Bowel incontinence is the unintentional loss of stool or gas. It is often caused due to the failure of one or more of the components which allow the body to control the evacuation of the stool when it is socially appropriate. It is the inability to control the bowel movement and is one of the most common problems for adults. Though it is not a serious medical problem, it can fatally create a problem in daily life. Bowel incontinence is also known as fecal incontinence. A normal bowel movement requires a composite communication and reaction system between the nerves and muscles of the rectum and anus. The structure of this area is complicated. A rectum is a place where the stool is held. Two sphincters or circular muscles divide the rectum from the anus and control when the anus should consent to a bowel movement. The internal anal sphincter (IAS) is under spontaneous control of the body’s nervous system, while the external anal sphincter (EAS) can be rigorously controlled by the individual. The puborectalis muscle tugs at the intersection of the rectum and anus, which creates a 90-degree angle and makes it harder for stool to move reluctantly into the anus. When the rectum is filled and the IAS relaxes just a little for the normal bowel movement to occur. Cells in the anus can detect feces or flatus and if the brain says that it is a favorable social time to pass gas or have a bowel movement, then the puborectalis muscle relaxes and straightens the path from the rectum to the anus. Squatting or sitting helps in increasing the pressure in the abdomen, and the muscles that surround the rectum squeezes its contents. The EAS relaxes and a bowel movement occurs. If it is not a favorable time to release the bowel, the puborectalis muscle contracts, also the EAS contracts. The rectum relaxes and stool is enforced back to the upper part of the rectum, which causes the urge to have a bowel movement is temporarily quieted.
Causes of bowel incontinence
Bowel incontinence occurs due to the primary disease or illness. There are several possible causes of bowel incontinence. Many patients have more than one reason which causes the loss of bowel control.Damage to the muscles and nerves may occur straightly at the moment of vaginal childbirth or after anal or rectal surgery. Neurologic diseases like multiple sclerosis, spina bifida, stroke and spinal cord injury can be the probable causes of bowel incontinence. Complications of high blood sugar can also cause minor nerve damage which may lead to incontinence.
Patients who have inflammatory bowel disease and irritable bowel disease may build up bowel incontinence. Stool leakage is different than bowel incontinence. Minor staining can occur in those people who have hemorrhoids, poor hygiene, rectal prolapse and rectal fistula. Chronic diarrhea, laxative abuse, and parasite infections are the other causes of fecal incontinence. A person who has chronic constipation may have a problem with overflow incontinence or paradoxical diarrhea. In paradoxical diarrhea, the rectum gets filled by the stool, hardens and becomes impacted. Liquid stool begins to leaks around the fecal mass which imitates the incontinence.
Symptoms of bowel incontinence
Accidental stool leakage usually only affects adults when they have severe diarrhea. Chronic bowel incontinence can engage regular or occasional accidental leakage. An inability to hold in gas, silent leakage of stool during daily activities or physical exertion, or not being able to reach the bathroom in time.
There are Two types of bowel incontinence and they are:
- Urge bowel incontinence is when the person has an unexpected urge to use the bathroom but is not able to get there in time.
- Passive soiling is where not anything indicates that a bowel movement is about to occur.
There is the type of stools that are passed during bowel incontinence which can vary:
- The person passes gas and passes a small piece of stool.
- Stools may be in the liquid.
- Stools may be solid.
Episodes may be occurred daily, weekly, or monthly.
Other signs and symptoms which may include:
- Abdominal cramping or pain
- Urinary incontinence
- Flatulence, bloating or both can occur.
- Diarrhea or constipation.
- The anus is itchy or irritated.
Bowel incontinence can be a comparatively small problem which may result in the occasional soiling of underwear. The total lack of bowel control can be devastating.
Diagnosis of bowel incontinence
Taking a history of a person is very important and the medical professional will spend time learning about how frequent loss of bowel control occurs, in what situations and whether it is solid, liquid, or gas. Past medical and surgical history is quite important, above all obstetric history or surgery of the anus, as well as hemorrhoids. It could be a few years before the complication of a surgery or childbirth leads to bowel incontinence. Dietary habits and medications (as well as over-the-counter medications and laxative) will also be well thought-out and evaluated.A physical examination is likely to include a rectal examination to charge sphincter tone. In females, a pelvic test will also be performed. While blood tests are not usually required to make the diagnosis, but the other tests will be quite a lot helpful in deciding the potential cause of bowel incontinence. Anal manometry measures the pressure inside the rectum, both at rest and when the patient squeezes the anal sphincter. Nerve and muscle transmission studies may be considered. Ultrasound can estimate the anal sphincters and look for the muscle damage.
Treatment of bowel incontinence
Bowel incontinence can be treated in various ways and some of them are listed below:
- Medications: There are several medicines that the medical offices recommend which helps to reduce the bowel movements. Imodium, Hyoscyamine, and Lomotil are the names of the medicines that are helpful during bowel incontinence.
- Changes in diet: Bringing changes in diet can help in relieving the bowel incontinence. Drinking fluids frequently and consuming fiber-rich foods more than usual will help in reducing bowel incontinence which is caused due to constipation. High fiber foods help the people with chronic diarrhea, as it adds bulk to the stools.
- Bowel training: A bowel training program is very effective to the patients who have poor sphincter control or low awareness of the urge to defecate.
This may involve:
- Exercises that help to restore the strength of vital muscles for bowel control.
- Learning to use the bathroom at certain times of the day, for example after a meal.
Pelvic floor muscle training or Kegel exercises involve those exercises which help to strengthen muscles that have been weakened during labor. Women are advised to do the exercises few times a day during pregnancy and also after childbirth for about two months.
- Biofeedback: It is another type of bowel training. In this training, a pressure sensing probe is inserted into the anus. The patient will be able to get an idea of the patterns of their muscle activity when the muscles of the anal sphincter contract around the probe each time and the device senses it. By viewing their strength and response on a screen, by practicing muscle contractions, the patient will be able to learn how to strengthen those muscles.
- Surgery: Surgery is the last option for the treatment. It is conducted only if the treatments do not work. The surgery, which is done to repair a damaged or weakened anal sphincter is known as sphincteroplasty. In this surgery, the surgeon removes the damaged muscles and overlaps the muscle edges. This surgery provides extra support to the muscles and tightens the sphincter. Prolapsed rectum surgery will be done if other treatments do not work.
Prevention of bowel incontinence
There are several ways to prevent bowel incontinence.
- Avoiding constipation: doing regular exercise, eating fiber-rich foods and drinking plenty of water.
- Avoid straining when defecating, it can weaken the anal sphincter muscles.
- Seek treatment for diarrhea.