Synonyms
Bowel incontinence, anal incontinence
Introduction
The term incontinence (fecal incontinence) is used to describe a disease associated with the inability to hold back both bowel movements and intestinal wind arbitrarily. Fecal incontinence can affect people of all ages. As a rule, however, older people are affected much more frequently.
Patients suffering from this form of incontinence experience enormous social and psychological pressure. Whereas it was previously thought that fecal incontinence was a rather rare clinical picture, which mainly affects older people, it is now even assumed that 1-3 percent of the population (in Germany, this means approximately 800,000 people) suffer from fecal incontinence in various degrees of severity. Among the affected persons, the gender ratio is approximately 1:1, whereby among the men rather light forms (stool grease) and among the women severe forms of fecal incontinence can be found.
There are a number of different causes for the development of fecal incontinence. In most cases, this form of incontinence is not caused by a single factor, but by a combination of several factors. The initiation of defecation by the organism is coordinated by various mechanisms that mesh together like gears.
If only one of the underlying factors fails, this can usually be compensated by the body’s compensation strategies. To trigger fecal incontinence, therefore, several irregularities must be present which can no longer be compensated in their entirety. Among the most frequent causes of this type of incontinence are various disturbances in impulse processing.
This means that the interaction between the continence apparatus and the control (or processing) at the level of the brain no longer functions properly. Causal disorders can be caused by, among other things, a stroke, Alzheimer’s disease, multiple sclerosis or brain tumors of different localization. In addition, interruptions in the impulse transfer lead in many cases to the development of fecal incontinence.
The information regarding the retention and/or emptying of the bowel therefore does not find its way from the brain to the continence apparatus. The causal problem is therefore not in the brain itself, but at the level of the spinal cord. This problem can be triggered by paraplegia (tetraplegia), the so-called spina bifida syndrome and multiple sclerosis.
Sensory disorders in the area of the rectum and/or rectum can also provoke the development of fecal incontinence. The underlying causes include hemorrhoids, severe diarrhea, a rectal prolapse and chronic inflammation of the colon. At the muscular level, regular stool removal can be hindered by tumors, fistulas, perineal tears, abscesses and congenital malformations.
In addition, a lowering of the pelvic floor associated with aging and the overstretching of the bowel due to frequent constipation can lead to fecal incontinence. In addition to these physical causes, various drugs such as psychotropic drugs or high-dose laxatives (e.g. kerosenes) can also cause fecal incontinence. Furthermore, irregularities in the ability to retain stool are particularly common in patients with pronounced psychoses.
