Fecal incontinence (synonyms: Defecation; anal incontinence; anal fecal incontinence; encopresis; incontinentia alvi; incontinentia faecalis; incontinence of the anal sphincter; incontinence of the sphincter ani; loss of control of the rectal sphincter; defecation; fecal smear; involuntary defecation; loss of control of the rectal sphincter; ICD-10 R15: Fecal incontinence) describes the involuntary discharge of liquid or solid stool. In contrast, anal incontinence describes the involuntary discharge of gas with or without stool.
The WHO defines fecal continence as the learned ability to “voluntarily expel stool in a place- and time-appropriate manner.”
Forms of fecal incontinence include:
- Anorectal incontinence: caused by pelvic floor insufficiency/pelvic floor weakness; sphincter defects/sphincter defects, often caused by birth trauma or previous surgical procedures; similar to stress urinary incontinence.
- Urge incontinence: typical here is the short “warning time” between defecation and the beginning of defecation (defecation); stool urge and defecation willfully suppress is lost
- Overflow incontinence: chronic constipation with stool overfilling (coprostasis) of the entire colon (large intestine) and rectum; due to the long residence time in the intestine, the stool can liquefy and feign diarrhea (“paradoxical diarrhea”); as a result, instead of a portioned bowel movement, there is a “fecal smearing”.
- Combination of the previously mentioned forms
Many different diseases can underlie fecal incontinence.
One can distinguish the forms of fecal incontinence causative:
- Inflammatory
- Functional: e.g., laxative abuse/abuse) – Overflow incontinence, i.e., accumulation of large amounts of stool in the rectum (rectum) that constantly exerts pressure on the sphincter (sphincter muscle), causing it to lose its resting tone. As a result, it dilates and is no longer able to contract.
- Impaired reservoir function: chronic inflammatory bowel disease (IBD), tumor surgery).
- Iatrogenic (as a result of medical intervention): e.g., after surgery or radiatio (radiotherapy).
- Muscular: pelvic floor insufficiency/pelvic floor weakness; sphincter defects/sphincter defects, often due to birth trauma or previous surgical intervention.
- Neurogenic (due to nerve damage): central/peripheral causes.
- Sensory (disorders of sensitivity): loss of anal sensation; e.g., due to surgery.
- Traumatic (due to injuries)
- Idiopathic (without apparent cause)
Furthermore, symptomatic fecal incontinence with an intact continence organ can be distinguished from fecal incontinence in the narrower sense with a disorder of the continence organ.
Fecal incontinence can be a symptom of many diseases (see under “Differential diagnoses”).
Sex ratio: males to females is 1: 4-5 Peak incidence: the peak incidence is beyond the age of 65. However, it can occur at any age! The prevalence of anal and fecal incontinence in Germany is 5-10%, up to 30% in hospitals and up to 70% in nursing homes.
Course and prognosis: Depends on the form of fecal incontinence.
