Faecal incontinence information

Faecal incontinence is a devastating condition that is estimated to affect approximately 2% of the population. Women are affected more often than men, and the prevalence increases with age. Faecal incontinence causes shame and embarrassment among those who experience it, and sufferers may be reluctant to tell their doctor that the problem is occurring.

Faecal incontinence is a symptom and not a disease; therefore it is important for people who experience faecal incontinence to see their physician. There are several tests that a physician may order to diagnose fecal incontinence and, once diagnosed, several treatments that may be helpful. The following article will provide a brief overview of tests that may be done and options for treatment.

Tests for Faecal Incontinence

Testing for faecal incontinence will most likely start with a physical exam to ensure there is no obvious cause for the problem. Also included in the physical exam is a digital rectal exam, in which the physician inserts a gloved finger into the patient’s rectum to check for any tears, bleeding, or signs of infection. By performing a rectal exam, the physician can also check rectal tone, as decreased rectal tone may be a symptom of nerve damage to the area. Other tests performed depend on the patient’s symptoms and history, and may include any of the following:

• Anal Manometry- This test involves the insertion of a small balloon on the end of a tube into the patient’s anus and/or rectum. This test can provide information on the strength of the anal sphincter as well as test for function and sensitivity.
• Proctosigmoidoscopy- In this procedure, a small tube with a tiny camera is inserted into the rectum and the first one to two feet of intestine, called the sigmoid colon. With the aid of the camera, inflammation, tumors, and infection can be seen.
• Proctography- This test is simply an x-ray taken of the rectum after barium has been used to coat the rectum. Barium makes it easier to study the capacity (size and contour) of the rectum.
• Anorectal Ultrasonography- An ultrasound study of the anus and rectum is performed after insertion of a small transducer, or wand.
• Pelvic MRI (Magnetic Resonance Imaging)- Scans of the pelvis are taken, which will detect any abnormalities of the pelvic floor muscles and also if the muscles move in proper fashion. The scans will also detect abnormalities of the anal sphincter.
• Anal Electromyography- This test involves checking the muscles located around the anus to determine if they have proper nerve function.
• Defography- This test involves the use of x-rays to observe what happens in the rectum as it empties, to ensure proper shape and position

Medical Treatment Options for Faecal Incontinence

Treatment options for faecal incontinence may include adjustment of diet, medications, and bowel training, including biofeedback. The patient may be sent to a physician who specializes in gastroenterology, or to a proctologist who specializes in conditions of the anus and rectum.

Diet - Changes in the patient’s diet may help to control or eliminate fecal incontinence. Functional faecal incontinence is incontinence in the absence of any disease process. The problem may be caused by either diarrhea or constipation. Diarrhea may cause faecal incontinence when stools are too loose and the patient is unable to get to a bathroom in time. Control of diarrhea may be achieved with dietary changes, including eating diets that are high in fiber. Fiber can help by adding bulk to the stools and making them less watery. Conversely, if the problem is constipation, adding fiber to the diet will also help to avoid constipation. The patient should also increase fluid intake.

Medications - There are many medications that may be prescribed to help with faecal incontinence. If constipation is contributing to faecal incontinence, medications such as stool softeners and laxatives may be prescribed. It is important to note that patients should not take laxatives on a regular basis without consulting their physician, as frequent use of laxatives may lead to dependence on them to maintain bowel function.

For diarrhea leading to faecal incontinence, physicians may prescribe different drugs to control diarrhea. Some drugs act by slowing bowel motility (the time it takes for stool to transit the bowel. Other drugs that may be used to treat faecal incontinence may include anti-diarrheal medications and medications that decrease the water content of the stool.

Bowel Training - Bowel training for faecal incontinence involves the patient going to the bathroom at prescribed times; for example, after a meal. This helps the patient establish predictability over when the toilet is needed. This technique may be helpful for patients who have faecal incontinence due to loss of anal sphincter control or loss of awareness of the need to have a bowel movement.

Biofeedback can also be helpful for some patients. It involves insertion of a small, pressure-sensitive probe into the anus. Patients can practice anal sphincter control by squeezing the anal muscles around the probe, which gives a digital read-out. This helps the patient learn how to isolate these muscles and strengthens them, leading to better control of the anal sphincter.

Faecal incontinence is a devastating condition that millions of people worldwide live with. However, patients need to know that there are treatment options available to help them. Getting treatment for the problem of fecal incontinence may involve undergoing tests to help determine the cause of the problem. Treatment options include dietary changes to help with diarrhea or constipation, if either of these issues is contributing to the problem. Medications to treat faecal incontinence are aimed at controlling diarrhea or constipation. Bowel training and biofeedback are two methods patients may be taught. With the help of some of the treatments discussed, patients may find that they can control faecal incontinence.

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