contents in the colon.
The closing apparatus must hold the contents of the intestines, which have liquid, solid and gaseous forms. Feces are retained inside the rectum due to the interaction of the receptor apparatus and the anal canal, which is carried out with the help of nerve endings, the spinal cord and the muscular system.
The main causes of fecal incontinence have different etiologies and can be either congenital or acquired pathologies. These reasons include:
- anatomical pathologies, including malformations of the anal apparatus, rectal defects and the presence of fistulas in the anus;
- organic injuries received after childbirth, brain damage;
- mental disorders, including neurosis, hysteria, psychosis, schizophrenia, etc.;
- the presence of serious illnesses and complications after them (dementia, epilepsy, manic syndrome, etc.);
- traumatic injuries of the obturator apparatus, including surgical trauma, household injuries and falls, rectal ruptures;
- acute infectious diseases causing diarrhea and fecal impaction;
- neurological disorders caused by diabetes mellitus, pelvic injuries, anal tumors, etc.
Types of fecal incontinence
Fecal incontinence in adults and children differs in etiology and type of anal incontinence. The following types of incontinence can be distinguished:
- regular passage of feces without the urge to defecate;
- fecal incontinence with the urge to defecate;
- partial fecal incontinence during physical exertion, coughing, sneezing, etc.;
- age-related fecal incontinence under the influence of degenerative processes in the body.
Fecal incontinence in infancy is a normal condition in which the child does not yet have the ability to hold bowel movements and gases. If fecal incontinence in children continues up to 3 years, then it is necessary to consult your doctor, as disorders and pathologies may be detected.
Fecal incontinence in adults is usually associated with the presence of nervous and reflex pathology. Patients may experience anal insufficiency, which is caused by a violation of the external sphincter and pathological incontinence of the contents of a full rectum.
In case of innervation disorders, fecal incontinence in adults occurs at the moment of loss of consciousness, that is, during sleep, fainting and in stressful situations.
Receptor fecal incontinence in old people is observed in the absence of the urge to defecate, caused by lesions of the distal rectum and central nervous system. Fecal incontinence in old people is usually observed after impaired coordination of movements, mental disorders and degenerative processes.
In order to prescribe the most correct treatment, it is necessary to accurately determine the type of fecal incontinence - congenital, postpartum, traumatic and functional.
In women, fecal incontinence can be caused by damage to the anal sphincter after childbirth. As a result of postpartum disorders, there is a rupture of the perineum and further suppuration, which leads to the development of dysfunction of the anal apparatus.
Diagnosis of the disease
To determine an accurate diagnosis and establish the correct type of fecal incontinence, the attending physician prescribes diagnostic tests and also conducts an examination for the presence of anatomical, neurological and traumatic disorders of the anal apparatus.
The therapist and proctologist prescribe anal sensitivity testing, sigmoidoscopy, ultrasound and magnetic resonance imaging.
Treatment of fecal incontinence
The first stage of treatment for fecal incontinence is to establish regular bowel movements and normal functioning of the gastrointestinal tract. The patient is prescribed not only the correct diet, but also the diet is regulated with correction of the diet, its components and quantity.
After normalization of digestion, drugs are prescribed that stop bowel movements, including furazolidone and imodium.
The most effective treatment for fecal incontinence will be when prescribing special training and exercises to strengthen the anal muscles. The exercise program will allow you to train the sphincter and restore normal functioning of the anal apparatus.
In case of serious damage to the anus and rectum, surgery is prescribed. A colostomy is an operation to surgically connect the colon and abdominal wall. The anal passage is completely sutured, and after the operation the patient can defecate only in a special removable bag, which is connected to the abdominal wall. This operation is performed only in extreme severe cases.
Conservative treatment of fecal incontinence includes drug therapy, electrical stimulation and therapeutic exercises. Electrical stimulation of the perineum and sphincter is aimed at improving the contractile function of the anal muscles, restoring the obturator ability of the rectum and strengthening the anus. Drugs as part of the main therapy will improve nervous excitability in synapses and normalize the condition of muscle tissue. Drugs are prescribed depending on the diagnostic indications and the patient’s condition, the type of fecal incontinence and the stage of the disease.
If necessary, combined treatment of fecal incontinence is prescribed, which involves surgical removal of hemorrhoids and restoration of the rectum.
As additional therapy, a course of water procedures and Biofeedback can be prescribed, which is aimed at training the anal muscles using a special device and diagnostic monitor.
Video from YouTube on the topic of the article:
What is fecal incontinence?
Fecal incontinence is the inability to control bowel movements, resulting in the unexpected passage of stool from the rectum. Fecal incontinence is more common in women and older people of both sexes.
Many of those who are faced with this problem are embarrassed to talk about it with a doctor, believing that it is no longer possible to help them. However, in fact, today there are many effective methods for treating this disorder.
Why does fecal incontinence develop?
