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| ICD-10 | R15. |
|---|---|
| ICD-9 | 787.6 |
Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected are often beset by feelings of shame and humiliation. Some refuse to seek medical help, and instead attempt to self-manage the problem. This can lead to social withdrawal and isolation, which can turn into cases of agoraphobia. Such effects may be reduced by undergoing prescribed treatment, taking prescribed medicine and making dietery changes.
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Fecal incontinence affects people of all ages. Fecal incontinence is more common in women than in men, and more in older adults than in younger adults. It is not, however, a normal part of aging.
Fecal incontinence can have several causes including one or a combination of the following:
Fecal incontinence is most often caused by injury to one or both of the ring-like muscles at the end of the rectum called the internal and external anal sphincters. During normal function, these sphincters help retain stool. When damaged, the operation of the muscles is compromised, and leaks may occur.
In women, the damage often happens during childbirth. The risk of injury is greatest when the birth attendant uses forceps to help the delivery or does an episiotomy. Hemorrhoid surgery can damage the sphincters as well. A pelvic tumor that grows in or becomes attached to the rectum or anus also can cause muscle damage, as can surgery to remove the tumor.
In both men and women, similar damage can result from engaging in anal sex.
Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that detect stool in the rectum. Damage to the nerves controlling the sphincter muscles will render the muscles unable to work effectively and incontinence may occur. If the sensory nerves are damaged, detection of stool in the rectum is disabled, and one will not feel the need to defecate until too late. Nerve damage can be caused by childbirth, long-term constipation, stroke, and diseases that cause nerve degeneration, such as diabetes and multiple sclerosis.
Normally, the rectum stretches to hold stool until it is voluntarily released. But rectal surgery, radiation treatment, and inflammatory bowel disease can cause scarring, which may result in the walls of the rectum becoming stiff and less elastic. The rectum walls are unable to stretch as much and are unable to accommodate as much stool, resulting in fecal incontinence. Inflammatory bowel disease also can make rectal walls very irritated and thereby unable to contain stool.
Diarrhea, or loose stool, is more difficult to control than solid stool that is formed. For people who are normally unaffected by fecal incontinence, this can manifest itself as a temporary form.
Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocele), and generalized weakness and sagging of the pelvic floor. Often the cause of pelvic floor dysfunction is childbirth, and incontinence does not show up until the midforties or later.[citation needed]
Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary as some forms of fecal incontinence can be rather complicated. Most physicians that specialize in gastroenterology, rehabilitative medicine, neurotrauma, and pediatric surgery have experience with bowel management programs. "Social continence" may be achievable for some people using a bowel management program that cleans out the colon daily.
There are several devices and medications available to combat fecal incontinence. One method of relatively easy treatment is the use of diapers. Both cloth and disposable diapers are available for fecal incontinence. Pull-up type diapers are not recommended for fecal incontinence. Thicker-type diapers are generally seen as the best method of treating fecal incontinence, as these diapers are thicker and have inner linings to help control fecal matter better.
Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, decreasing the water content of the feces and making it firmer. Also, avoid foods and/or drinks that contribute to the problem. They include foods and drinks containing caffeine, like coffee, tea, and chocolate, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly.
Individuals affected with fecal incontinence can make dietary adjustments to assist in management of the condition.
Medication consists primarily of antipropulsive drugs.
Surgical procedures used to treat otherwise intractable fecal incontinence include:
Graciloplasty and artificial anal sphincter both significantly improve continence, with artificial anal sphincter being superiorRuthmann O, Fischer A, Hopt UT, Schrag HJ (2006). "[Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence]" (in German). Chirurg 77 (10): 926–38. doi:10.1007/s00104-006-1217-0. PMID 16896900. , however both methods have high rates of complications.Ruthmann O, Fischer A, Hopt UT, Schrag HJ (2006). "[Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence]" (in German). Chirurg 77 (10): 926–38. doi:10.1007/s00104-006-1217-0. PMID 16896900. Belyaev O, Müller C, Uhl W (2006). "Neosphincter surgery for fecal incontinence: a critical and unbiased review of the relevant literature.". Surg. Today 36 (4): 295–303. doi:10.1007/s00595-005-3159-4. PMID 16554983.
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This article may require cleanup to meet Wikipedia\'s quality standards. Please improve this article if you can. (January 2008) |
Recently, electrical stimulation of sacral nerves has been used to treat fecal incontinence, mainly of neurogenic origin, in order to obtain a “modulation” effect on neural activities, by supplying additional electrical stimulation to both pelvic floor muscles, and sensitive neurological pathways. This therapeutic approach is referred to as Sacral Neuromodulation (SNM).
See: Sacral Neuromodulation in fecal incontinence. Full Journal article.
| Antidiarrheals, intestinal anti-inflammatory/anti-infective agents (A07) | |
|---|---|
| Intestinal anti-infectives | Antibiotics (Neomycin, Nystatin, Natamycin, Streptomycin, Polymyxin B, Paromomycin, Amphotericin B, Kanamycin, Vancomycin, Colistin, Rifaximin)
Sulfonamides (Phthalylsulfathiazole, Sulfaguanidine, Succinylsulfathiazole) other (Miconazole, Broxyquinoline, Acetarsol, Nifuroxazide, Nifurzide) |
| Intestinal adsorbents | Charcoal - Bismuth - Pectin - Kaolin - Crospovidone - Attapulgite - Diosmectite |
| Antipropulsives | Diphenoxylate - Opium - Loperamide - Difenoxin |
| Intestinal anti-inflammatory agents | corticosteroids acting locally (Prednisolone, Hydrocortisone, Prednisone, Betamethasone, Tixocortol, Budesonide, Beclometasone)
antiallergic agents, excluding corticosteroids (Cromoglicic acid) aminosalicylic acid and similar agents (Sulfasalazine, Mesalazine, Olsalazine, Balsalazide) |
| Antidiarrheal micro-organisms | Saccharomyces boulardii |
| Other antidiarrheals | Albumin tannate - Ceratonia - Racecadotril |
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