What is Fecal Incontinence?
Fecal incontinence is the inability to control bowel movements, causing unexpected leakage of either liquid or solid stool from the rectum. If you’re struggling with fecal incontinence, you don’t need to suffer in silence. Patrick Nosti, MD, FACOG, at Urogynecology of Kansas City, offers innovative treatment solutions. Find out more by booking an evaluation today.
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Fecal Incontinence, also known as Accidental bowel leakage (ABL), is the loss of normal control of the bowels, leading to leakage of solid or liquid stool or gas. About 8 out of every 100 women struggle with ABL. The number of women affected increases with age. And, researchers think that in reality, the total number of women is likely much higher, but many are too embarrassed to seek treatment.
Causes of Fecal Incontinence
There are many causes of accidental bowel leakage, including injury caused during childbirth, damage to the anal sphincter or nerves, pelvic organ prolapse, fistula, medical problems and abnormal stool consistency.
Pregnancy can increase the risk of accidental bowel leakage. It is more common in women who deliver vaginally than women who have a C-section. However, research also suggests that just carrying a pregnancy can increase your risk of these changes as well.
Delivering a large baby vaginally, especially if forceps are used, poses more risk than having a smaller baby. An episiotomy or significant tear of the tissues around the vagina and rectum can result in damage to the nerves, muscles, and tissues around the rectal canal. This can result in a tear of the anal sphincter muscles that help to hold in stool, but also some of the surrounding tissues that are important as well.
Anal Sphincter Injury
There are two main circular muscles, or sphincters, that help to hold in stool near the anal opening. During vaginal childbirth, the anal sphincter muscles can be damaged or torn. These muscles allow us to control bowel movements. It is estimated that as many as 40% of women experience muscle injuries in this area during childbirth. Some of these tears are recognized and repaired, but some are hidden. Injury is more common after episiotomy or forceps delivery.
The anal sphincter muscles can also become weakened for other reasons, such as diabetes or neurologic conditions. They can also be damaged during other surgeries, such as surgery to fix an anal fissure or hemorrhoids. This can cause decreased strength resulting in problems controlling passage of bowel movements.
Ultrasound can help to detect these injuries. Depending on the extent of the injury and the length of time from when it occurred (for example, how long ago you delivered your baby), surgery can repair the damage. If the damage occurred in the past, surgery may not be able to help.
Injury to the anal sphincter nerves can cause decreased sensation and muscle strength, both of which can contribute to ABL. Vaginal delivery, chronic constipation, or illnesses that affect the nerves such as diabetes and spinal cord injury can result in nerve damage. For some women, nerve damage that occurs during vaginal delivery improves on its own one or two years after childbirth.
Several types of prolapse can affect bowel control.
- Rectocele: A rectocele is a hernia of the bowel upward into the vaginal canal. It causes a vaginal bulge that can sometimes result in difficulty emptying the bowels.
- Rectal prolapse: Rectal prolapse is a condition where the rectum slides out through the anal opening. This causes a bulge coming from the anus, not from the vagina. Distortion of the anal opening can result in damage to the sphincter muscles and bowel leakage.
- Hemorrhoids: Hemorrhoids are caused by enlarged blood vessels near the anal opening. Sometimes they can cause small bulges near the anal opening. These can make it difficult to clean near the anus, resulting in seepage of bowel contents. There are many treatments for hemorrhoids, ranging from medicines to surgery to remove them. However, if hemorrhoids are removed, one out of every 10 women will end up with fecal incontinence.
Abnormal openings or connections (tracts or tunnels) known as “fistulas” can develop between the bowel and vagina, or the bowel and the skin. Fistulas can occur:
- After vaginal delivery or vaginal surgery. This is more likely if a large tear occurred during delivery but is still unusual.
- Spontaneously as a result of diverticulitis or other bowel conditions, including Crohn’s disease.
- In patients who have had radiation in the pelvis.
Abnormal Stool Consistency
Bowel movements with normal consistency are easiest to control. Ideally, stools should be like toothpaste. Abnormal stool consistency (either loose or hard stools) may contribute to ABL:
- Diarrhea or loose bowel movements are more difficult to control. This can also increase the sensation of needing to pass stool, called fecal urgency.
- Severe constipation. People who have significant problems passing stool can experience a hard lump of stool with diarrhea that develops around it.