The bowel movement process is controlled by 3 factors: sphincter pressure, rectal sensitivity and rectal capacity. The anal sphincter is a muscle that contracts and thereby prevents stool from leaving the rectum. The function of the sphincter is key in holding back stool. Rectal sensation helps a person understand that stool is already in the rectum and that it is time to visit the toilet. The intestine is capable of stretching and maintaining pressure for some time after “notifying” a person of the need to empty his bowels. This ability is called rectal capacity.
At the same time, a person is required to respond to appropriate signals in a timely manner. In addition, he must be able to reach the toilet. If anything goes wrong with any of these factors, fecal incontinence occurs.
What are the causes of fecal incontinence?
In most cases, fecal incontinence is caused by muscle damage. In women, this problem often arises during childbirth, especially when it is difficult, and doctors are forced to use forceps or perform an episiotomy. An episiotomy is an incision into the vagina to increase its capacity before childbirth. In addition, muscle damage can occur during rectal surgery, for example, as well as with inflammatory bowel disease or perirectal abscess.
Often people are able to compensate for muscle weakness. Typically, incontinence develops in old age as the general weakening of the muscles, in particular the pelvic organs.
Another common cause of fecal incontinence is damage to the nerves that control the anal muscles or regulate rectal sensation. Such damage can occur in the following situations:
- During childbirth.
- With prolonged abstinence from bowel movements.
- For spinal cord tumors and multiple sclerosis.
Also, fecal incontinence can develop as a result of decreased elasticity of the rectum, which reduces the time between the signal of the presence of feces and the appearance of the desire to go to the toilet. Surgery or radiation therapy can leave scars and thereby reduce the elasticity of the intestine. Inflammatory bowel disease can have the same effects.
Because diarrhea is much more difficult to control than normal bowel movements, it places increased stress on the organs involved and can also lead to fecal incontinence.
How does a doctor determine the cause of fecal incontinence?
Along with an external examination, the doctor will prescribe specific procedures, such as anorectal manometry, which allows you to determine the elasticity, sensitivity and pressure in the rectum. Such procedures will help determine the cause of incontinence.
How is fecal incontinence treated?
Fortunately, there are now effective treatments for incontinence, so you and your doctor will just have to figure out which one is best for you. Attempts at self-medication in the vast majority of cases are unsuccessful.
Treatment methods for fecal incontinence depend on the cause of the problem. Your doctor may recommend:
- Making dietary changes: and diarrhea usually proves extremely effective in controlling incontinence. Regulating the amount of fiber you eat, drinking more fluids, or changing your overall daily food intake can often help prevent diarrhea and constipation.
- Drug treatment. Your doctor may prescribe laxatives, antidiarrheals, and stool softeners. Consult your doctor before taking any over-the-counter drug.
- Training: One of the most effective methods is to develop a clear bowel movement schedule. To do this, you need to go to the toilet at the same time every day (for example, after eating) or use so-called anorectal biofeedback. This procedure measures the contractions of the sphincter during specific Kegel exercises. This training method will strengthen the sphincter muscles and allow you to better control the bowel movement process.
- Operation: There are several different surgeries available to treat fecal incontinence. They often allow the sphincter muscles to be repaired or replaced.
Questions to ask your doctor
- Which treatment option is optimal in my case?
- How long will the course of treatment last?
- Can I cure myself at home?
- Do I need to take medications?
- Will exercise help?
- How long is the recovery period after surgery?
- Will I need physical therapy?
- Do I need to eat more fiber?
If stool and gas production gets out of control, it can become a serious problem.
There are diseases and disorders that we are ashamed of, and the presence of which we try not to tell others about. Among the “shameful” disorders of our body there are those that even the usual presence in public makes a reason for fear and anxiety. Fecal and gas incontinence, or anal incontinence, is one such disorder.
Incontinence of feces and gases, forms and varieties
Fecal and gas incontinence is the inability to control the action of the anal sphincter. According to the degree of weakening of control over this process, three stages are distinguished:
- Loss of control over the gas separation process.
- Incontinence of gases and liquid feces.
- Incontinence of gases, liquid and solid feces is the most severe form of loss of control over the process of the sphincter.
In this case, a person may or may not feel that he is having a bowel movement. In the first case, fecal leakage can occur when a person feels the urge to defecate, but cannot control this process. In the second, when fecal leakage occurs spontaneously and the person does not feel any urge.
Fecal and gas incontinence is normal for infants. But by the age of three, the child must learn to control these processes. If anal incontinence is observed in adults, this is a serious problem. Fecal and gas incontinence often occurs in old age, but can appear much earlier.
Causes of inoperability of the anal sphincter
The reasons for the development of this phenomenon can be very different; both anatomical defects and physiological disorders can lead to incontinence. Among the causes of fecal and gas incontinence:
- Anatomical problems. For example, fistulas in the anus and anal fissures can cause problems with the sphincter.
- Organic causes. Damage to the brain or spinal cord, postoperative and postpartum injuries.
- Psychogenic factors: neuroses, psychoses, hysteria .
Fecal and gas incontinence can be a manifestation of certain diseases. Uncontrolled bowel movements can result from catatonic syndrome, manic-depressive syndrome, dementia, and epilepsy.
