Gastroenterology Book

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Fecal Incontinence

Aka: Fecal Incontinence, Stool Incontinence
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  1. Definition
    1. Involuntary loss of bowel function with an inability to prevent stool passage
  2. Epidemiology
    1. Incidence: 2% (21% in elderly)
  3. Types
    1. Overflow
      1. Results from Fecal Impaction
    2. Reservoir
      1. Decreased rectal capacity
    3. Rectosphincteric
      1. Structural injury to anal sphincter
      2. Neurologic innervation disrupted to the anal sphincter
  4. History
    1. Rectal fullness or stool urgency
    2. Urinary Incontinence
    3. Fecal Impaction
    4. Dementia history
    5. Medications
      1. Laxative abuse
      2. See Diarrhea Secondary to Medications
    6. Anal sphincter injury history
      1. Colorectal surgery history
      2. Fourth degree Perineal Laceration with child birth
    7. Neurologic injury history
      1. Cerebrovascular Accident history
      2. Spinal cord injury
      3. Cauda equina symptoms
  5. Exam
    1. Neurologic Exam
    2. Digital Rectal Exam
      1. Assess for Fecal Impaction
      2. Assess for rectal tone
  6. Evaluation: Measures used by colorectal specialists
    1. Rectal tone quantification
      1. Anal manometry
    2. Evaluate for colon masses
      1. Lower endoscopy
    3. Evaluate for anal sphincter defect
      1. Ultrasound
      2. MRI
  7. Management: General
    1. Schedule stooling times after meals (especially in Dementia)
    2. Allow for easy restroom access
    3. Treat and prevent Fecal Impaction
    4. Consider biofeedback
    5. Loperamide (Imodium)
      1. Limit to occasional use only (e.g. travel)
      2. Risk of Constipation, Fecal Impaction and subsequent worse Fecal Incontinence
  8. Management: Surgery
    1. Indications
      1. Refractory Fecal Incontinence not responding to general measures
      2. Anal spincter dysfunction
        1. Anal sphincter muscle injury
        2. Rectal Prolapse
    2. Surgical repair options
      1. Overlapping sphincter repair
      2. Pelvic floor reconstruction
      3. Artificial bowel sphincter
  9. References
    1. Enck (1994) Dis Colon Rectum 37(10): 997-1001
    2. Fargo (2012) Am Fam Physician 85(6): 624-30
    3. Tariq (2007) Clin Geriatr Med 23(4): 857-69

Fecal Incontinence (C0015732)

Definition (NCI) Inability to control the escape of stool from the rectum.
Definition (NCI) A disorder characterized by inability to control the escape of stool from the rectum.
Definition (MEDLINEPLUS)

Bowel incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you get to a toilet. More than 5.5 million Americans have bowel incontinence. It affects people of all ages—children and adults. It is more common in women and older adults, but it is not a normal part of aging.

