Fecal incontinence

The term fecal continence describes the ability to control the contents of the large intestine (solid, liquid, gaseous) and pass them at the desired moment and place. This complex function is based on the interplay of different muscular, sensory and anatomical structures and mechanisms. If this function does not work properly anymore, it is called fecal incontinence.

Symptoms of fecal incontinence are often kept a secret, and psychological and social consequences–even social isolation–are severe.

Subject to its severity, fecal incontinence is divided in three stages:

  • incontinence I: involuntary passing of gas
  • incontinence II: involuntary passing of liquid fecal matter
  • incontinence III: involuntary passing of normally shaped fecal matter

Causes fecal incontinence

There are several causes of fecal incontinence:

  • disorders of the central nervous system
  • disorders of the peripheral nerves of the pelvic
  • diabetes mellitus
  • damaged muscles of pelvic and anal sphincter (birth trauma, accident, surgery outcome)
  • rectal and anal tumors
  • weakness of the anal sphincter due to age
  • constipation with formation of fecaliths (stony feces) within the rectum

Diagnostics fecal incontinence

If fecal incontinence is presumed, it is necessary to evaluate symptoms and medical history. It is important to ask how much time elapses between the urge of passing stool and the passing itself, whether there are signs of stool in clothing, whether sanitary napkins are used, etc., and how frequent fecal incontinence occurs. The Cleveland Clinic incontinence Score can help assess the severity of incontinence.

An important examination is the rectal examination (inspection, feeling for anomalies with fingers), rectoscopy/proctoscopy (inserting a rectoscope for better vision), and anal manometry (tests the pressure of anal sphincter). In addition to a colonoscopy (endoscopy of bowels), an MRI defecography (examines defecation cycle) is recommended, especially in case of an accompanying rectocele (rectum bulges into vagina) and presumptive rectal prolapse. Endoscopic ultrasound of the rectum gives us important information on the anal sphincter and its surroundings, potential scars, fistulas and damage. Gynecological and–due to frequent simultaneous urinary incontinence–urological examinations do also make sense.

Treatment fecal incontinence

The treatment of fecal incontinence depends on the causes and the stage of the incontinence.

If patients suffer from fecal incontinence as a result of irritable bowel syndrome or chronic inflammatory bowel disease, those have to be treated primarily to achieve a normal consistency of feces.

Given a proven weakness of the anal sphincter, measures to control feces like the so-called biofeedback training with EMG-triggered (EMG = electromyography) electrodes are carried out at first. If these conservative (non-surgical) treatment options do not have a successful outcome, sacral nerve stimulation can help after implanting an electrode. This treatment option stimulates the nerves of the pelvic floor and the rectum.