Treatment of fecal and gas incontinence
To treat this disorder, you need to understand the causes of its occurrence and, based on this, adjust the treatment. It is also important how much control over the work of the anal sphincter is lost.
For the treatment of fecal and gas incontinence, the following is used:
- therapeutic exercises and water procedures
- diet
- surgical intervention
Physiotherapy
This is a very important part of treatment ,
aimed at training the anal sphincter muscles. There are many different techniques .
For example, you can simply try to squeeze and unclench your sphincter several times a day for a few minutes.
Sphincter training using the biofeedback method is quite common. In this case, a special device is inserted into the anus - a balloon filled with air. The patient tries to make an effort and squeeze the sphincter. This creates pressure on the balloon. Data on how strongly the anal sphincter contracts is displayed on a special monitor connected to the balloon.
Another option for restoring the functions of the anal sphincter is to irritate it with an electric current.
Diet
In some cases, stool leakage occurs only with diarrhea. In this case, first of all you need to pay attention to your diet. It is necessary to exclude foods that provoke from the menu.
In addition, people suffering from fecal and gas incontinence are advised to eat more protein and dietary fiber.
Surgical intervention
The cause of urinary incontinence in men may be the constant consumption of caffeine, a new study conducted by American urologists has shown.
If the above methods are ineffective, surgery is recommended. The operation is performed only in stationary conditions. The essence of the intervention is to sutured the non-functioning sphincter. The nature of the surgical intervention depends on the severity of the damage to the sphincter and on which parts of the muscular structure of the anal sphincter are deformed.
For minor damage, sphincteroplasty is used, and for more extensive damage, sphincterolevatoroplasty is used. With sphincteroplasty, a gentle excision of the defect is performed, after which two or three catgut sutures are made. When performing sphincterolevatoplasty, a more extensive surgical intervention is performed, during which the sphincter muscles are sutured, part of the rectal wall is corrugated, and thus the correct shape of the anal canal is formed.
The choice of the type of surgical intervention is made by the doctor based on data on the state of the anal sphincter, the state of the nervous system and other important health indicators.
If the process of releasing gases and feces has become uncontrollable, this is a rather serious violation and it will take a lot of time to restore the functioning of the sphincter. Be patient, tune in to a positive result and follow all the doctor’s recommendations - this will help you cope with the problem.
Fecal incontinence is a condition that invariably has a severe impact on a person’s life, both in social and moral aspects. In long-term care facilities, the prevalence of fecal incontinence among residents is up to 45%. The prevalence of fecal incontinence is similar among men and women, at 7.7 and 8.9%, respectively. This indicator increases in older age groups. Thus, among people 70 years and older it reaches 15.3%. For social reasons, many patients do not seek medical help, which most likely leads to an underestimation of the prevalence of this disorder.
Of primary care patients, 36% report episodes of fecal incontinence, but only 2.7% have a documented diagnosis. Healthcare system costs for patients with fecal incontinence are 55% higher than for other patients. In monetary terms, this translates into an amount equal to US$11 billion per year. In most patients, proper treatment achieves significant success. Early diagnosis helps prevent complications that adversely affect the quality of life of patients.
Causes of fecal incontinence
- Gynecological trauma (childbirth, hysterectomy)
- Severe diarrhea
- Coprostasis
- Congenital anorectal anomalies
- Anorectal diseases
- Neurological diseases
The passage of feces provides a mechanism with a complex interaction of anatomical structures and elements that provide sensitivity at the level of the anorectal zone and the pelvic floor muscles. The anal sphincter consists of three parts: the internal anal sphincter, the external anal sphincter and the puborectalis muscle. The internal anal sphincter is a smooth muscle element and provides 70-80% of the pressure in the anal canal at rest. This anatomical formation is under the influence of involuntary nervous tonic impulses, which ensures the closure of the anus during the rest period. Due to the voluntary contraction of the striated muscles, the external anal sphincter serves as additional retention of feces. The puborectalis muscle forms a supportive cuff surrounding the rectum, which further strengthens existing physiological barriers. It remains in a contracted state during the rest period and maintains an anorectal angle of 90°. During defecation, this angle becomes obtuse, thereby creating conditions for the passage of feces. The angle is sharpened by voluntary contraction of the muscle. This helps retain the contents of the rectum. Fecal masses gradually filling the rectum lead to stretching of the organ, a reflex decrease in anorectal resting pressure and the formation of a portion of feces with the participation of the sensitive anoderm. If the urge to defecate appears at an inconvenient time for a person, the activity of the smooth muscles of the rectum, controlled by the sympathetic nervous system, occurs with simultaneous voluntary contraction of the external anal sphincter and puborectal muscle. To shift defecation over time, sufficient compliance of the rectum is required, as the contents move back into the expandable rectum, endowed with a reservoir function, until a more suitable moment for defecation.
Fecal incontinence occurs when the mechanisms that maintain fecal retention are disrupted. This situation of fecal incontinence can occur due to loose stools, weakness of the striated pelvic floor muscles or internal anal sphincter, sensory disturbances, changes in colonic transit time, increased stool volume, and/or decreased cognitive function. Fecal incontinence is divided into the following subcategories: passive incontinence, urge incontinence, and fecal leakage.
