Fecal Incontinence -- More Common Than You Think!
by Marja Sprock, M.D.

Fecal incontinence is an embarrassing problem that few people would admit to. In fact it is estimated that only a third of patients suffering with the condition has discussed this with their physicians. It is a frequent, distressing problem with often a devastating impact on people’s lives. In epidemiologic studies it is estimated that at least 2% of us are bothered by fecal incontinence, likely since it is still quite taboo, the real number is much higher.

Severity of incontinence, reason for incontinence and treatment options are various. Several medical specialties treat different aspects of fecal incontinence. The primary care physician, gastroenterologist, colorectal surgeon and urogynecologist can all work together to attempt to eliminate or attenuate the problem.

There is a difference between fecal incontinence, involuntary loss of a bowel movement, or fecal soiling.

Soiling can be due to inadequate hygiene, prolapse of hemorrhoids and or rectum. In people with fecal incontinence, lack of hygiene is usually their last problem, since they are so aware of the smell and the chance of discovery of their debilitating problem. People usually carry new underwear or diapers and wipes anywhere. Often, like people with urinary urgency or overactive bladder, the sign to eliminate comes on quickly and they will have to run, cut in line and get on the toilet. Please do not comment on people cutting in line at the bathroom, they would love to be able to wait. Some people are not even that “lucky” and get caught by surprise.

In some people’s mind fecal incontinence happens in their grandmother and great aunt, however it may just as well be the problem of the college professor or student in the class or maybe your closest friend.

Some people have an urge to go and know when they are going to have a bowel movement, others are caught by surprise. In some people the problem occurs daily in others once a month. In general it is very difficult to hold liquid stool for a long time, remember your last diarrhea attack, and it often helps to attempt to make stool more solid with the help of medications and/or food. A colonoscopy, an exam of the colon with a small camera, is often indicated with incontinence due to diarrhea.

General health questions and diet questions (coffee use, fiber etc.) will be asked when you see a physician, in addition to questions about stool consistency, frequency and urgency, as well as an exam of the abdomen, anal, perineal (between vagina and rectum) and vaginal area. Diseases like diabetes mellitus, multiple sclerosis inflammatory bowel diseases, dementia, stroke, gallbladder removal, traumatic birth experiences, back problems can all have an impact. Fecal incontinence occurs often because of multiple reasons, often after the compensation mechanism of the broken part gives out. Some people have had radiation in the area for a different disease or have had a hemorrhoid removal or surgery on the anal sphincter.

Sensation in the area will also be checked, since nerve injury can have occurred with for example child birth or back injury. The main nerve providing innervation to the anorectum (anus and above) originates in the lower back and can also cause urinary problems.

Some of the problems may have originated with vaginal child birth, larger is definitely not always better, and the baby’s head being born looking up does not help either.

A cesarean section is also not totally protective, since many women first go through labor before this is performed. Also the problem with fecal incontinence may not show up for years.

The internal or external anal sphincter may not function well either or the muscles, squeeze pressure is very low.

Pelvic floor/support exercises, anal tightening, “Kegel exercises”, are all terms to strengthen the muscles in the lower gastro-intestinal/urogenital area and achieve more control. Training and biofeedback for fecal incontinence often takes more time investment than for urinary incontinence, however can give significant improvement.

A rectal sling, mimicking the course of one of the support muscles, is currently being tested. The material is similar to the vaginal meshes and being inserted in a less clean area than the vagina. It may take a couple of years before it will be used more and will not be without possible complications. Sometimes a large bulge of the rectum into the vagina or rectocele is cause for incomplete emptying and stool loss and can be surgically repaired.

Recently the FDA approved the Interstim device for fecal incontinence and has expanded the treatment options and chance of successful treatment significantly. The sacral nerves are involved in the sensation and passive and active muscle control of the anorectum. This has opened a whole new realistic treatment option for the patient with fecal incontinence and has been used successfully in Europe for several years. The Interstim is a device that is inserted to intermittently stimulate the sacral nerve and establish enhanced control. The insertion is minimally invasive, like a pacemaker, and a tester device can be inserted in the office.

Fecal incontinence, debilitating as it is can be improved or cured, depending on the cause. There is usually more than one reason for the incontinence and it often manifests when the compensation mechanism fails. Sometimes there is an underlying disease that contributes and cannot be cured.

Careful evaluation and indicated testing should be performed before therapy is started. If your stool loss is with liquid stool only, remember that it is difficult for anybody to hold the extreme urge and low consistency of liquid. Some people will benefit from diet changes, others from muscle training and surgery or nerve implantation devices may be the answer.

Fecal incontinence -- more common than you think!

Marja Sprock, MD is a fellowship trained urogynecologist under David Richardson, MD at Henry Ford Hospital in Detroit. Her practice, Central Florida UroGynecology, is in Rockledge, FL.

Please call for an appointment at 321-806-3929, send us a note or visit us online at www.CFUroGyn.com.