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Fecal Incontinence
Aka: Fecal Incontinence, Stool Incontinence
- See Also
- Encopresis
- Definitions
- Fecal Incontinence
- Involuntary loss of bowel function with an inability to prevent stool passage
- Contrast with Encopresis as seen in children
- Epidemiology
- Prevalence: 2-6% (21% in elderly, and up to 50% in Nursing Homes)
- Types
- Overflow
- Results from Fecal Impaction
- Reservoir
- Decreased rectal capacity
- Rectosphincteric
- Structural injury to anal sphincter
- Neurologic innervation disrupted to the anal sphincter
- Causes
- Anal sphincter defects (e.g. related to prior obstetric or other surgical procedures)
- Rectal Prolpase
- Neuropathy
- Inflammatory Bowel Disease
- Central Nervous System disorders
- History
- Rectal fullness or stool urgency
- Urinary Incontinence
- Fecal Impaction
- Dementia history
- Medications
- Laxative abuse
- See Diarrhea Secondary to Medications
- Anal sphincter injury history
- Colorectal surgery history
- Fourth Degree Perineal Laceration with child birth
- Neurologic injury history
- Cerebrovascular Accident history
- Spinal cord injury
- Cauda equina symptoms
- Exam
- Neurologic Exam
- Perianal Sensation
- Anal Wink (evaluate sacral reflex)
- Digital Rectal Exam
- Assess for Fecal Impaction
- Assess for rectal tone
- Assess for Rectal Prolapse
- Imaging: Refractory cases to evaluate sphincter defects
- Pelvic MRI or
- Endoanal Ultrasound
- Evaluation: Measures used by colorectal specialists
- Rectal tone quantification
- Anorectal manometry (balloon catheter within Rectum measures pressures with rest and contraction)
- Evaluate for colon masses
- Lower endoscopy
- Evaluate for anal sphincter defect
- Ultrasound
- MRI
- Management: General
- Treat and prevent Fecal Impaction
- Schedule stooling times after meals (especially in Dementia)
- Allow for easy restroom access
- Fiber supplementation (30 grams/day) with adequate fluid intake (e.g. 64 ounce non-caffeinated fluid per day)
- Consider biofeedback
- Diarrhea related Incontinence
- Loperamide (Imodium)
- Limit to occasional use only (e.g. travel)
- Risk of Constipation, Fecal Impaction and subsequent worse Fecal Incontinence
- Other general measures
- Barrier ointments (e.g. Zinc Oxide)
- Management: Surgery
- Indications
- Refractory Fecal Incontinence not responding to general measures
- Anal spincter dysfunction
- Anal sphincter Muscle injury
- Rectal Prolapse
- Surgical repair options
- Overlapping sphincter repair (sphincteroplasty)
- Good short-term results but recurs in most patients after 5 years
- Glasgow (2012) Dis Colon Rectum 55(4):482-90 [PubMed]
- Anal Bulking Agent injection
- Maeda (2013) Cochrane Database Syst Rev (2): CD007959 [PubMed]
- Sacral Nerve Stimulation
- Pelvic floor reconstruction
- Colostomy or artificial bowel sphincter
- References
- Cohee (2020) Am Fam Physician 101(1):24-33 [PubMed]
- Enck (1994) Dis Colon Rectum 37(10): 997-1001 [PubMed]
- Fargo (2012) Am Fam Physician 85(6): 624-30 [PubMed]
- Tariq (2007) Clin Geriatr Med 23(4): 857-69 [PubMed]