Classification of functional fecal incontinence
| Functional fecal incontinence |
Diagnostic criteria:
|
| Subcategories | Mechanism |
| Passive incontinence | Loss of sensitivity in the rectosigmoid region and/or impaired neuroreflex activity at the level of the rectoanal segment. Weakness or rupture of the internal sphincter |
| Incontinence with urge to stool | Disruption of the external sphincter. Change in rectal capacity |
| Fecal leakage | Incomplete bowel movement and/or impaired rectal sensation. Sphincter function preserved |
Risk factors for fecal incontinence
- Elderly age
- Female
- Pregnancy
- Traumatization during childbirth
- Perianal surgical trauma
- Neurological deficits
- Inflammation
- Haemorrhoids
- Pelvic organ prolapse
- Congenital malformations of the anorectal area
- Obesity
- Condition after bariatric surgery
- Limited mobility
- Urinary incontinence
- Smoking
- Chronic obstructive pulmonary disease
Many factors contribute to the development of fecal incontinence. These include loose stool consistency, female gender, old age, and multiple births. The greatest importance is given to diarrhea. Urgency to stool is the main risk factor. With age, the likelihood of fecal incontinence increases, mainly due to weakening of the pelvic floor muscles and decreased anal tone at rest. Childbirth is often accompanied by damage to the sphincters as a result of trauma. Fecal incontinence and surgical delivery or traumatic birth through the birth canal are certainly interrelated, but there is no evidence in the literature of the advantage of cesarean section over non-traumatic natural birth in terms of preserving the pelvic floor and ensuring normal fecal continence.
Obesity is one of the risk factors for NC. Bariatric surgery is considered an effective treatment for advanced obesity, but after surgery, patients often experience fecal incontinence due to changes in stool consistency.
In relatively young women, fecal incontinence is clearly associated with functional bowel disorders, including IBS. The causes of fecal incontinence are numerous, and they sometimes overlap. Sphincter damage may go unnoticed for many years until age-related or hormonal changes, such as muscle atrophy and atrophy of other tissues, disrupt established compensation.
Clinical examination of fecal incontinence
Patients are often embarrassed to admit incontinence and complain only of diarrhea.
In identifying the causes of fecal incontinence and making the correct diagnosis, one cannot do without a detailed history and a targeted rectal examination. The medical history must necessarily reflect an analysis of the drug therapy being carried out at the time of treatment, as well as the characteristics of the patient’s diet: both can affect the consistency and frequency of stool. It is very useful for the patient to keep a diary recording everything related to the stool. These include the number of episodes of urinary incontinence, the nature of incontinence (gas, loose or hard stools), the volume of involuntary passage, the ability to feel the passage of stool, the presence or absence of urgency, straining and sensations associated with constipation.
A comprehensive physical examination includes examining the perineum for excess moisture, irritation, fecal matter, anal asymmetry, fissures, and excessive sphincter relaxation. It is necessary to check the anal reflex (contraction of the external sphincter to a prick in the perineal area) and make sure that the sensitivity of the perineal area is not impaired; note prolapse of the pelvic floor, bulging or prolapse of the rectum when straining, the presence of prolapsed and thrombosed hemorrhoids. Rectal examination is crucial to identify anatomical features. Very severe cutting pain indicates acute damage to the mucous membrane, for example, an acute or chronic fissure, ulceration or inflammatory process. A decrease or sharp increase in anal tone at rest and during straining indicates a pathology of the pelvic floor. During a neurological examination, attention should be paid to the preservation of cognitive functions, muscle strength and gait.
Instrumental studies of fecal incontinence
Endoanal ultrasound is used to assess the integrity of the anal sphincters, and anorectal manometry and electrophysiology may also be used if available.
There is no specific list of studies that should be carried out. The attending physician will have to weigh the negative aspects and benefits of the study, the cost, the overall burden on the patient with the ability to prescribe empirical treatment. The patient's ability to tolerate the procedure, the presence of concomitant diseases, and the level of diagnostic value of what is planned to be done should be taken into account. Diagnostic studies should be aimed at identifying the following conditions:
- possible damage to the sphincters;
- overflow incontinence;
- pelvic floor dysfunction;
- accelerated passage through the colon;
- significant discrepancy between anamnestic data and the results of a physical examination;
- exclusion of other possible causes of NK.
The standard test to check the integrity of the sphincters is endoanal sonography. It shows very high resolution when examining the internal sphincter, but with respect to the external sphincter the results are more modest. MRI of the anal sphincter provides greater spatial resolution and is therefore superior to the ultrasound method, both for the internal and external sphincters.
Anorectal manometry allows one to obtain a quantitative assessment of the function of both sphincters, rectal sensitivity and wall compliance. With fecal incontinence, pressure at rest and during contraction is usually reduced, which allows us to judge the weakness of the internal and external sphincters. In the case where the results obtained are normal, one can think about other mechanisms underlying NK, including loose stools, the appearance of conditions for fecal leakage and sensory disturbances. The rectal balloon test is designed to determine rectal sensitivity and elasticity of the organ walls by assessing sensory-motor responses to an increase in the volume of air or water pumped into the balloon. In patients with fecal incontinence, sensitivity may be normal, weakened or enhanced.
