How Do I Treat Bowel Incontinence?

Fecal incontinence is anal incontinence, which means that stool and gas cannot be controlled at will, and flows out of the anus involuntarily, which is a symptom of defecation dysfunction. The incidence of fecal incontinence is not high, but it is not uncommon. Although it is not directly life-threatening, it causes physical and mental pain to patients, and seriously interferes with normal life and work.

Basic Information

English name: fecal incontinence
Visiting department: Anorectal

Common locations: anus
Common symptoms: Feces and gases cannot be controlled at will and flow out of the anus involuntarily

Causes of Fecal Incontinence

Congenital malformation of the anus

(1) Congenital lumbosacral meningocele or spina bifida may be associated with anal incontinence. The patient's external sphincter and puborectalis muscle lost normal innervation, had no contractile function, and were in a relaxed state. And because both the sensory and motor systems are affected, the rectal mucosa lacks a sense of swelling when the feces are full, and can not cause a sense of instinct and initiate defecation. The feces in the rectum are discharged at any time. Such children are often accompanied by urinary incontinence.

(2) Anorectal deformities The anorectal itself and the pelvic structure have changed, and the higher the blind rectum, the more obvious and complicated the change. When the deformity is high, the blind rectum is located above the pelvic ridge, the puborectalis is shortened, and it is obviously shifted forward and upward; the internal sphincter is absent or only in the embryonic state; the external sphincter is mostly in a loose state, filled with adipose tissue, and the muscle fibers are abnormal disorder. The etiology is mainly related to deformity accompanied by defects in sensory and motor nerve tissue structure.

2. Trauma

Due to trauma damage to the anorectal ring, the sphincter lost its sphincter function and became incontinent. Such as stab wounds, cuts, burns, frostbite and lacerations (mainly perineal lacerations during delivery).

3. Neurological disease

More common in brain trauma, brain tumors, cerebral infarction, spinal cord tumors, spinal tuberculosis, and cauda equina injury can cause fecal incontinence.

4. Anorectal diseases

The most common are anorectal tumors; such as rectal cancer, anal canal cancer, Crohn's disease invades the anorectal rectum and affects the anal sphincter, or anal canalitis caused by chronic diarrhea of ulcerative colitis, or rectal prolapse The resulting anal relaxation and severe scars around the anus affect the anal sphincter, which can cause fecal incontinence when the anus is incompletely closed.

Clinical manifestations of fecal incontinence

Unable to control excretion of feces and gas, which often causes the perineum to be wet, and the feces stain the clothes and pants. During complete incontinence, feces can flow by themselves at any time; when coughing, walking, squatting, and sleeping, feces and mucus often flow out of the anus. When incontinence is incomplete, although dry stool can be controlled, but thin stool can not be controlled. When concentrated on controlling the anus, the feces will not flow out.

Fecal Incontinence Check

Laboratory inspection

(1) Anorectal manometry includes resting pressure controlled by the internal anal sphincter, maximum pressure when the external sphincter contracts randomly, and the perceptual threshold of stimulus during relaxation. Both resting anal pressure and maximum pressure decrease during fecal incontinence.

(2) Electromyography is an objective basis for understanding the physiological activities of pelvic floor muscles and sphincter muscles to understand the location and extent of nerve and muscle damage.

(3) Defecation angiography can record the dynamic changes during defecation. The rectum angle can be used to infer the state of the puborectalis and the degree of damage.

(4) Saline enema test Inject 1500ml of normal saline into the rectum while sitting, record the leakage and maximum retention to understand the self-control ability of defecation. Retention is reduced or zero during fecal incontinence.

(5) Anal canal ultrasound images can accurately determine the anal sphincter defect site and measure the thickness of the internal sphincter asymmetry.

2. Auxiliary inspection

(1) The visual inspection may show the original surgery or scar scar of the trauma.

(2) Anal finger examination sees anal canal relaxation or poor sphincter contractile function, etc. Clinical diagnosis can establish that the primary cause is in the nervous system and the colon. Barium enema and endoscopy should be established through neurological examination. In recent years, there have been some new developments in anorectal function tests, including abnormal muscle tension seen in electromyography, prolonged anal reflex latency, disappearance of anal skin reflex and normal rectal swelling. Anorectal balloon manometry showed abnormal pressure maps.

(3) The disappearance of the rectal angle of the anal canal can be seen on X-ray examination of defecation . These examinations can help distinguish the etiology of the disease and develop appropriate treatment methods.

Fecal Incontinence Diagnosis

Medical history

Ask if there is a history of congenital anal deformity, surgery, trauma, whether the female patient has a history of birth injury, whether there are neurological and urinary system diseases, whether they have received radiation therapy; the current severity of incontinence, the number of defecations and the nature of the feces, and whether Feeling of pleasure.

2. Physical examination

Through digital rectal examination, endoscopy, defecation contrast, electromyography and so on.

Differential diagnosis of fecal incontinence

It is mainly distinguished from occasional loose stools in patients with diarrhea such as acute bacillary dysentery and acute enteritis. However, the stools of these patients can be controlled freely in most cases, and the patients often have abdominal pain, pus, blood or watery stools. After symptomatic treatment, With the relief of diarrhea symptoms, stool formation, and occasional stool incontinence disappeared. Fecal incontinence is mainly the identification of the causes, including neurological disorders and injuries, muscle dysfunction and impairment, and congenital diseases.

Fecal Incontinence Treatment

Non-surgical therapy

(1) Diet regulation treats inflammation of the anorectal rectum, forms stool, avoids diarrhea and constipation, and eliminates the discomfort of anorectal inflammation. The commonly used method is to eat more fiber-rich and nutritious foods and avoid irritating foods. If there is inflammation of the anal canal, antibiotics can be taken symptomatically. If there is inflammation of the perianal skin, the perianal should always be kept clean to keep it dry or rubbed with external medicine.

(2) Anal sphincter exercise method is to instruct the patient to contract the anus (anus levator), and raise the anus about 500 times a day for several seconds each time. This can enhance the function of the anal sphincter.

(3) Stimulation of anal sphincter contraction For neurological anal incontinence, electrical stimulation and acupuncture can be used. Electrical stimulation therapy is to place the stimulation electrode in the external sphincter, and use electrical stimulation of the anal sphincter and levator ani muscle to cause regular contraction. Some patients with anal incontinence can be improved. Acupuncture is a traditional medicine therapy in the motherland, and some patients can also achieve good curative effects. The common acupuncture points are Changqiang, Baihui, Chengshan, etc.

2. Surgery

The surgical treatment of anal incontinence is mainly used for anal sphincter injury and anal incontinence after congenital high anal atresia.

(1) Anal canal sphincter repair is suitable for patients with anal canal sphincter injury caused by trauma. Generally repair within 3 to 12 months after injury. If the time is too long, the sphincter can produce wasteful atrophy.

(2) Anterior canal sphincter folding is suitable for patients with sphincter relaxation.

(3) Transvaginal sphincter folding is suitable for patients with sphincter relaxation.

(4) Parks posterior anal canal pelvic floor repair is suitable for those with severe anal incontinence and rectal prolapse who still have severe anal incontinence.