What Is Anal Incontinence?

Anal incontinence, also known as fecal incontinence, refers to the loss of the body's ability to store and control liquid and solid contents and gases in the rectum, resulting in increased stool frequency. It is a symptom of defecation dysfunction and is caused by a variety of reasons. Although it is not a direct threat to life, it causes physical and mental pain and strictly interferes with normal life and work. Anal incontinence is divided into three categories: complete incontinence; incomplete incontinence; sensory incontinence.

Basic Information

nickname: Fecal incontinence
English name: anal incontinence
Visiting department: General Surgery
Common causes: Neurological disorders and injuries (neurogenic), muscular dysfunction and injuries (muscular), surgery or trauma (iatrogenic), congenital diseases

Common symptoms: Complete anal incontinence, incomplete incontinence, sensory incontinence of the anus
Contagious: no

Causes of anal incontinence

1. Neurological disorders and injuries (neurogenic)

Such as stroke, shock, and fright, temporary fecal incontinence can occur; if the chest, lumbar, and sacral vertebral compression damages the spinal cord or spinal nerve, it can cause paraplegia and cause anal incontinence; In addition, after the rectum is close to the anus Intramural sensory nerve defects and mental retardation can cause anal incontinence.

2. Muscle dysfunction and impairment (myogenic)

Anal contraction and defecation are maintained by innervation of the inner and outer sphincter and levator ani muscles. These muscles are loose, the tension is reduced, or they are cut, removed, or a large area of scars can cause anal incontinence. Anal incontinence can also occur if rectal prolapse, hemorrhoids, and muscle relaxation and loss of tension due to polyp prolapse. Older people with certain conditions can also cause atrophic anal incontinence. Anorectal abscess, anal fistula, rectal cancer and other surgical cuts or resections of the sphincter can also cause anal incontinence. Burns, scalds, and chemical corrosion can also cause extensive anal incontinence. Prolonged diarrhea and anorectal cancer can also cause anal incontinence.

3. Surgery or trauma (iatrogenic)

Local sphincter defects due to surgical injury and vulvar laceration during delivery.

4. Congenital diseases

Anus with high anal lock and hypoplasia, anal incontinence due to congenital anal sphincter insufficiency.

Clinical manifestations of anal incontinence

1. Complete anal incontinence

Symptoms of incontinence are severe. Patients cannot control the bowel movements at will. There is no fixed number of bowel movements. When the bowel moves, the feces are discharged from the anus; even when coughing, squatting, walking, or sleeping, feces or intestinal fluid can flow out, contaminating clothes and bedding . Dermatological changes such as dampness, erosion, itching around the anus, or eczema on the skin around the anus.

2. Incomplete anal incontinence

There is no incontinence when the stool is dry. Once it is thin, it cannot be controlled, and anal incontinence occurs.

3. Anal sensory incontinence

Not a lot of feces, but when the feces are thin, a small amount of feces overflow unconsciously before defecation, contaminating clothes and pants, and more severe diarrhea, often mucus irritates the skin.

Anal incontinence check

Inspection

(1) Common incontinence of the anus is round, or deformities, defects, scars, feces and intestinal fluid are discharged from the anus, and the skin of the anus may have eczema-like changes. Pull the hips with your hands, the anal canal is completely relaxed and round, and sometimes the anal canal is partially scarred. The rectal cavity can often be seen from the round hole.

(2) Incomplete incontinence The anus is not tightly closed, and fecal contamination can also occur in the anus during diarrhea.

(3) Mucosal eversion often occurs in sensory incontinence .

2. Digital rectal examination

Anal relaxation, contraction of the sphincter and anorectal ring is not obvious and disappears completely when the anal canal is contracted. If it is caused by injury, the anus can be scabbed with scar tissue. Incomplete incontinence can weaken the sphincter contraction.

3. Endoscopy

Proctoscopy can observe the deformity of the anal canal, the state of the anal canal skin and mucosa, and the closure of the anus. Fiber enteroscopy can be observed for colitis, clonal disease, polyps, cancer and other diseases. Hard duct colonoscopy can be used to observe complete rectal prolapse.

4. Defecography

The anatomic sphincter, anal canal, and rectal morphology and anatomy can be determined. X-ray barium examination of the dynamic function status can observe the incontinence and its severity. Involuntary leakage of a large amount of barium is a sign of incontinence.

5. Anal manometry

Can determine the internal and external sphincter and puborectalis muscle abnormality. The anorectal suppresses reflexes and understands its basal pressure, systolic pressure, and rectal dilatation tolerance capacity. Patients with incontinence have reduced anal canal basal and systolic blood pressure, the relaxation of the internal sphincter reflex has disappeared, and the rectal sensory dilation tolerance has decreased.

6. EMG measurement

The scope of sphincter function can be determined to determine the degree of injury and recovery of voluntary and involuntary muscles and their nerves.

7. Anal Canal Ultrasound

It can clearly show the submucosal layer of the anorectal rectum, the internal and external sphincter and its surrounding tissue structure, which can help diagnose anal incontinence and observe whether the sphincter is damaged.

Diagnosis of anal incontinence

Make a diagnosis based on medical history, clinical symptoms, and auxiliary examinations.

Anal incontinence complications

The most common complication in patients with anal incontinence is inflammation of the perineum, palate, and perianal skin. Some patients can also cause retrograde urinary tract infections or vaginitis, and skin swelling and ulceration. This is because the stool stimulates the skin and mucous membranes, and the perineum skin is often in a state of moisture and invasion of metabolites. In addition, friction between the skin causes skin redness, swelling and ulceration.

Anal incontinence treatment

For the treatment of anal incontinence, different treatment methods should be selected according to the cause of the disease and the scope of the injury. If anal incontinence is secondary to a disease, it is necessary to treat the primary lesions, such as central nervous system disease, metabolic disease, anorectal disease, etc., to treat the primary disease, some anal incontinence can be cured, and some can be improved.

Non-surgical therapy

(1) Promote bowel movements to treat colorectal inflammation, make normal feces, avoid diarrhea and constipation, avoid taking irritating foods, and often use fiber foods.

(2) Anal canal sphincter training improves the ability of the external sphincter puborectalis and levator anal muscles to contract freely and increases anal function.

(3) Electrical stimulation is often used for anal incontinence.

2. Surgery

Congenital diseases, anal canal sphincter resection after rectal cancer, etc. require surgical treatment, can be used sphincter repair, rectal vaginal sphincter repair, sphincter fold, skin graft transplantation, sphincteroplasty and so on.

(1) Anal canal sphincter repair is mostly used in patients with short-term injury. Such as wound infection should be repaired within 6 to 12 months to avoid muscle atrophy. If the consultation time is late and the sphincter has atrophied into fibrous tissue, it is difficult to find and suture during surgery, which affects the efficacy.

(2) The sphincter fold is suitable for cases of sphincter relaxation.

(3) Skin graft anal angioplasty is suitable for anal incontinence caused by anal canal skin defect and mucosal eversion.

(4) Sphincteroplasty is currently used to transplant gracilis or gluteus maximus around the anal canal to replace or strengthen sphincter function. For sphincter complete destruction or congenital non-sphincter, and those who cannot be treated with sphincter repair.