Carrying out a test with expulsion of a balloon from the rectum involves the test subject pushing out a balloon filled with water while sitting on a toilet seat. Expulsion within 60 seconds is considered normal. This test is usually used in a screening examination of patients suffering from chronic constipation to identify pelvic floor dyssynergia.
Standard defecography allows for dynamic visualization of the pelvic floor and detection of rectal prolapse and rectocele. Barium paste is injected into the rectosigmoid colon and then dynamic x-ray anatomy is recorded - the motor activity of the pelvic floor - of the patient at rest and during coughing, contraction of the anal sphincter and straining. The defecography method, however, is not standardized, so each institution performs it differently, and the study is not available everywhere. The only reliable method for visualizing the entire anatomy of the pelvic floor, as well as the anal sphincter area, without exposure to radiation is dynamic pelvic MRI.
Anal electromyography allows us to identify sphincter denervation, myopathic changes, neurogenic disorders and other pathological processes of mixed origin. The integrity of the connections between the endings of the pudendal nerve and the anal sphincter is checked by recording the terminal motor latency of the pudendal nerve. This helps determine whether sphincter weakness is due to damage to the pudendal nerve, a disruption in the integrity of the sphincter, or both. Due to the lack of sufficient experience and lack of information that could prove the high significance of this method for clinical practice, the American Gastroenterological Association opposes the routine determination of terminal motor latency of the pudendal nerve during the examination of patients with NK.
Sometimes stool analysis and determination of intestinal transit time help to understand the reasons underlying diarrhea or constipation. To identify pathological conditions that aggravate the situation with fecal incontinence (inflammatory bowel disease, celiac disease, microscopic colitis), an endoscopic examination is performed. It is always necessary to understand the cause, as this determines treatment tactics and ultimately improves clinical results.
Treatment of fecal incontinence
Often very difficult. Diarrhea is controlled with loperamide, diphenoxylate, or codeine phosphate. Exercises for the pelvic floor muscles, and in the presence of defects of the anal sphincter, improvement can be achieved after sphincter restoration operations.
Initial treatment approaches for all types of fecal incontinence are the same. They involve changes in habits aimed at achieving stool consistency, eliminating defecation disorders and ensuring access to the toilet.
Lifestyle change
Medicines and diet changes
Older people usually take numerous medications. It is known that one of the most common side effects of medications is diarrhea. First of all, you should review what the person is being treated with that can trigger NK, including over-the-counter herbs and vitamins. It is also necessary to determine whether there are components in the patient’s diet that aggravate the symptoms. This includes, in particular, sweeteners, excess fructose, fructans and galactans, and caffeine. A diet rich in dietary fiber may improve stool consistency and reduce the incidence of urticaria.
Container type absorbents and accessories
Not many materials have been developed to absorb feces. Patients tell how they get out of the situation with the help of tampons, pads and diapers - everything that was originally invented to absorb urine and menstrual flow. The use of pads in cases of fecal incontinence is associated with the spread of odor and skin irritation. Anal tampons come in different styles and sizes and are designed to block the leakage of stool before it even happens. They are poorly tolerated, which limits their usefulness.
Toilet accessibility and “gut training”
Fecal incontinence is often a problem for people with limited mobility, especially the elderly and psychiatric patients. Possible measures: visiting the toilet on a schedule; making changes to the interior of the house to make visiting the toilet more convenient, including moving the patient’s sleeping place closer to the toilet; location of the toilet seat directly next to the bed; Place special accessories in such a way that they are always at hand. Physiotherapy and exercise therapy can improve a person's motor function and, due to greater mobility, make it easier for him to access the toilet, but, apparently, the number of episodes of fecal incontinence does not change from this, at least it should be noted that the results of studies on this topic are contradictory .
Differentiated pharmacotherapy depending on the type of fecal incontinence
Fecal incontinence due to diarrhea
At the first stage, the main efforts should be directed to changing the consistency of the stool, since formed stool is much easier to control than liquid stool. Adding dietary fiber to your diet usually helps. Pharmacotherapy aimed at slowing bowel movement or stool binding is usually reserved for patients with refractory symptoms that do not respond to milder measures.
