Fecal Incontinence

Aka: Fecal Incontinence, Stool Incontinence

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II. Definitions

  1. Fecal Incontinence
    1. Involuntary loss of bowel function with an inability to prevent stool passage
    2. Contrast with Encopresis as seen in children

III. Epidemiology

  1. Prevalence: 2-6% (21% in elderly, and up to 50% in Nursing Homes)

IV. 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

V. Causes

  1. Anal sphincter defects (e.g. related to prior obstetric or other surgical procedures)
  2. Rectal Prolpase
  3. Neuropathy
  4. Inflammatory Bowel Disease
  5. Central Nervous System disorders

VI. 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

VII. Exam

  1. Neurologic Exam
    1. Perianal Sensation
    2. Anal Wink (evaluate sacral reflex)
  2. Digital Rectal Exam
    1. Assess for Fecal Impaction
    2. Assess for Rectal Tone
    3. Assess for Rectal Prolapse

VIII. Imaging: Refractory cases to evaluate sphincter defects

  1. Pelvic MRI or
  2. Endoanal Ultrasound

IX. Evaluation: Measures used by colorectal specialists

  1. Rectal Tone quantification
    1. Anorectal manometry (balloon catheter within Rectum measures pressures with rest and contraction)
  2. Evaluate for colon masses
    1. Lower endoscopy
  3. Evaluate for anal sphincter defect
    1. Ultrasound
    2. MRI

X. Management: General

  1. Treat and prevent Fecal Impaction
    1. Schedule stooling times after meals (especially in Dementia)
    2. Allow for easy restroom access
    3. Fiber supplementation (30 grams/day) with adequate fluid intake (e.g. 64 ounce non-caffeinated fluid per day)
  2. Consider biofeedback
  3. Diarrhea related Incontinence
    1. Loperamide (Imodium)
      1. Limit to occasional use only (e.g. travel)
      2. Risk of Constipation, Fecal Impaction and subsequent worse Fecal Incontinence
  4. Other general measures
    1. Barrier ointments (e.g. Zinc Oxide)

XI. 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 (sphincteroplasty)
      1. Good short-term results but recurs in most patients after 5 years
      2. Glasgow (2012) Dis Colon Rectum 55(4):482-90 [PubMed]
    2. Anal Bulking Agent injection
      1. Maeda (2013) Cochrane Database Syst Rev (2): CD007959 [PubMed]
    3. Sacral Nerve Stimulation
    4. Pelvic floor reconstruction
    5. Colostomy or artificial bowel sphincter

XII. References

  1. Cohee (2020) Am Fam Physician 101(1):24-33 [PubMed]
  2. Enck (1994) Dis Colon Rectum 37(10): 997-1001 [PubMed]
  3. Fargo (2012) Am Fam Physician 85(6): 624-30 [PubMed]
  4. Tariq (2007) Clin Geriatr Med 23(4): 857-69 [PubMed]

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Related Studies

Ontology: Fecal Incontinence (C0015732)

Definition (CCC) Involuntary defecation
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. Millions of Americans have this problem. It affects people of all ages - children and adults. It is more common in women and older adults. 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_CTCAE) A disorder characterized by inability to control the escape of stool from the rectum.
Definition (NCI_NCI-GLOSS) Inability to hold stool in the rectum.
Definition (NCI) Involuntary passage of stool from the rectum.(NICHD)
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, 162091006, 139367004, 142629005, 158446000, 158449007, 165229000
LNC MTHU013375
English Fecal Incontinences, Incontinence, Fecal, Incontinences, Fecal, FAECAL INCONTINENCE, FECAL INCONTINENCE, 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), [D]Incontinence of faeces, [D]Incontinence of faeces NOS, [D]Incontinence of feces, [D]Incontinence of feces NOS, Alteration in bowel elimination: incontinence, unable to restrain bowel movement (symptom), rectal discharge incontinent of stool (physical finding), unable to restrain bowel movement, rectal discharge incontinent of stool, incontinent of stool, fecal incontinence, Bowel incontinena, Incontinent of faeces, Incontinence fecal, Feces incontinence of, 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, Incontinent of feces, Incontinent of feces (& symptom), Incontinent of feces (finding), Incontinent of faeces (& symptom), Incontinence of faeces (finding), [D]Incontinence of feces (situation), Incontinent of faeces (& symptom) (finding), Incontinent of feces - finding, Incontinence-faeces-sym, [D]Incontinence of feces NOS (situation), Incontinence faecal, [D]Incontinence of faeces NOS (situation), Incontinent of faeces - finding, Incontinent of feces symptom, Incontinence-feces-sym, [D]Incontinence of faeces (situation), Incontinent of faeces symptom, Fecal incontinence, 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 (Fecal), faecal incontinence, Incontinence;feces, bowel incontinence
Portuguese INCONTINENCIA FECAL, Incontinência intestinal, 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), alteración de la evacuación intestinal: incontinencia (hallazgo), incontinencia de heces, incontinencia fecal (hallazgo), trastorno de la evacuación intestinal: incontinencia, deposiciones fecales involuntarias, incontinencia fecal, alteración de la evacuación intestinal: incontinencia, [D]incontinencia fecal (situación), [D]incontinencia fecal, [D]incontinencia fecal, SAI (situación), [D]incontinencia fecal, SAI, 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 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
Finnish Ulosteenpidätyskyvyttömyys
Russian KALA NEDERZHANIE, КАЛА НЕДЕРЖАНИЕ
Czech Střevní inkontinence, Inkontinence stolice, inkontinence stolice, fekální inkontinence, feces - inkontinence
Korean 분변의 실금
Croatian FEKALNA INKONTINENCIJA
Polish Nietrzymanie stolca, Nietrzymanie kału
Hungarian Faeces tartási képtelenség, Széklet-incontinentia, Faeces incontinentiája, Faeces incontinentia, Faecalis incontinentia, Széklettartási képtelenség, Faecestartás zavara, Bél incontinentia
Norwegian Avføringsinkontinens, Analinkontinens
Derived from the NIH UMLS (Unified Medical Language System)

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