Fecal Incontinence Health Article

Definition

Fecal incontinence is the inability to control the passage of gas or stools (feces) through the anus. For some people, fecal incontinence is a relatively minor problem that is limited to a slight occasional soiling of underwear, but for others it involves a considerable loss of bowel control. This loss can have a devastating effect on a patient's quality of life and psychological well-being. Fortunately, professional medical treatment is usually able to restore bowel control or at least substantially reduce the severity of the condition.

Description

Fecal incontinence, also called bowel incontinence, can occur at any age, but is most common among people over the age of 65, who sometimes have to cope with urinary incontinence as well. The condition is more common among women than men. The problem affects as many as 6.5 million Americans.

The wider public health impact of fecal incontinence is considerable. In the United States, more than $400 million is spent each year on disposable underwear and other incontinence aids. Fecal incontinence is the second most common reason for seeking a nursing home placement. One-third of the institutionalized elderly suffer from this condition. Incontinence sufferers, however, often hesitate to ask their doctors for help because they are embarrassed or ashamed.

Causes and symptoms

Fecal incontinence can result from a wide variety of medical conditions, including childbirth-related anal injuries, other causes of damage to the anus or rectum, and nervous system problems.

Vaginal-delivery childbirth is a major cause of fecal incontinence. In many cases, childbirth results in damage to the anal sphincter, which is the ring of muscle that closes the anus and keeps stools within the rectum until a person can find an appropriate opportunity to defecate. Nerve injuries during childbirth may also be a factor in some cases. A study in 2000 by the Brigham and Women's Hospital in Boston, Massachusetts, found that women who had episiotomies were at higher risk for postpartum fecal incontinence. Childbirth-related incontinence is usually restricted to gas, but for some women it involves the passing of liquid or solid stools.

The removal of hemorrhoids by surgery or other techniques (hemorrhoidectomies) can also cause anal damage and fecal incontinence, as can more complex operations affecting the anus and surrounding areas. Anal and rectal infections, as well as Crohn's disease, can lead to incontinence by damaging the muscles that control defecation. New-onset fecal incontinence can also be a sign of colorectal cancer. For some people, incontinence becomes a problem when the anal muscles begin to weaken in midlife or old age.

Dementia, mental retardation, strokes, brain tumors, multiple sclerosis, and other conditions that affect the nervous system can cause fecal incontinence by interfering with muscle function or the normal rectal sensations that trigger sphincter contraction and are necessary for bowel control. One study of multiple sclerosis patients discovered that about half were incontinent. Nerve damage caused by long-lasting diabetes mellitus (diabetic neuropathy) is another condition that can give rise to incontinence.