Antidiarrheals for fecal incontinence
| Conservative therapy for NK | Possible side effects |
|---|---|
| Dietary fiber in the form of dietary supplements | Increased gas discharge, bloating, abdominal pain, anorexia. Able to alter drug absorption and reduce the need for insulin |
| Loperamide | Paralytic ileus, rashes, weakness, cramps, constipation, nausea and vomiting. May increase the tone of the anal sphincter at rest. Cautious use in active inflammatory processes in the colon, as well as in infectious diarrhea |
| Diphenoxylate-atropine | Toxic megacolon, central nervous system effects. The anticholinergic effect of atropine may occur. Cautious use in active inflammatory processes in the colon, as well as in infectious diarrhea |
| Colesevelam hydrochloride | Constipation, nausea, nasopharyngitis, pancreatitis. Use cautiously if there is a history of colonic obstructive obstruction. May alter drug absorption |
| Cholestyramine | Increased gas formation and discharge of gases, nausea, dyspepsia, abdominal pain, anorexia, sour taste in the mouth, headache, rashes, hematuria, feeling of fatigue, bleeding gums, weight loss. May alter drug absorption |
| Colestipol | Gastrointestinal bleeding, abdominal pain, bloating, increased passage of gas, dyspepsia, liver dysfunction, skeletal muscle pain, rashes, headache, anorexia, dry skin. May alter drug absorption |
| Clonidine | Recoil syndrome in the form of arterial hypertension, dry mouth, sedation, manifestations from the central nervous system, constipation, headache, rash, nausea, anorexia. If there is no effect, the drug should be discontinued slowly |
| Laudanum | Sedation, nausea, dry mouth, anorexia, urinary retention, weakness, hot flashes, itching, headache, rash, central nervous system reaction in the form of depression, arterial hypotension, bradycardia, respiratory depression, development of addiction, euphoria |
| Alosetron | Constipation, severe ischemic colitis. The drug must be discontinued if there is no effect at a dose of 1 mg 2 times a day for 4 weeks |
Patients with IBS-D deserve special attention, since their use of dietary fiber can increase abdominal pain and bloating, which makes them refuse this measure. If there is no improvement, they switch to pharmacotherapy that is more effective for this group of patients, including loperamide, TCAs, probiotics and alosetron.
Fecal incontinence due to constipation
Chronic constipation can lead to distension of the rectum as a result of a persistent tendency towards overcrowding and suppression of sensitivity. Both create conditions for overflow incontinence. This type of incontinence is especially common among older people. In case of overflow incontinence, it is advisable to increase the amount of dietary fiber in the diet as an initial measure, and only then, if necessary, can laxatives be prescribed.
Fecal leakage
Leakage is not the same as NDT. In this case, they mean the passage of a small amount of liquid or soft feces after normal bowel movements. The patient may talk about wetting in the perianal area, changes in the frequency of bowel movements, or symptoms more characteristic of dysfunction of the anal sphincters, which, upon an objective examination of the anorectal area, is not always regarded by the doctor as a violation of physiological functions. Leakage is more common in men with preserved anal sphincter function. It can be explained by hemorrhoids, poor hygiene, anal fistula, rectal prolapse, hypo- or hypersensitivity of the rectum. In patients suffering from leakage, proper diagnosis and treatment of the specific pathology can completely eliminate symptoms. If manifestations still remain, it is recommended to empty the rectal ampulla using an enema or suppositories every day, regardless of the urge to defecate. For enemas, it is better to use plain water, since repeated administration of sodium phosphate or glycerin can damage the mucous membrane and lead to rectal bleeding. The desired time for a regular procedure is the first 30 minutes after eating in order to enhance the normal reflexes characteristic of the colon after eating.
Rectally injectable blocking agents
Several means have been proposed to block the anal sphincter with the formation of an obstacle to the involuntary passage of feces. Among them are silicone, carbon-coated beads and, the newest, dextranomer in hyaluronic acid [(Solesta) Solesta]. A 2010 Cochrane systematic review found that, due to the small number of trials conducted, no clear conclusion could be reached regarding the effectiveness of injectables. Nevertheless, this approach remains the subject of close attention as it is promising and promises the emergence of new drugs that are truly capable of eliminating NK. Side effects include pain, bleeding and, rarely, abscess formation.
Non-pharmacological treatment options
Biofeedback method
The biofeedback method is one of the forms of psychotherapy based on the principle of reinforcement, in which information about a physiological process, which in a normal situation is transmitted at a subconscious level, is visually demonstrated to the patient so that he can influence the process, but already controlling it with his own by will. The essence of what is happening is to monitor the work of the striated muscles of the pelvic floor, so that the patient, taking this into account, voluntarily coordinates the performance of special exercises for strength training. Simultaneously with the development of strength, the ability to separate sensitive signals can be trained. According to the opinion of the majority of specialists dealing with this problem, this method of treatment is suitable for patients with mild to moderate manifestations of the disease, who meet the physiological criteria for dysfunction of the anal sphincters, who are ready for cooperation in work, are well motivated, and are able to put up with a certain severity of the feeling of rectal distension, retaining the ability to voluntarily compress the external sphincter.
Sacral nerve stimulation
Initially invented for the rehabilitation of patients with paraplegia, stimulation of the sacral nerves, instead of its main purpose, as it turned out later, promotes defecation. Later, promising results were obtained with NK. The first reports on this subject indicated the success of this technique in a large percentage of cases, which made sacral nerve stimulation a popular intervention and prompted the rapid development of the method.
Currently, publications have begun to appear on the results of long-term follow-up of patients, but they are much less optimistic and describe a smaller percentage of success. Among elderly patients, the number of postoperative complications reaches 30%. Complications include pain at the implant site, inflammation in the subcutaneous pocket, electrical sensation, and rarely battery displacement or failure, requiring repeat surgery.
