Fecal incontinence

What is it?

Fecal incontinence is the involuntary or unintentional release of gases and feces.

This is a physically and psychologically disabling condition with a high social and medical impact, which can lead to a significant decrease in the quality of life. According to studies, the prevalence in the general population is 2-3%; however, these figures are surely underestimated, given the reluctance of patients to discuss this disorder with their doctors. Fecal incontinence is more common in women due to greater flabbiness of the pelvic and abdominal muscles, complicated by problems during childbirth, as well as in elderly patients.

Fecal incontinence is classified into: 

  • primary or idiopathic (5% of cases): when the cause is not established;
  • secondary (95% of cases) in relation to obstetric injuries, anorectal area operations, rectal prolapse, injuries, diabetes, neurological diseases, severe dementia.

In fact, at obstetric injuries, after anorectal surgical procedures or in the case of rectal prolapse, the phenomena of rupture, displacement or denervation of the anal sphincter apparatus may occur, which may lead to the inability to retain feces in the rectal ampoule.

Which are the symptoms?

Patients are unable to control or delay the urge to defecate. The disorder can present at various levels of severity, from modest leakage of stool to a total inability to control defecation. Abdominal bloating, flatulence, ulcers and anal itching may be associated. Other secondary symptoms may include infections of the skin, rectum and urinary tract, as well as stress related to the impact on social life. In addition, there is a correlation with urinary incontinence (20% of sufferers report fecal incontinence); in these cases, a multidisciplinary approach is necessary.

  • Involuntary leakage of gas and stools

How is it diagnosed?

Endoanal ultrasound is the gold standard for anatomical evaluation of the sphincter system (there is an intact sphincter or anatomical deficiency). In addition, anorectal manometry is usually used, which is a method of functional diagnostics that allows to identify defects in the function of the anal sphincter and possible changes in the distensivity/sensitivity of the rectal ampoule. In some cases, an MRI of the pelvis may be useful to expand the scope of the study to tissues located further from the anal canal. Neurophysiological methods of the second level are represented by anal electromyography and motor delay of the terminal portion of the pudendal nerve (PNTML) and are able to study the nerve and muscle components of the pelvic floor.

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How is it treated?

In general, patients with mild symptoms respond well to conservative treatment; constipation and antidiarrheal medications such as loperamide may be sufficient. Significant results may be achieved with the help of pelvic and perineal rehabilitation (biofeedback), which uses methods of re-education of the perineal muscles; the number of sessions varies, at that, additional auxiliary procedures need to be conducted. If these therapeutic techniques do not help, surgical intervention should be considered, using methods of sphincteroplasty or reconstruction of the anal sphincter, or sacral neuromodulation.

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