Have you been noticing that your undergarments are stained with stools when you use the toilet? Or have you been using a pad or a panty liner since a few months due to leakage of stools?

Have you been suffering from this problem in silence since long?
You may be suffering from bowel incontinence, also called as fecal incontinence.

In simple terms, bowel incontinence is leakage of stools. The condition can vary in severity: at one end, some patients complain of leakage of stools when they pass gas and at the other end are patients who have complete loss of bowel control.

How common is bowel incontinence?

Please know that you are not alone! More than 2% of the US population suffersfrom the problem according to most research studies. Though valid Indian data is not available, it is unlikely that the prevalence is any different.
Though it can affect both men and women, women have a higher prevalence (almost 8%) because childbirth can lead to damage of anal and pelvic floor muscles and nerves. Unfortunately, the problem can afflict younger women too, though the prevalence does increase with age.

What causes bowel incontinence?

Bowel movement is complex. It involves coordinated activity of the lower gut (the large intestine, rectum and anal canal) and the muscles surrounding the anus (anal sphincter muscles) under the guidance of signals from the nervous system (brain and spinal cord). The amount and consistency of the stools also impacts defecation.

Even a slight problem with any of these components can lead to bowel incontinence. Also more than one of these components can be affected simultaneously.

The causes of bowel incontinence include:

  • Muscle and nerve injury during childbirth: Childbirth is one of the most important causes of bowel incontinence.Stretching associated with vaginal delivery can damage the muscles around the rectum and anal canal, especially the anal sphincter muscles. Almost 40% of women suffer from some sort of anal sphincter muscle injury due to vaginal birth. Vaginal delivery can also damage the nerves supplying the anal sphincter muscles leading to decreased sensation and muscle strength.
    Patients who have undergone an episiotomy or have had a forceps delivery are more likely to suffer such injury. Fortunately, nerve injury related to vaginal delivery can improve within one to two years after childbirth.
  • Nerve damage due to other reasons: In addition to childbirth, nerve damage can be caused by diseases such as diabetes and stroke or by spinal cord injury.

Anal surgery for conditions such as hemorrhoids, fissures or fistulas can involve intentional cutting of the anal sphincter muscles as a part of the surgery.

Improper diet: A diet low in fiber can lead to reduced bulk of the stools leading to stool leakage

Conditions associated with chronic or recurrent diarrhea: It is difficult for the rectum to hold liquid stools. Also the increased urgency to go in diarrhea can be associated with stool leakage. Conditions that cause recurring diarrhea include Crohn’s disease, irritable bowel syndrome and ulcerative colitis.

  • Constipation: Chronic constipation can be associated withhard stools that can get stuck in the rectum causing what is known as fecal impaction. Fecal impaction can lead to stretching of the rectal muscles damaging them. Also watery stools can leak around the impacted stool. This problem is more prevalent in the elderly and frail.
  • Fistula: A fistula is an abnormal communication between the anal canal and the vagina. Vaginal delivery or surgery can cause tissue injury leading to development of a fistula through which stools can leak. Radiation therapy and conditions such as diverticulitis are also associated with the development of fistula.
  • Rectocele and rectal prolapse: Rectocele is the dropping of the rectum into the vagina. It can result in difficulty in completely evacuating stool leading to seepage of liquid stools. The rectum can also slide out through the anal opening leading to distortion of the anal opening, damage of the sphincter muscles and bowel leakage.
  • Hemorrhoids caused by enlarged blood vessels near the anal openingcan make it difficult to defecate, leading to seepage of bowel contents.
  • Medications such as certain antibiotics or gabapentin can make bowel movements slow
  • Conditions that impair mental function such as stroke or dementia can lead to confusion and inadvertent soiling of the undergarments
  • Radiation therapy or chemotherapy for cancer can cause tissue damage leading to reduced strength of the lower bowel muscles
  • Certain diseases that affect soft tissue of the body like scleroderma

What is the treatment plan?

The good news is that most people can be cured or significantly improved with treatment. The treatment depends on the cause and may sometimes require just diet modification. However, often you may need a combination of pelvic floor exercises, biofeedback therapy, medication and sometimes even surgery. The various treatment options are:

  • Diet modification: Increase in fiber in the diet or replacement of the food responsible for your condition may sometimes be all that is necessary
  • Medications: Sometimes taking medication to change the consistency of stool from liquid or loose form to solid may help. Fiber supplements like Citrucel or Metamucil can be used to improve stool consistency. Reduction of frequency of bowel movements with the use of anti-diarrheal medications may also help.
  • Pelvic floor exercises: Kegel exercises may help to strengthen the muscles that control defecation
  • Biofeedback: A probe is inserted into the anus that measures pressure and a sensing electrode is placed on the abdomen. Both devices are attached to a computer display which tells the patient whether she is using the proper muscles to control bowel movement. Biofeedback thus helps to isolate the right muscles and helps to improve their strength and coordination.
  • Sacral nerve stimulation: The nerves that governed bowel and bladder function are controlled by the implantation of a special generator and nerve stimulator near the nerves through the patient’s back.
  • Surgery: When all other alternatives fail, then surgery may be the only option.Patients who have experienced anal muscle injuries during childbirth may especially require surgery.
    For example, if there is a defect in the anal sphincter muscles, sphincteroplasty can be performed in which the two ends of the damaged muscle are joined together in an overlapping manner.

There are other treatment options that have been introduced in recent years: for example, injection of materials into the anal sphincter to increase its bulk. Also, an artificial bowel sphincter has been introduced that may be an option if all other options fail to improve symptoms.

We recognize that bowel incontinence is an embarrassing and disruptive condition. We have the solutions for you and will help you get back control of your life.

UPHI’s Colorectal Centre of Excellence for Motility Disorders boasts of an internationally trained multidisciplinary team, advanced diagnostics and the latest in treatment programs including a comprehensive physiotherapy program, all under one roof.

At UPHI, you always come first!

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