Causes include

Treatments include changes in diet, medicines, bowel training, or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (NCI) Inability to hold stool in the rectum.
Definition (HHC) Involuntary defecation.
Definition (NAN) Change in normal bowel habits characterized by involuntary passage of stool
Definition (MSH) Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus.
Definition (CSP) failure of control of the anal sphincters, with involuntary passage of feces and flatus; it may be either psychogenic or organic in origin.
Concepts Disease or Syndrome (T047)
MSH D005242
ICD9 787.6
ICD10 R15, R15.9
SnomedCT 207139008, 207142002, 70026004, 72042002, 142629005, 158446000, 158449007, 139367004, 162091006, 165229000
English Fecal Incontinences, Incontinence, Fecal, Incontinences, Fecal, FECES INCONTINENCE OF, Alteration in bowel elimination: incontinence, FAECAL INCONTINENCE, FECAL INCONTINENCE, Fecal incontinence, INCONTINENCE FECAL, BOWEL INCONTINENA, Faecal incontinence, Feces Incontinence, Incontinence of faeces NOS, Incontinence of feces NOS, [D]Incontinence of feces (context-dependent category), [D]Incontinence of feces NOS (context-dependent category), Incontinent of feces, [D]Incontinence of faeces, [D]Incontinence of faeces NOS, [D]Incontinence of feces, [D]Incontinence of feces NOS, unable to restrain bowel movement (symptom), rectal discharge incontinent of stool (physical finding), unable to restrain bowel movement, rectal discharge incontinent of stool, Incontinence of faeces (finding), [D]Incontinence of faeces (situation), [D]Incontinence of faeces NOS (situation), Incontinent of faeces (& symptom) (finding), incontinent of stool, fecal incontinence, Bowel incontinena, Incontinent of faeces, Incontinence fecal, Feces incontinence of, [D]Incontinence of feces NOS (situation), [D]Incontinence of feces (situation), Fecal Incontinence, Fecal Incontinence [Disease/Finding], rndx bowel incontinence, rndx bowel incontinence (diagnosis), incontinence stool, Incontinence;bowel, bowel incontinent, stool incontinence, Incontinence;faeces, of bowel incontinence, incontinence of stool, incontinent bowel, incontinence faecal, incontinence bowel, Fecal incontinence NOS, Incontinence faecal, Bowel Incontinence, Incontinence of feces, Bowel incontinence, Incontinence of faeces, Involuntary stool, Bowels: incontinent, Incontinence of feces (finding), BOWEL INCONTINENCE, Incontinence of bowel, feces; incontinence, incontinence; fecal, Foecal incontinence, Incontinence-faeces-sym, Incontinence-feces-sym, Incontinent of faeces (& symptom), Incontinent of faeces - finding, Incontinent of faeces symptom, Incontinent of feces (& symptom), Incontinent of feces (finding), Incontinent of feces - finding, Incontinent of feces symptom, Incontinence (Fecal), faecal incontinence, Incontinence;feces, bowel incontinence
Portuguese INCONTINENCIA FECAL, Incontinência intestinal, Incontinencia fecal, Incontinência fecal, Incontinência Fecal
Spanish INCONTINENCIA FECAL, Incontinencia intestinal, Incontinencia de heces, Incontinente de heces, [D]incontinencia fecal, SAI (categoría dependiente del contexto), [D]incontinencia fecal (categoría dependiente del contexto), [D]Incontinence of faeces, Incontinent of feces (& symptom), [D]Incontinence of feces, Incontinent of feces symptom, Incontinent of faeces symptom, Incontinent of feces, Incontinent of faeces (& symptom), Incontinence of feces, [D]Incontinence of faeces NOS, Incontinent of faeces, Incontinence-feces-sym, Incontinence of faeces, [D]Incontinence of feces NOS, Incontinence-faeces-sym, Incontinencia intestinal (fecal), [D]incontinencia fecal, SAI, [D]incontinencia fecal, SAI (situación), [D]incontinencia fecal, [D]incontinencia fecal (situación), alteración de la evacuación intestinal: incontinencia (hallazgo), alteración de la evacuación intestinal: incontinencia, incontinencia fecal (hallazgo), incontinencia fecal, trastorno de la evacuación intestinal: incontinencia, Incontinencia fecal, Incontinencia Fecal
German STUHLINKONTINENZ, Stuhl Inkontinenz, inkontinent Stuhl, Inkontinenz Stuhl, Inkontinenz von Stuhl, Darminkontinenz, Incontinentia alvi, Stuhlinkontinenz
Dutch fecesincontinentie, incontinent voor feces, feces, incontinentie van, darmincontinentie, foecale incontinentie, Incontinentie voor ontlasting, faeces; incontinentie, incontinentie; faeces, Incontinentie voor faeces, fecale incontinentie, Incontinentia alvi, Incontinentie voor feces
French Incontinent des matières fécales, Incontinence colique, Incontinence intestinale, INCONTINENCE DES MATIERES, Incontinence fecale, Incontinence fécale, Incontinence anale, Incontinence des matières fécales
Italian Incontinenza intestinale, Incontinente alle feci, Incontinenza fecale
Japanese 便失禁, 大便失禁, ﾀﾞｲﾍﾞﾝｼｯｷﾝ, ﾍﾞﾝｼｯｷﾝ
Swedish Avföringsinkontinens, AVFORINGSINKONTINENS
Czech feces - inkontinence, Střevní inkontinence, Inkontinence stolice
Finnish Ulosteenpidätyskyvyttömyys, ULOSTEEN PIDATYSKYVYTTOMYYS
Russian KALA NEDERZHANIE, КАЛА НЕДЕРЖАНИЕ
Danish Afforingsinkontinens
Norwegian INKONTINENT FOR AVFORING r15
Hungarian szeklet incontinencia, Faeces tartási képtelenség, Széklet-incontinentia, Faeces incontinentiája, Faeces incontinentia, Faecalis incontinentia, Széklettartási képtelenség, Faecestartás zavara, Bél incontinentia
Korean 분변의 실금
Croatian FEKALNA INKONTINENCIJA
Basque GOROTZ INKONTINENTZIA
Hebrew inkontinentzia shel tzoa
Polish Nietrzymanie stolca, Nietrzymanie kału
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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