Surgery
Surgical treatment is indicated when the cause of fecal incontinence is anatomical changes. Most often, sphincteroplasty is used to restore the sphincter by stitching the defect together with an overlap. After surgery, the edges of the wound often diverge, which significantly prolongs the healing time. Up to 60% of patients report improvement, but the long-term results of lap sphincteroplasty are poor. For patients with an extensive anatomical defect of the sphincter, for whom simple sphincteroplasty is unacceptable, graciloplasty and transposition of the gluteus maximus muscle have been developed. When performing graciloplasty, the gracilis muscle is mobilized, the distal tendon is split in half, and the muscle is enclosed around the anal canal. With dynamic graciloplasty, electrodes are applied to the muscle and connected to a neurostimulator, which is sutured into the abdominal wall, its lower part. Complications include inflammation, problems with stool passage, leg pain, intestinal damage, perineal pain and the formation of anal strictures.
If other options for surgical treatment have been exhausted, the option remains with implantation of an artificial anus. The artificial sphincter is passed around the natural sphincter through the perianal tunnel. The device remains inflated until it is time to defecate. During defecation, the artificial sphincter is deactivated (deflated). In general, a positive effect from the intervention is observed in approximately 47-53% of patients, that is, in those who tolerate the artificial sphincter well. The majority require surgical revision, and in 33% of cases, removal. Complications include inflammatory processes, destruction of the device or its malfunction, chronic pain syndrome and obstruction during the passage of feces. Colostomy or permanent stoma for fecal incontinence is considered an option for patients who have failed or where all other methods have been completely insufficient.
Key aspects of patient management
- Fecal incontinence is actually a disabling disorder that dramatically reduces a person's quality of life.
- For the development of diagnostic and therapeutic tactics, the collection of anamnesis with a detailed elucidation of how the pathology of defecation was formed, and an anorectal examination are crucial.
- Treatment of all types of fecal incontinence begins with analysis and lifestyle correction. The goal is to outline measures aimed at improving stool consistency, coordinating bowel dysfunction, and ensuring toilet accessibility.
- Intrarectal occlusive agents and sacral nerve stimulation have been shown to reduce the number of incontinence episodes.
- Surgical interventions should be reserved for those rare cases that do not respond to conservative treatment methods, in particular for patients with obvious anatomical defects.
Fecal incontinence is one of the serious problems. Characterized by spontaneous excretion of feces. It can occur in both adults and.
For what reasons does this phenomenon occur and can the disease be cured?
Description of the pathological process
Fecal incontinence or encopresis in adults is a pathological phenomenon that occurs as a result of loss of control over the excretory process.
The disease is so called when there is a problem with emptying the intestinal tract, a person loses the ability to retain feces inside himself. Because of this, not only the liquid mass leaks, but also the solid mass.
In 70 percent of all cases, this process is a symptom of various disorders in children over the age of five. Often before this, the child experiences chronic stool retention.
Most often the disease is diagnosed in men.
There is also an opinion that fecal incontinence in adults is a sign of impending old age. Many people believe that this disease is only a disease of old age. But the situation looks a little different.
About 50 percent of patients are between 40 and 60 years of age. But the disease also has a direct relation to old age.
Causes
Many patients are interested in the question of why fecal incontinence occurs in adults and children? What reasons may contribute to the development of such a phenomenon? This pathology is always secondary.
The causes of fecal incontinence in older people, adults and children may be hidden in:
- constant diarrhea. Diarrhea is considered the most harmless cause of this disease. Due to the fact that the stool becomes liquefied, it is very difficult to keep it in the rectum. Diarrhea acts as a temporary factor for encopresis. After the symptom is eliminated, everything returns to normal;
- long-term constipation. As a result of the accumulation of solid masses, the intestinal walls begin to stretch and the sphincter begins to relax. Because of this, the urge to empty the digestive canal weakens;
- injury to muscle structures or weakening of their tone. Damage to the muscles in the sphincter occurs due to household injuries or surgery. The most common occurrence of fecal incontinence is after hemorrhoid surgery;
- difficulties with innervation. There are two types of disturbances in the conduction of impulses. The first option lies in the nerve endings of the two sections of the sphincter, when the processes of relaxation and contraction are disrupted. Another type is based on problems in the cerebral cortex or the pathway to it. Then the person does not feel the urge to defecate, thereby missing it;
- scarring of the rectum. This condition is accompanied by a decrease in the elasticity of the intestinal walls. As a result, encopresis occurs. The cause of the phenomenon is inflammation, intestinal surgery, radiation exposure;
- expansion of hemorrhoids. Swollen cones do not allow the muscular system in the anal passage to fully close;
- problems with the muscle structures in the pelvis. This may include fecal incontinence after childbirth, when muscle structures have reduced strength. The likelihood of pathology occurring increases in those who have had a rupture or incision in the perineum during childbirth.
Fecal incontinence in the elderly involves weakening of muscle fibers and loss of elasticity. Some patients experience fecal incontinence after a stroke.
