Fecal incontinence

Diagnosis

The healthcare provider will conduct physical examination and history taking about the condition. A visual examination of the anus is frequently recommended. To evaluate for nerve injury in this location, a device may be utilized. There are several tests available to properly determine the cause of fecal incontinence:

• Digital rectal examination: The purpose of this technique is to assess the strength of the sphincter muscle and look for any abnormalities in the rectal region. Patient is advice to bear down while the exam is being performed. Rectal prolapse will also be examined during this operation.
• Magnetic resonance imaging (MRI): To evaluate whether the muscles are still intact, an MRI can produce detailed images of the sphincter. Additionally, defecography can deliver visuals while defecating.
• Anorectal ultrasonography: Healthcare provider will examine the structure of the sphincter using this test. The device will be inserted to evaluate the rectum and anus and give out detailed imaging.
• Anal manometry. Using a narrow and flexible tube, it will be inserted to the rectum and anus. The tip of the tube has a small balloon that can be inflated. This test helps to determine the anal sphincter’s degree of tightness as well as the rectum’s sensitivity and functionality.
• Colonoscopy: This procedure uses a flexible tube attached to a small camera and inserted into the rectum to visualize the entire colon.
• Balloon expulsion test: A water-filled small balloon is inserted into the rectum. Patient will be advice to go to the restroom and push out the balloon. Patients who have defecation disorder will take more than one to three minutes.
• Proctography: The patient will use a specially designed toilet for defecation while an x-ray video image are taken. The test measures the rectum’s capacity to hold stool. It also assesses the body’s capacity to eliminate stool.
• Nerve test: The responsiveness of the nerves regulating the sphincter muscles is assessed. The tests could be able to identify nerve injury that may result in bowel incontinence.

Treatment

Surgery

Surgery may be necessary to address an underlying problem, such as rectal prolapse or sphincter injury brought on by delivery, in order to treat fecal incontinence. The choices consist of:

• Sphincteroplasty:  During childbirth, the anal sphincter may have been weakened or injured, which is fixed by this operation. By doing so, the sphincter will become tighter and the muscle will be strengthened. When a muscle is injured, healthcare provider will locate it and cut the edges free of the surrounding tissue. The muscles are reattached, and then edges are sewn in an overlapping pattern. For those attempting to avoid colostomy, sphincteroplasty can be an alternative.
• Colostomy: Through an abdominal incision, stool is diverted during this procedure. The stool is collected through the abdomen by attaching a special bag. Usually, a colostomy is only considered when other therapies have failed. This procedure is also known as bowel diversion.
• Sphincter cuff device: An air-filled cuff that encloses the anal sphincter can be implanted. To avoid bowel incontinence, the cuff is deflated during bowel motions and inflated again afterward.
• Surgical correction: Surgery to treat hemorrhoids, a rectocele, or rectal prolapse will probably lessen or resolve fecal incontinence.

Medications

The type of medication will depend on the underlying cause of fecal incontinence.

• Anti-diarrheal medication: Loperamide and those with atropine and diphenoxylate.
• Laxatives: If your incontinence is being brought on by chronic constipation, try methylcellulose and psyllium.

Other type of therapies

Healthcare provider might suggest an exercise regimen and other treatments to rebuild muscle strength if muscle injury is the cause of fecal incontinence. Anal sphincter control and awareness of the urge to defecate can both be improved by these treatments.

• Kegel exercises: Increase the pelvic floor muscles’ strength. These muscles provide support for the uterus, colon, and bladder in females. Contract the muscles and hold for 3 seconds then relax for another 3 seconds. Repeat the procedure for 10 times. Hold the contraction for a longer period of time as your muscles get stronger. Work your way up to three sets of 10 contractions per day.  Increasing the strength of these muscles might lessen incontinence.
• Radiofrequency therapy: The anal canal wall will receive a radiofrequency to help with muscle tone improvements. The minimally invasive radiofrequency therapy is typically carried out while the patient is sedated and under local anesthetic. This procedure is also known as Secca procedure.
• Biofeedback: Simple exercises that can strengthen the anal muscles are taught by physical therapists. The procedure could be done with anal manometry and rectal balloon. These workouts can improve the pelvic floor muscles, contract the muscles for bowel movement, and improve the senses for defecation.
• Vaginal balloon (Eclipse System): An intravaginal pump-style device. The pressure from the inflated balloon on the rectal area reduces the frequency of fecal incontinence.
• Bowel training: Patient is encouraged to have a routine bowel movement every day. Patient can exert more control by determining when they need to seek for the restroom.
• Bulking agents: The walls of the anus can be thickened by injections of non-absorbable bulking agents that could lessen the chances of leaks.
• Sacral Nerve Stimulator: The procedure uses a small device that stimulates the pelvic nerves. People with bowel incontinence caused by nerve injury may benefit from this procedure.
• Posterior tibial nerve stimulation: The ankle’s posterior tibial nerve is stimulated by this minimally invasive procedure.