Fecal incontinence

Fecal incontinence is also called as fecal incontinence, bowel incontinence, is a lack of control over defecation, leading to involuntary loss of bowel contents-including flatus, liquid stool elements and mucus or solid feces.Fecal incontinence is also called a bowel control problem is the accidental passing of solid or liquid stool or mucus from the rectum.

Age/sex prevalence of Fecal incontinence

Females are more likely to develop fecal incontinence than males.
Fecal incontinence affects people of all ages but is more common in older adults.

Races affected by Fecal incontinence

Individuals of any race can be affected by fecal incontinence.

Causes of Fecal incontinence

Risk factors for fecal incontinence are as follows:-
• Age
• Female gender
• Urinary incontinence
• History of vaginal delivery
• Obesity
• Prior anorectal surgery
• Poor general health

Following are the causes of fecal incontinence:-
Muscle damage: Injury to the muscles at the end of rectum that is anal sphincter will make difficult for rectum to hold stool back properly.

Nerve damage: Injury to nerves that help to sense stool in the rectum or those that control the anal sphincter can lead to fecal incontinence. The damage to the nerve can be caused by childbirth, constant straining during bowel movements, spinal cord injury or stroke. Some diseases such as diabetes and multiple sclerosis also affect these nerves and cause damage that leads to fecal incontinence.

Constipation:
Chronic constipation lead to mass of dry, hard stool in the rectum that is too large to pass.

Radiation:
Radiation can cause damage to rectum in cases of treatment of prostate cancer.

Cognitive impairment:
Cognitive impairment after a stroke or in advanced alzheimer’s disease.

Inflammatory bowel disease:
This disease can also lead to inflammatory injury to rectum.

Surgeries of rectum in colorectal cancer:
Surgeries involving rectum leads to scarring of the rectum which may result in the walls of the rectum becoming stiff and inelastic, reducing compliance.

Fecal incontinence sign and symptoms

Bowel incontinence refers to the inability to control the passage of small amount of stool.

Investigations of Fecal incontinence

Physical examination helps a doctor to check the strength of the anal sphincter muscle.

Other tests to be done are as follows:-
• Stool testing
• Endoscopy
• Anorectal manometry
• Endosonography
• Nerve tests
• MRI defecography

Treatment for Fecal incontinence

Bowel incontinence is usually treatable. In many cases it can be cured completely.
Recommended treatments vary according to the cause of bowel incontinence.Often, more than one treatment method may be required to control symptoms.
Nonsurgical treatments are often recommended as initial treatment for bowel incontinence. These include:-
• Diet.
These steps may be helpful:-
Eat 20 to 30 grams of fiber per day. This can make stool more bulky and easier to control.
Avoid caffeine. This may help prevent diarrhea.
Drink several glasses of water each day. This can prevent constipation.

• Medications.
Try these medicines to reduce the number of bowel movements and the urge to move the bowels:
Lomotil
Hyoscyamine
Methylcellulose can help make liquid stool more solid and easier to control. For people with a specific cause of diarrhea, such as inflammatory bowel syndrome, other medications may also help.

• Exercises.
Begin a program of regularly contracting the muscles used to control urinary flow (Kegel exercises). This builds strength in the pelvic muscles and may help reduce bowel incontinence.

• Bowel training.
Schedule bowel movements at the same times each day. This can help prevent accidents in between.

• Biofeedback.
A sensor is placed inside the anus and on the abdominal wall. This provides feedback as a person does exercises to improve bowel control.
Surgery may be recommended for people whose bowel incontinence is not helped by noninvasive treatments. The types of surgery include:

• Sphincter surgery.
A surgeon can stitch the anal muscles more tightly together (sphincteroplasty). Or the surgeon takes muscle from the pelvis or buttock to support the weak anal muscles (muscle transposition). These surgeries can cure many people with bowel incontinence that’s due to a tear of the anal sphincter muscles.

• Sacral nerve stimulator.
A surgeon implants a device that stimulates the pelvic nerves. This procedure may be most effective in people with bowel incontinence due to nerve damage.

• Sphincter cuff device.
A surgeon can implant an inflatable cuff that surrounds the anal sphincter. A person deflates the cuff during bowel movements and reinflates it to prevent bowel incontinence.

• Colostomy.
Surgery to redirect the colon through an opening created in the skin of the belly. Colostomy is only considered when bowel incontinence persists despite all other treatments.
Newer, nonsurgical procedures are also available to treat bowel incontinence, such as:

• Radiofrequency anal sphincter remodeling.
A probe inserted into the anus directs controlled amounts of heat energy into the anal wall. Radiofrequency remodeling creates a mild injury to the sphincter muscles, which become thicker as they heal.

•Injectable biomaterials.
Materials such as silicone, collagen, or dextranomer/hyaluronic acid can be injected into the anal sphincter to boost its thickness and function.
These minimally invasive procedures can reduce bowel incontinence in some people, without the risks of surgery. Because they are relatively new, their long-term effectiveness and safety aren’t as well known as other treatments

Complications of Fecal incontinence

• Emotional distress
• Skin irritation

Differential diagnosis of Fecal incontinence

Fecal incontinence may present with signs similar to rectal discharge
• Fistulae
• Proctitis
• Rectal prolapsed
• Pseudoincontinence
• Encopresis
• Irritable bowel syndrome

Homeopathic treatment for Fecal incontinence

Belladonna
• Very well indicated medicine for prolapsed anus.
• Helps to treat the complaint of involuntary stools.
• The stools are thin, green, and dysenteric in lumps like chalk.
• Shuddering during stool.
• Stinging pain in rectum, spasmodic stricture.

Causticum
• Patient passes stool easily when standing
• Rectum is insensible to solid stool
• Diarrhea from cold
• Anus prolapses on coughing
• Well indicated remedy for partial paralysis of rectum.

Phosphoric acid
• Well indicated medicine in children for involuntary passage of stool with escape of flatus, when moved.
• Stool has no odor
• Also act well for complaint of painless diarrhea with much flatus.
• Diarrhea in weakly, delicate children with rickets.
• Stools are profuse, painless, dirty white, watery but with little debility.

Gelsemium
• Well indicated medicine for painless and involuntary stool.
• Involuntary stool complain due to paralysis of anal sphincter.
• Prolapse or rectal pains after labor
• Also help to treat cases in which painless diarrhea occur after sudden emotions as grief, bad news, anticipation of an unusual ordeal.

Hyoscyamus niger
• Stools involuntary bloody, yellow, watery or although hard.
• Stools are worst after mental excitement during sleep, fevers and while urinating.
• Very well acted remedy for diarrhea after childbirth.

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