What is Fecal Incontinence?
Overview
Bowel (or fecal) incontinence is the inability to delay or prevent the passage of waste materials, called feces or "stool", from the body. When one feels the urge to have a bowel movement, one may not be able to control it in a timely manner. In some instances, stool may leak from the rectum unexpectedly.
Fecal incontinence is much more common than people realize. Unlike many medical conditions, it is not something that most people find easy to mention to their family, friends or physicians. It is estimated that nearly 6.5 million Americans have fecal incontinence. It affects people of all ages — children as well as adults. Fecal incontinence is more common in women than in men and more common in older adults than in younger ones. It is not, however, a normal part of aging.
Disruption on a Way of Life
Fear, anger, embarrassment and loneliness are a result of the condition. Managing the emotional side effects is vital. Being "forearmed" can alleviate anxieties and afford you the peace of mind to go to work, out to play, and enjoy your relationships.
Causes
There are numerous causes of incontinence including trauma while giving birth, inflammatory bowel disease, complication from diabetes, multiple sclerosis, Parkinson’s disease, irritable bowel syndrome and spinal chord injuries.
Traditional Treatments
Here are some examples of treatments doctors have been using:
Biofeedback
There are various forms of biofeedback involving the patient in his or her own treatment. The process typically involves retraining various neuromuscular pathways. One positive outcome can be the voluntary scheduling of bowel movements.
Biofeedback depends on the cause of fecal incontinence, how severe the muscle damage is, and ability to do the exercises.
Surgery
“Surgery may be an option for people whose fecal incontinence is caused by injury to the pelvic floor, anal canal, or anal sphincter. Various procedures can be performed, from the relatively simple like repairing damaged areas, to complex ones like attaching an artificial anal sphincter or replacing anal muscle with muscle from the leg or forearm.“
Colostomy is a relatively extreme surgical alternative for individuals with severe fecal incontinence unresponsive to other treatments. The lower portion of the bowel is removed while the remaining segment is reattached, typically, to a surgically formed opening in the abdominal wall. Feces are then collected in an external pouch.
Sports and Exercise
Exercise improves bowel habits in most people. If you lead a sedentary lifestyle (long drives to work, a 9-to-5 desk job) try to take a walk at least once a day.
Dietary Information
Consistency of the stool and how quickly it passes through the digestive system is often determined by the food we eat. Avoiding foods that contribute to the problem of diarrhea, for instance, will help in the management of bowel incontinence.
What New Options Do I have if Traditional Treatments or Surgery Do Not Work for Me?
Fecal incontinence is a disabling problem and a distressing condition that can be responsible for progressive social isolation. Many patients experience a significant improvement of their symptoms with either conservative medical treatment or surgery. Nevertheless, there remains a “considerable number of patients in whom medical therapy has failed and/or surgical treatment has either failed or is inappropriate due to the patients' poor general medical condition or personal choice. Consequently, these patients are condemned to living with their embarrassing symptoms.”
“To date, biofeedback has been the only non-surgical option for these patients. However, the success rate is variable and may not be beneficial in patients with isolated deficiency in the internal anal sphincter function.”
Hanauer. S (2006). Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflammatory Bowel Disease http://www.pelvicfloordigest.org/2005/basic_sciences_miscellaneous_coloproctology_last.html
Gastroenterology & Nutritional Medical Service (2008) http://www.drbhandari.com/Patient_Education/Fecal_Incontinence.htm
ProCon2 (2009) http://procon2.com/
Giamundo, P. , et al. (2002) The Procon incontinence device: a new nonsurgical approach to preventing episodes of fecal incontinence. American Journal of Gastroenterology. http://www3.interscience.wiley.com/journal/118937794/abstract?CRETRY=1&SRETRY=0
Ibid.
New Treatments
There are many available treatments options today, with further research underway. Medical therapies include surgery, nerve stimulation and biofeedback, which can help strengthen pelvic floor muscles and the anal sphincter.
Artificial Sphincter
An artificial sphincter implant can be an effective treatment option. New treatments and medical devices have been developed recently for patients in whom traditional treatments or surgery does not work.
Injectable Bulking Agents
Bulking agents have provided only sporadic relief even though they have been in use for decades. Increasing competition from alternative therapies plus a lack of standardization for the injection of bulking agents will limit the use of this modality in the future.
Bowel Incontinence Silicone Catheters
“Bowel incontinence catheters provide a physical barrier that contains the unscheduled passage of feces. PRO-CON a new, experimental device has recently been evaluated. Based on the pilot study, the majority of the 10 patients in whom PRO-CON was initially used were successful in preventing fecal accidents. The device consists of a disposable 70 cm long, 4.3 mm internal diameter, 6.7 mm outer diameter, double lumen, biochemically inert, pliable, cuffed, rubber catheter. However, the original product PRO-CON had a monitor-beeper alarm which complicated its use.”
Based on feedback from the study performed by P. Giamundo and S.D. Wexner, the device manufacturer decided to simplify the product eliminating the alarm part of the system and concentrated on making the product a simple mechanical barrier. As Giamundo-Wexner write on their article, “The mechanical barrier component, can not be underestimated; even when patients voluntarily turned off the alarm, with the catheter still in position, very few experienced episodes of fecal accidents or major leakage.”
International Foundation for Functional Gastrointestinal Disorders (IFFGD) (2008). http://www.aboutincontinence.org/. Incontinence interview with Nancy Norton. http://www.oprah.com/article/oprahandfriends/moz/moz_20070625
Vaizey, C. (2005) Injectable bulking agents for treating faecal incontinence. British Journal of Surgery. http://www.bjs.co.uk/bjsCda/cda/microJournalArticleDetail.do;?DOI=10.1002%2Fbjs.4997&issueDOI=10.1002%2Fbjs.v92%3A5&vid=2
Giamundo, P. , et al. (2002) The Procon incontinence device: a new nonsurgical approach to preventing episodes of fecal incontinence. American Journal of Gastroenterology. http://www3.interscience.wiley.com/journal/118937794/abstract?CRETRY=1&SRETRY=0
Ibid.
Normal Bowel Function
Bowel control is a complex process, involving the co-ordination of many different nerves and muscles.
Digestion begins with enzymes from saliva mixing with food during the process of chewing. From the mouth, food passes through the esophagus to the stomach where additional enzymes and acids continue the digestive process.
From the stomach, food is passed through the small intestine’s three segments where water and nutrients are absorbed. Digested food enters the large intestine at the end of the ileum (the third segment of the small intestine after the duodenum and jejunum).
The large intestine begins at this juncture (referred to as the cecum). Further water absorption occurs in the large intestine, preparing the remnants of digestion for evacuation from the body. This waste passes through the ascending, transverse, and descending portions of the large intestine (also called the colon) before entering the rectum (or rectal vault).
The final stage is the passage of the remaining waste through the involuntary internal and voluntary external sphincters of the anus. All in all, the intestine is a very long tube (about 20 feet) folded in the abdomen.
There is a very wide range of "normal" bowel function among people. In terms of frequency, it is not essential to have one bowel movement per day. Some people always go several times per day; others have several days in between bowel movements. Food usually takes an average of 1-3 days to be processed and up to 90% of that time is spent in the colon.