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Bowel Incontinence

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Overview
Causes
Diagnosis
Treatment
 Where To Seek Treatment

 


Contributed by Singapore General Hospital

Overview

Incontinence is the loss of the ability to control gas or stool. It can vary from mild difficulty with gas control to total loss of control over liquid and solid stools. It is a common problem, but patients do not often bring it up because of embarrassment.

Causes

There are many causes of incontinence.

Injury during childbirth is one of the most common causes. These injuries may cause damage to the anal muscles and loss of muscle strength. The nerves supplying the anal muscles may also be injured. While some injuries may be recognised immediately following childbirth, many others may go unnoticed and not become a problem until later in life. In these situations, past childbirth may not be recognised as the cause of incontinence.

Operations, infections or trauma to the anal region similarly can cause damage and result in loss of bowel control. In addition, muscle strength may also decrease with aging. As a result, a minor problem in a younger person may become more serious later in life.

Diarrhoea may be associated with loss of control due to liquid stools. Other conditions such as inflammation of the colon (colitis), tumour or rectal prolapse may also cause incontinence. Do consult your doctor if you have loss of bowel control.

Diagnosis

An initial discussion of the problem with your doctor will help establish the severity of the problem.

A history of past childbirth in a woman may suggest a cause. In some cases, medical illnesses and medications play a role in problems with control. A physical exam of the anal region should be performed. It may readily identify an obvious injury to the anal muscles.

Additional tests are usually required. In manometry, a fine plastic tube is placed into the anus to record strength of the muscles. A separate test of nerve function may also be conducted. An ultrasound probe is also used to look for areas of damage in the muscles. A colonoscopy is usually done to look for causes of incontinence higher up in the colon.

Treatment

Mild problems may be treated with changes in your diet and constipating medications. You may be started on simple exercise that strengthens the anal muscles.

In other cases, biofeedback can be used to help patients sense when stool is ready to be evacuated and help strengthen the muscles. Injuries to the anal muscles may be repaired with surgery. Diseases, which cause inflammation in the colon and rectum, such as colitis, may contribute to anal control problems. Treating these diseases also may eliminate or improve symptoms of incontinence.

In the past, patients with no hope of regaining bowel control required a colostomy. This is rarely required nowadays. Artificial anal muscle, currently still under research, may soon find a place in treating patients with difficult control problems.

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