The causes of fecal incontinence are varied: improper diet, constipation, muscle weakness in old age or chronic diseases can be triggers for fecal incontinence. Therapeutic measures that can help against fecal incontinence include a change in diet and strengthening of the pelvic floor. In the following article, you will learn how to recognize fecal incontinence, what causes it and what promises relief if you are fecal incontinent.
What is fecal incontinence?
Fecal incontinence describes the inability to retain stool and digestive gases in the rectum until voluntary defecation occurs. Up to three percent of the German population is affected.
When is fecal incontinence referred to?
In general, we speak of fecal incontinence when intestinal gas or intestinal contents regularly escape involuntarily from the rectum and cannot be retained until the patient goes to the toilet. Fecal incontinence must be distinguished from defecation (encopresis). Enfecation describes – sometimes even voluntary – defecation of normal consistency in places that are not intended for it in the sociocultural environment of the affected person.
Here’s how the diagnostic process works
To diagnose fecal incontinence, a doctor’s visit is necessary. To make the diagnosis of fecal incontinence, the symptoms that the patient describes during the medical consultation are decisive for the doctor. A physical examination with rectal digital examination, during which the tension of the sphincter muscle is measured, is also helpful in the diagnosis. The tension of the sphincter muscle can also be measured with the aid of instrumental measuring devices, for example in the form of continence tests. A healthy person can normally retain about 800 ml of fluid here. Depending on the case, imaging examinations such as an MRI of the rectum can also be helpful.
How does defecation work in normal cases?
When stool advances into the rectum, stretch receptors there are activated. As a result, the internal sphincter muscle automatically relaxes. Meanwhile, the muscle tension of the external sphincter increases, which we can control voluntarily. The sensation is that of an urge to defecate. The stool is emptied only when the external sphincter and the pelvic floor relax.
Symptoms and classification of fecal incontinence
Fecal incontinence is medically classified into three degrees of severity based on the severity of its symptoms:
- Grade 1: uncontrolled discharge of intestinal gases.
- Grade 2: Uncontrolled discharge of liquid stool.
- Grade 3: Uncontrolled discharge of solid stool.
In addition, there are two special forms of fecal incontinence:
- Fecal smearing describes the discharge of smallest amounts of stool.
- Urge syndrome, urge incontinence, is defined as the need to immediately visit a toilet as soon as there is an urge to defecate, because the stool can no longer be retained in affected individuals after entering the rectum.
Typical causes of fecal incontinence
There are many different causes of fecal incontinence:
- In the elderly, a common cause of fecal incontinence is chronic constipation combined with a declining ability to control the pelvic floor and sphincter muscle at will. Often in these cases of pelvic floor weakness, urinary incontinence occurs at the same time.
- During natural childbirth or surgery, muscular injury to the sphincter may occur, which can cause fecal incontinence.
- Ulcers in the rectum, such as colon cancer, can damage muscles and nerves in the rectum, causing fecal incontinence.
- Chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis can bring fecal incontinence. This may be due to impaired voluntary control of the sphincter muscle caused by chronic inflammation of the rectum. The risk of incontinence is exacerbated by a tendency to severe diarrhea and inflammatory fistulas between the intestine and the skin.
- In neurological diseases of the nerves, such as paraplegia or after a stroke, voluntary contraction of the pelvic floor muscles may be limited, which may result in fecal incontinence.
- After the consumption of alcohol, the general muscle tension in the body decreases and therefore also that of the sphincter and the pelvic floor.Therefore, stool can be retained worse when drunk.
- In children, malformations of the musculature or nervous system may already be present at birth, which symptomatically can often be accompanied by fecal incontinence. These include, for example, malformations of the intestine (atresia), muscle diseases and forms of spina bifida (meningomyeloceles).
What to do for fecal incontinence?
The topic of “incontinence” in general is stressful and shameful for those affected and also for relatives. It is all the more important to get professional help. Of course, this also applies in the case of fecal incontinence. General measures such as stool regulation, in cooperation with the family doctor and physiotherapist through muscle exercises and targeted nutrition, can be the first step in treatment. In addition, nursing measures and medical aids such as inserts and diapers are an important support in everyday life with fecal incontinence.
Aids for fecal incontinence
There are many medical products available for adults that assist in leading a largely normal daily life despite fecal incontinence. These include, for example, pads, anal tampons and diapers for adults, which can be purchased in drugstores, for example.
Which therapy helps?
Pelvic floor training and pelvic floor exercises help to strengthen the external sphincter muscle with targeted exercises. With the help of these exercises, the voluntary tension of the pelvic floor muscles is promoted. Biofeedback training can be just as helpful as pelvic floor exercises as a further treatment option. If fecal incontinence occurs primarily with thin stools, medications such as loperamide can help by slowing bowel activity. If constipation occurs, on the other hand, fecal incontinence can be treated with the help of medications that have a supportive effect on bowel activity (laxatives).
Treatment by surgical procedures
As a last option of therapy, there are also surgical procedures. Muscle tears of the internal and external sphincter, for example, can be sutured to restore muscle function. If fecal incontinence is triggered not by the muscles but by the nerve supply to the rectum, a pacemaker can be implanted, for example. This stimulates the nerves of the sphincter muscle and activates the muscle in this way.
Nutrition: what to eat for fecal incontinence?
In general, flatulent foods should be avoided in fecal incontinence. Nutritional counseling can also be helpful in fecal incontinence to provide individualized tips. For example, constipation or a tendency to diarrhea can be specifically prevented. For example, people with a tendency to diarrhea or urge incontinence should tend to avoid fiber or at least consume it with sufficient fluids. On the other hand, in the case of constipation, it is advisable to eat targeted dietary fiber in order to stimulate bowel movements as a result.
Which doctor treats fecal incontinence?
In general, it is recommended to go with symptoms of fecal incontinence first to the treating family doctor. There, initial examinations can already be made and therapy recommendations given. These include, for example, a change in diet, medication to regulate stool or referral to a physiotherapist. If these treatment measures do not provide sufficient improvement, fecal incontinence is typically treated by a proctologist.