Unlike senile uncontrolled excretion of feces in children, everything happens for other reasons. First of all, it should be noted that in children up to the age of 4-5 years, this process is quite normal. It is often accompanied by enuresis and is physiological in nature. Gradually, with age, the child acquires skills and is able to hold feces or urine.
This phenomenon also occurs in children for psychological reasons. Often, children cannot go to the toilet outside the home, as it causes them discomfort. If you do not go to the toilet for a long time, the process can occur spontaneously.
It is worth mentioning separately about children from disadvantaged families. Faecal incontinence can occur in the absence of the required skills. Parents do not monitor the child. This phenomenon may be accompanied by a constant disorder, as a result of which they do not recognize the smell of feces and do not react in any way to the discharge.
Diagnosis
If you are unable to hold your stool, it is not that difficult to diagnose. If a patient experiences fecal incontinence, the causes should be recognized as soon as possible and then treated with therapy.
Based on the person’s complaints, the doctor prescribes an examination, which includes:
- anorectal manometry. This technique is performed to identify the level of susceptibility of the rectum. The force of compression of the sphincter and its innervation is also assessed;
- This method helps to take high-precision photographs of the muscular apparatus of the anorectal area;
- transrectal ultrasound diagnosis. Performed to evaluate the external structure of muscle strictures;
- proctography. This technique refers to x-ray examination. It allows you to examine the rectum when there is feces there;
- The examination consists of visually examining the intestinal walls for the presence of scars and tumors;
- electromyography. This method makes it possible to assess the condition of the neuromuscular system in the pelvic floor.
After identifying the cause, the attending physician prescribes treatment for encopresis based on the patient’s age and characteristics of the disease.
Therapeutic measures
How to treat encopresis at home? Treatment of encopresis is carried out based on the cause of the disease.
Diet
This technique for fecal incontinence is used only when the cause is constipation or diarrhea.
- It is necessary to consume foods that contain high fiber content. Their effect is aimed at normalizing the consistency and manageability of stool, preventing the formation of constipation. But their content in the diet must be increased gradually, since a large accumulation of gases in the intestines is possible.
- Drink plenty of fluids. Precisely purified water, not juices and tea. At the same time, you should take fruit and vegetable juices with extreme caution, as this can lead to diarrhea.
- A special diary should be kept indicating what the patient ate. With the development of pathology, he will be able to understand which product leads to a change in the consistency of stool, and exclude it from the diet.
- Fecal incontinence in adults over 60 years of age is treated with a folk remedy. To do this you need to use Vaseline oil. It should be taken two spoons up to two times a day. This process helps soften stool and promotes its elimination.
The doctor decides with the patient on an individual basis what diet to follow.
Conservative treatment
What to do if fecal incontinence occurs in women and men? In some cases, the use of medications is required.
Treatment for fecal incontinence involves:
- using laxative tablets for constipation;
- the use of antidiarrheals for diarrhea;
- the use of medications that reduce the amount of water in stool.
Along with drug therapy, the patient needs to adhere to some recommendations:
- compliance with the regime. If the patient has constipation, then it is necessary to establish the process of emptying. We must mentally ask the body to cleanse the body of feces at a certain time;
- performing physical exercises. They will help strengthen the muscular structures of the pelvic floor and sphincter. This technique will help when gas incontinence occurs after childbirth. An excellent exercise is to relax and contract the sphincter. It is enough to carry out this procedure up to three times a day for a month, and the problem will disappear by itself;
- conducting physiotherapy. Electrical stimulation has an excellent effect;
- performing water procedures. You need to take baths or visit the pool more often. This will strengthen the muscle structures.
Surgery
If other methods do not help eliminate the problem, the doctor resorts to surgery.
There are several methods of surgery called:
- straight sphincter. It is based on strengthening the muscle tissue of the anus with the help of a strong connection with the rectum. It is used in cases where muscles are affected due to damage or atrophy;
- artificial sphincter. It is placed around the real sphincter. The device is a special cuff that regulates pressure and acts as a pump;
- Most often used after surgery on the digestive canal. This procedure involves connecting the large intestine to the anterior abdominal wall. When the process of defecation occurs, the stool will be collected in a bag.
What type of treatment to choose is up to the doctor to decide based on age, cause of the disease and course.
Fecal incontinence is medically called encopresis. In some cases, this process is physiological and goes away over time. In other situations, why pathology occurs can only be explained by a doctor on an individual basis.
But no matter what becomes the decisive factor, you need to follow some tips:
- When leaving home, be sure to visit the toilet. It is necessary to empty the intestinal canal by any means.
- If the patient is going somewhere far away, then you need to take care of a change of underwear. If necessary, take wet wipes. They will help eliminate the remains of feces.
- Take tablets that help reduce the intensity of gas and stool odors. They can be purchased at a pharmacy without a doctor's prescription.
- Carry out the treatment prescribed by the doctor.
Fecal incontinence can lead not only to health problems, but also to social problems. When the first signs of uncontrollable fecal output occur, you should seek help from a specialist and determine the cause of the disease.
