Treatment of fecal incontinence

Encopresis is a disorder of bowel movement control in which involuntary passage of stool occurs. In some cases, a person feels a sudden strong urge but does not have time to reach the toilet. In others, the person does not notice the urge and only becomes aware of the bowel movement after soiling their underwear.

The manifestations of encopresis depend on whether a person feels the urge to defecate and how well they can control it. According to the nature of the disorder, the following are distinguished:

• the urge form — a sudden strong urge occurs, but it is not possible to hold back the bowel movement until visiting the toilet;
• the passive form — stool is passed without a pronounced urge, so a person may notice it only after soiling their underwear;
• the mixed form — combines urge and passive episodes.

Leakage after defecation may occur separately, when a small amount of stool remains in the rectum and is passed later. Such a manifestation is possible with incomplete emptying, rectocele, or impaired function of the pelvic floor muscles.

According to its severity, the disorder may manifest as:

• incontinence of gas;
• leakage of liquid stool;
• involuntary passage of formed stool;
• complete loss of control over defecation.

The severity of the condition is determined not only by the nature of the discharge, but also by the frequency and volume of episodes, the ability to reach the toilet in time, and the impact of the problem on everyday life.

Bowel movement control is ensured by the coordinated function of the nervous system, rectum, anal sphincter, and pelvic floor muscles. If one of these components does not function properly, it becomes more difficult for a person to feel the urge or retain the intestinal contents until visiting the toilet. Anal incontinence often occurs due to a combination of several causes.

The main causes include:

• damage to the anal sphincter after an injury, surgery, or difficult childbirth;
• impaired function of the nervous system after a stroke, spinal injury, or against the background of neurological diseases;
• diarrhea, since frequent loose stools are more difficult to retain;
• prolonged constipation with overfilling of the rectum and leakage of liquid contents;
• inflammatory bowel diseases and other digestive disorders;
• weakening of the pelvic floor muscles, pelvic organ prolapse, or rectal prolapse.

Doctors at “Oxford Medical” explain that in women, the problem may be associated with damage to the muscles and nerves during childbirth, while in men, it may be associated with injuries and previous surgeries in the rectal or pelvic area. In elderly people, the risk increases due to decreased muscle tone, neurological diseases, and limited mobility.

With frequent episodes, the skin around the anus may become irritated, causing itching, burning, and discomfort. If the disorder is associated with intestinal diseases, flatulence may also occur.

Diagnosis begins with a consultation with a proctologist. The doctor clarifies how often the episodes occur, whether the person feels the urge, what the nature of the bowel movements is, and whether there have previously been injuries or surgeries. The doctor then performs an examination and a digital rectal examination to assess the condition of the anal sphincter.

To establish the cause of fecal incontinence, the following are prescribed if necessary:

• anoscopy or sigmoidoscopy — to examine the anal canal and rectum;
• anorectal manometry — to assess sphincter strength, rectal sensitivity, and muscle function;
• ultrasound of the anal canal — to detect damage to the anal sphincter;
• colonoscopy — examination of the entire large intestine using an endoscope, if it is necessary to rule out inflammation, neoplasms, or other diseases.

The doctor determines the list of examinations individually after the examination, so a complete diagnostic assessment is not required for every patient. The diagnostic results help determine whether the disorder is associated with the function of the sphincter, nervous system, pelvic floor muscles, or intestinal diseases, and select the appropriate treatment.

Treatment of anal incontinence is selected after examination, since the same symptoms may have different causes. The main objective of therapy is to normalize bowel movements, improve the function of the sphincter and pelvic floor muscles, and also eliminate the disease that led to the disorder.

Depending on the diagnostic results, treatment may include:

• therapy for inflammatory and other intestinal diseases that cause frequent urges, loose stools, or leakage;
• individual dietary adjustment — in case of constipation, vegetables, fruits, whole-grain products, and a sufficient amount of water are added to the diet, while in case of diarrhea, fatty and spicy foods, caffeine, and other products that worsen the symptoms are limited;
• medications to normalize the consistency and frequency of bowel movements, reduce sudden urges, or eliminate constipation;
• exercises for the pelvic floor muscles that help contract the muscles correctly, feel the urge better, and control the sphincter;
• establishing a regular defecation schedule — visiting the toilet at a set time, most often after meals, to make bowel movements more predictable;
• treatment of neurological disorders together with a neurologist or another relevant specialist.

Doctors at “Oxford Medical” warn: you should not take laxatives or antidiarrheal medications on your own. Incorrectly selected medications may worsen leakage, constipation, or sudden urges.

If conservative treatment does not help or significant sphincter damage or anatomical changes are detected during the examination, surgery may be required. The doctor may restore the damaged sphincter, correct rectal prolapse, or eliminate another disorder that prevents stool retention. In some cases, a small device is implanted that transmits weak impulses to the nerves and helps improve bowel movement control. The proctologist determines the treatment strategy individually.

Prevention of encopresis is aimed at maintaining regular bowel function, preserving the tone of the pelvic floor muscles, and timely treatment of conditions that may impair bowel movement control.

To reduce the risk, it is recommended to:

• promptly treat prolonged constipation, diarrhea, and inflammatory bowel diseases;
• monitor nutrition, drink enough water, and maintain physical activity;
• not postpone visiting the toilet and avoid prolonged straining;
• perform pelvic floor muscle exercises recommended by the doctor after childbirth, injuries, or surgeries;
• consult a proctologist at the first episodes of stool leakage or loss of control over gas.

Timely examination and treatment help reduce the risk of repeated episodes of involuntary defecation and prevent the disorder from worsening.

The cost of treatment depends on the cause of the disorder, the required scope of diagnostics, and the chosen strategy. First, the patient has a consultation with a proctologist, after which the doctor determines which examinations are needed and whether conservative therapy is sufficient.

Current prices for consultations with doctors can be viewed here. To book an appointment at the proctology department, use the online booking form or call our contact center.

The information is for informational purposes and does not replace a consultation with a doctor.

Sources:

• National Institute of Diabetes and Digestive and Kidney Diseases
• American Society of Colon and Rectal Surgeons
• National Institute for Health and Care Excellence