Fecal Incontinence

Fecal incontinence is the leakage of liquid or solid stool. It is a common problem, which affects about 6% of women younger than 40 years and 15% of older women. Prevalence among men ranges from 6-10% and also increases with age.

The causes of fecal incontinence include anal sphincter muscle damage, usually due to childbirth, anorectal surgery, spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, chronic diarrhea and rectal prolapse. Counter intuitively severe constipation can also lead to fecal incontinence. This is caused by an overflow of liquid stool around hard impacted stool in the rectum resulting in leakage.

A majority of patients have mild to moderate symptoms and about 5% will have severe symptoms. Independent risk factors for both men and women are increasing age, loose watery stools and presence of urinary incontinence.

Assessment begins with a detailed history of the problem and a physical examination to determine the integrity of the anal sphincter muscles. The integrity of the anal sphincter muscle and the nerves that supply it is evaluated by performing a transanal ultrasound, anal manometry and electromyography. The patient is also asked to maintain a stool frequency chart that will help in objectively quantifying the problem.

The management of fecal incontinence depends on the severity of the problem , presence of co-morbid conditions and the patient's age. Medical management is geared towards the goal of having a firm bowel movement either once a day or once every other day. This is achieved by increasing fiber intake and taking medication to slow the bowels down. Biofeedback can be tried in patients with mild to moderate fecal incontinence.

Injecting non-absorbable materials (Solesta®)beneath the lining of the lower rectum, placing an inflatable silicone ballon into the rectum, Procon2® can be an option in some patients. SECCA® procedure - uses radiofrequency energy to create cuts beneath the lining of the anal opening, has also been used with varying degrees of success.

Patients with gross sphincter defects should undergo surgical repair. Those who fail to respond to sphincteroplasty and those with no anatomical defects have the option of either sacral nerve stimulation or other advanced procedures like the artificial anal sphincter. Stoma formation should be reserved for patients who do not respond to any of the above procedures.

Read more about fecal incontinence at the American Society of Colon & Rectal Surgeons website.