What is incontinence?
Incontinence is the impaired ability to control gas or stool.
Its severity ranges from mild difficulty with gas control to
severe loss of control over liquid and formed stools.
Incontinence to stool is a common problem, but often it is not
discussed due to embarrassment.
What causes incontinence?
There are many causes of incontinence. Injury during childbirth
is one of the most common causes. These injuries may cause a
tear in the anal muscles. The nerves supplying the anal muscles
may also be injured. While some injuries may be recognized
immediately following childbirth, many others may go unnoticed
and not become a problem until later in life. In these
¬situations, a prior childbirth may not be recognized as the
cause of incontinence.
Anal operations or traumatic injury to the tissue surrounding
the anal region similarly can damage the anal muscles and hinder
bowel control. Some individuals experience loss of strength in
the anal muscles as they age. As a result, a minor control
problem in a younger person may become more significant later in
life.
Diarrhea may be associated with a feeling of urgency or stool
leakage due to the frequent ¬liquid stools passing through the
anal opening. If bleeding accompanies lack of bowel control,
¬consult your physician. These symptoms may indicate
inflammation within the colon (colitis), a rectal tumor, or
rectal prolapse - all conditions that require prompt evaluation
by a physician.
How is the cause of incontinence determined?
An initial discussion of the problem with your physician will
help establish the degree of control difficulty and its impact
on your lifestyle. Many clues to the origin of incontinence may
be found in patient histories. For example, a woman's history of
past childbirths is very important. Multiple pregnancies, large
weight babies, forceps deliveries, or episiotomies may
contribute to muscle or nerve injury at the time of childbirth.
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. In
addition, an ultrasound probe can be used within the anal area
to provide a picture of the muscles and show areas in which the
anal muscles have been injured.
Frequently, additional studies are required to define the
anal area more completely. In a test called anal manometry, a
small catheter is placed into the anus to record pressure as
patients relax and tighten the anal muscles. This test can
demonstrate how weak or strong the muscle really is. A separate
test may also be conducted to determine if the nerves that go to
the anal muscles are functioning properly.
What can be done to correct the problem?
Treatment of incontinence may include:
• Dietary changes
• Constipating medications
• Muscle strengthening exercises
• Biofeedback
• Surgical muscle repair
• Artificial anal sphincter
After a careful history, physical examination and testing to
determine the cause and severity of the problem, treatment can
be addressed. Mild problems may be treated very simply with
dietary changes and the use of some constipating medications.
Diseases which cause inflammation in the rectum, such as
colitis, may contribute to anal control problems. Treating these
diseases also may eliminate or improve symptoms of incontinence.
Sometimes a change in prescribed medications may help. Your
physician also may recommend simple home exercises that may
strengthen the anal muscles to help in mild cases. A type of
physical therapy called 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.
Some individuals may benefit from a technique that delivers
electrical energy to the skin and muscles surrounding the anus
which results in firming and thickening of this area to help
with continence.
In certain individuals that have nerve damage or anal muscles
that are damaged beyond repair, an artificial sphincter may be
implanted. The artificial sphincter is a plastic, fluid filled
doughnut that is surgically implanted around the damaged anal
sphincter. This artificial sphincter keeps the anal canal
closed. When an individual wants to have a bowel movement, the
fluid can be pumped out of the doughnut to allow the anal canal
to open.
In extreme cases, patients may find that a colostomy is the
best option for improving their quality of life.
