Rectum

Fecal Incontinence

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Fecal Incontinence, Stool Incontinence

  • Definition
  1. Involuntary loss of bowel function with an inability to prevent stool passage
  • Epidemiology
  1. Incidence: 2% (21% in elderly)
  • 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
  • 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
  • Exam
  1. Neurologic Exam
  2. Digital Rectal Exam
    1. Assess for Fecal Impaction
    2. Assess for rectal tone
  • 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
  • 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
  • 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