Fecal Incontinence

Between 2 to 18 percent of the general population report an inability to control their bowels. Of those, about 33 percent restrict activities due to incontinence. Fecal or bowel incontinence is the loss of control over bowel (stool) movements. Complete fecal incontinence is defined as the inability to control solid stool, whereas partial incontinence involves liquid stool or gas. 

Women are more likely to have bowel problems than men, and fecal incontinence is a condition that becomes more common with age. Because an uncontrollable bowel is not something people like to talk about, you may not be aware that this issue is common and there are many treatments available.

Treating Fecal Incontinence — Dr. Bidhan Das

fecal_incontinence
Bidhan Das, MD, a colorectal surgeon at Houston Methodist’s Center for Restorative Pelvic Medicine, defines fecal incontinence, lists causes and symptoms and suggests ways the condition can be treated.

Causes of Fecal Incontinence
Normal control of bowel movements depends on proper functioning of the colon and rectum, the muscles surrounding the anus (anal sphincter muscles), the brain and the nervous system, and the amount and consistency of stool produced. Bowel incontinence can be the result of several issues:
  • Childbirth
  • Prior surgical procedure
  • Injury (trauma)
  • Rectal prolapse (protrusion)
  • Aging 
  • Chronic disease, such as diabetes
  • Improper diet

Diagnosing Fecal Incontinence
The initial evaluation for fecal incontinence includes obtaining a general medical history and a history leading up to the incontinence. A simple physical examination is required to determine the status of the anal sphincter muscle.

Even before fecal incontinence becomes a chronic problem, diagnostic procedures allow the physician to look for tears and other abnormalities in the anal sphincter muscles. Common diagnostic procedures include the following:
  • Anorectal ultrasound
  • Anal manometry 
  • Defecography
  • Pudendal nerve testing

Methods of Testing for Fecal Incontinence

Anorectal ultrasound
An anorectal ultrasound, or ultrasound of the anus, is used to determine the nature of an injury to the sphincter muscle. The sphincter muscle is a small circular muscle found at the end of the anal cavity, which keeps the anal canal closed. Injury to the muscle can result in loss of bowel control or the presence of a fistula.
 
During this relatively painless test, a smooth probe about the diameter of the index finger is placed in the rectum to take pictures of the wall of the anus using sound waves. The sound waves bounce off the walls of the tissues to make echoes. The echoes are then transmitted onto a screen where your physician can inspect suspicious lesions.

The procedure lasts about ten minutes. Prior to the procedure, you are required to clean out the rectum using enemas or laxatives, as instructed by the physician.

Anal manometry
If you are experiencing difficulty with constipation or incontinence (loss of bowel control), you may undergo an anal manometry test. This simple diagnostic test uses various squeezing and resting reflexes to measure pressures in the anal cavity and anal sensation. During the procedure, a plastic tube with a balloon on the end is inserted into the rectum and inflated to measure a reflex. The test measures changes in the pressure of water dripping into the tube. The tube is then removed from the anus to obtain the readings.

Anal manometry usually takes about 30 minutes to complete. Prior to the procedure, you are required to clean out the rectum using enemas or laxatives, as instructed by the physician.

Defecography
Defecography, also known as evacuation proctography, is used to determine proper treatment options for chronic constipation, rectal prolapse, rectocele (an out-pouching of the rectum), fecal incontinence or anismus (inappropriate spasm of the anal sphincter, a ring-sized muscle located at the end of the anal cavity, which keeps the anal canal closed).

This procedure, although uncomfortable, is an essential tool to help doctors evaluate the pelvic floor muscles and rectum while you are having a bowel movement. You are seated in a special chair that allows X-rays of the pelvis to be taken. The X-rays are taken in different positions: at rest, straining, squeezing and during defection. During the test, barium paste is given in the form of an enema. The paste is visible within the rectum on the X-rays, showing the details of the small intestine. Any problems with pelvic floor relaxation can be seen on the X-ray.

The entire test should take about 30 minutes to complete. Houston Methodist ensures your privacy and accommodates your needs as much as possible.

Pudendal nerve testing
Pudendal nerve testing is conducted to determine whether the pudendal nerve, found in the pelvis, is functioning normally. A dysfunctional pudendal nerve can lead to incontinence or loss of control when passing gas or stool. The test indicates whether there is a delay between the time the nerve senses stimulation and when the nerve actually sends a message to the sphincter muscle.

During the procedure, you lie on your side and bend the knees. A technologist performs the test by placing an electrode-grounding pad (like an electrocardiography [EKG] pad) on the thighs or buttocks. Another electrode is placed on the technologist’s index finger. The finger with the electrode is gently inserted into the rectum. A mild, painless electrical stimulus is sent through the electrode to the pudendal nerve, causing the muscles on the thighs and/or buttocks to twitch. The same stimulus is sent to the right and left branches of the nerve. The bodily response to the stimulation is recorded and interpreted by a physician to determine whether there are any nerve-conduction delays. 
The procedure will take approximately 15 to 20 minutes to complete and results are usually determined within an hour.

Treating Fecal Incontinence
For most patients, fecal incontinence can be cured or significantly improved with treatment once the underlying cause is identified. There are a variety of treatment options. The treatment plan is based on each patient’s condition and lifestyle. Treatment may include these recommendations:
  • Dietary changes
  • Pelvic floor physical therapy
  • Over-the-counter or prescription medications
  • Surgery - patients who have experienced anal muscle injuries, such as during childbirth, may elect to undergo surgery
These issues can be embarrassing but can be resolved. Patients with stool leakage or gas that interferes with their daily life should discuss the problem with their primary care physician or with one of our specialists.
Houston Methodist combines the expertise of urogynecologists — specialty physicians trained in the areas of urology and gynecology — as well as traditional gynecologists and colorectal surgeons to provide the most advanced care available for women and men with problems related to the lower urinary tract and the pelvic floor. The Center for Restorative Pelvic Medicine at Houston Methodist Hospital is the first of its kind in the Greater Houston area and is one of the few centers in the country that offers a single-center location for the diagnosis and treatment of complex pelvic-floor disorders.

TREATMENT LOCATIONS

Our physicians at Houston Methodist specialize in managing fecal incontinence at the following convenient locations.