Classification and severity levels | Fecal incontinence

Classification and severity levels

There are various systems for classifying the severity of fecal incontinence. In everyday clinical practice, however, the classification of fecal incontinence according to Parks is used above all. This system divides fecal incontinence into three degrees: Grade 1: This is the lightest form of bowel incontinence, which cannot be held back and goes uncontrolled. Grade 2: This is the medium-heavy form thin-liquid stools cannot be held back and come off uncontrollably. Grade 3: This is the heaviest formSelf-formed chair cannot be retained.

Diagnosis

The first and most important step in the diagnosis of fecal incontinence is a detailed doctor-patient consultation (anamnesis). In the course of this conversation, the patient should report his or her individual symptoms. During the anamnesis, the specialist also asks about important factors such as the frequency of bowel movements, the nature of the stool and the circumstances of involuntary bowel movements.Also the taking of medicines, possible previous illnesses and/or existing allergies should be discussed during the doctor-patient conversation.

This is followed by an inspection of the anal region. In the course of this, the attending physician pays attention to irritations, changes in the skin in the area of the anus, fissures, scars, hemorrhoids and fistulas. Afterwards, a so-called digital-rectal examination is performed in a left-sided position.

During this examination, the doctor evaluates both the anatomy and function of the external sphincter. Reduced occlusion can already be detected at this point of the diagnosis. In addition, manometric examinations such as the so-called pull-through nanometry or a measurement of the filling pressure values can be performed.

In many cases, proctoscopy and rectoscopy are also recommended. If the findings are unclear, the scope of diagnostic measures should be extended. The measurement of the pinching ability and holding time of the external sphincter muscle represents another possibility for the diagnosis of fecal incontinence.

In addition, the so-called electromyography of the muscles is considered to be a possibility of delimiting a nerve damage which is the cause of the incontinence. Injuries, damage in the area of the external sphincter muscle or the pelvic muscles can be excluded by an ultrasound examination. The preparation of simple x-rays of the rectum is rarely performed.

Much more frequently, the so-called colonic contrast enema (contrast medium examination of the colon) is used to diagnose fecal incontinence. All examinations for the diagnosis of fecal incontinence are usually completely painless. Nevertheless, most patients find the examination methods unpleasant or embarrassing.

The actual trigger plays a decisive role in the choice of the appropriate treatment for a patient with fecal incontinence. After extensive diagnosis and determination of the underlying disease, a treatment plan can be drawn up together with the affected patient. In case of inflammatory changes of the bowel and/or rectum, in most cases a drug therapy is initiated.

Tumors can be removed during surgery. If the cause of fecal incontinence is in the area of the mucous membranes or the intestinal wall, surgical ablation can be performed in these cases as well, thus eliminating the problem. The so-called “sacral nerve stimulation” represents a completely new treatment method for patients suffering from fecal incontinence.

Before sacral nerve stimulation was first used in patients with fecal incontinence, it was considered a miracle cure for years in the treatment of urinary incontinence. Basically, this procedure can be compared to the way a pacemaker works. During the performance of this treatment method, impulses from a pacemaker stimulate the nerve plexus in the area of the sacrum via small electrodes inserted by means of a puncture.

Through targeted stimulation, the external sphincter muscle can be stimulated to build up sufficient muscle strength again. In addition, the electrical stimulation also has an effect on the perception of intestinal contents and thus on the ability to hold. The sacral stimulation method is particularly suitable for the treatment of neurologically caused faecal incontinence.

Forms of incontinence caused by the lowering of the pelvic floor can be effectively treated by regular and targeted physiotherapy. Even the squeezing of the sphincter muscle several times a day can help to increase its holding power. The drug therapy of fecal incontinence aims to prevent unexpected bowel movements.

In this sense, laxatives in the form of suppositories or enemas can be used to empty the bowel at a specific time. Adapting the diet, for example enriching food with dietary fiber, has been shown to have a positive effect on the continence apparatus. Furthermore, mild forms of fecal incontinence can be treated by means of targeted toilet training.

With this method, the affected patient should learn to defecate at a certain time every day. In the initial phase of this stool training, the emptying of the bowels can be supported by laxative suppositories. As a rule, a suppository with bisacodyl (for example Dulcolax) is used within the first week.If the training is successful, you can then switch to the active ingredient glycerine (for example Glycilax).

After approximately two to three weeks of use of the suppositories, a complete discharge should be attempted. The bowel of the patient suffering from fecal incontinence should already have become accustomed to the regular “stool time” within this period. Most patients are helped during the training by keeping a so-called stool diary in which each bowel movement is recorded exactly.