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Encyclopedia > Fecal incontinence
Symptom/Sign: Fecal incontinence
Classifications and external resources
ICD-10 R15.
ICD-9 787.6

Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected are often beset by feelings of shame and humiliation. Some refuse to seek medical help, and instead attempt to self-manage the problem. This can lead to social withdrawal and isolation, which can turn into cases of agoraphobia. Such effects may be reduced by undergoing prescribed treatment, taking prescribed medicine and making dietery changes. A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ... In medicine, a sign is a feature of disease as detected by the doctor during physical examination of a patient. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // R00-R99 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R09) Symptoms and signs involving the circulatory and respiratory systems (R00) Abnormalities of heart beat (R000) Tachycardia, unspecified (R001) Bradycardia, unspecified (R002) Palpitations (R008) Other and unspecified abnormalities of heart beat (R01) Cardiac murmurs and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Look up isolation in Wiktionary, the free dictionary. ... Agoraphobia is an anxiety disorder precipitated by the fear of having a symptom attack or panic attack in a setting from which there is no easy means of escape. ...

Contents

Prevalence

Fecal incontinence affects people of all ages. Fecal incontinence is more common in women than in men, and more in older adults than in younger adults. It is not, however, a normal part of aging.


Causes

Muscle damage

Fecal incontinence is most often caused by injury to one or both of the ring-like muscles at the end of the rectum called the internal and external anal sphincters. During normal function, these sphincters help retain stool. When damaged, the operation of the muscles is compromised, and leaks may occur. Look up stool in Wiktionary, the free dictionary. ...


In women, the damage often happens during childbirth. The risk of injury is greatest when the birth attendant uses forceps to help the delivery or does an episiotomy. Hemorrhoid surgery can damage the sphincters as well. A pelvic tumor that grows in or becomes attached to the rectum or anus also can cause muscle damage, as can surgery to remove the tumor. Parturition redirects here. ... Forceps can be used to assist the delivery of a baby as an alternative to the ventouse method. ... Medio-lateral episiotomy as baby crowns. ... Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. ... A pelvic tumor is any one of numerous tumors that occur in the pelvis. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... This article is about the bodily orifice. ...


In both men and women, similar damage can result from engaging in anal sex.[citation needed] Roman men having anal sex. ...


Nerve damage

Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that detect stool in the rectum. Damage to the nerves controlling the sphincter muscles may render the muscles unable to work effectively. If the sensory nerves are damaged, detection of stool in the rectum is disabled, and one will not feel the need to defecate until too late. Nerve damage can be caused by childbirth, long-term constipation, stroke, and diseases that cause nerve degeneration, such as diabetes and multiple sclerosis. Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... For other uses, see Stroke (disambiguation). ... For other uses, see Nerve (disambiguation). ... This article is about the disease that features high blood sugar. ...


Loss of storage capacity

Normally, the rectum stretches to hold stool until it is voluntarily released. But rectal surgery, radiation treatment, and inflammatory bowel disease can cause scarring, which may result in the walls of the rectum becoming stiff and less elastic. The rectum walls are unable to stretch as much and are unable to accommodate as much stool. Inflammatory bowel disease also can make rectal walls very irritated and thereby unable to contain stool. For other uses, see Radiation (disambiguation). ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ...


Diarrhea

Main article: Diarrhea

Diarrhea, or loose stool, is more difficult to control than solid stool that is formed. For people who are normally unaffected by fecal incontinence, this can manifest itself as a temporary form. Diarrhea, also spelled diarrhoea (see spelling differences), is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause of death in developing countries (particularly among infants), accounting for 5 to 8 million deaths... Diarrhea, also spelled diarrhoea (see spelling differences), is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause of death in developing countries (particularly among infants), accounting for 5 to 8 million deaths...


Pelvic floor dysfunction

Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocele), and generalized weakness and sagging of the pelvic floor. The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. ... Rectal prolapse normally describes a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body. ... A rectocele is an abnormal bulging of the rectovaginal septum (which is normally a semi-rigid divider between the rectum and vagina) into the vaginal area. ...


Other causes

Fecal incontinence can other causes including one or a combination of the following:

The kidneys are important excretory organs in vertebrates. ... A fecal impaction is a solid, immobile bulk of stool that can develop in the rectum as a result of chronic constipation. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... Orlistat (marketed under the trade name Xenical by Roche; or over-the-counter as Alli[1] by GlaxoSmithKline, pronounced , like the English word ally)—also known as tetrahydrolipstatin—is a drug designed to treat obesity. ... A ball and stick model of Olestra, showing a central sucrose molecule with ester-linked fatty acids Olestra (also known by its brand name Olean) is an artificial fat substance created by Procter & Gamble in 1968. ... This article does not cite any references or sources. ... Stimulants are drugs that temporarily increase alertness and wakefulness. ...

Diagnosis

Severity scales

The Cleveland Clinic Incontinence Score is widely used because it is practical and easy to use and interpret. The score takes into account the frequency of incontinence and the use of pads and lifestyle alteration. A Fecal Incontinence Severity Index[1] is based on a type-by-frequency matrix with four types of leakage (gas, mucus, liquid stool, solid stool) and five frequencies (one to three times per month, once per week, twice per week, once per day, twice or more per day). Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio. ...


Other tests include: AMS, Pescatori, Williams score, Kirwan, Miller score, Parks criteria, and the Vaizey scale.


Tests

Anal manometry checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum. Anorectal ultrasonography evaluates the structure of the anal sphincters. Proctography, also known as defecography, shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can evacuate the stool. Proctosigmoidoscopy allows doctors to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors, or scar tissue. Anal electromyography tests for nerve damage, which is often associated with obstetric injury. In medicine, manometry is a study performed to examine the pression of one part of the body, generally the muscle function of the esophagus. ... Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structure and any pathological lesions, making them useful for scanning the organs. ... Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. ... Electromyography (EMG) is a medical technique for measuring muscle response to nervous stimulation. ...


Treatment

Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary because some forms of fecal incontinence can be rather complicated. Most physicians that specialize in gastroenterology, rehabilitative medicine, neurotrauma, and pediatric surgery have experience with bowel management programs. "Social continence" may be achievable for some people using a bowel management program that cleans out the colon daily. Gastroenterology (MeSH heading[2] ) is the branch of medicine where the digestive system and its disorders are studied. ...


There are several devices and medications available to combat fecal incontinence. One method of relatively easy treatment is the use of diapers. Both cloth and disposable diapers are available for fecal incontinence. Pull-up type diapers are not recommended for fecal incontinence. Thicker-type diapers are generally seen as the best method of treating fecal incontinence, since these diapers are thicker and have inner linings to help control fecal matter better.

 Dealing with Fecal Incontinence 

Dietary changes

Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, decreasing the water content of the feces and making it firmer. Also, avoidance of foods and drinks such as those containing caffeine, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly. Foods to be avoided also include those that typically cause diarrhea, such as cured or smoked meat; spicy foods; alcohol; dairy products; fatty and greasy foods; and artificial sweeteners. In polymer chemistry and Process Engineering, curing refers to the toughening or hardening of a polymer material by cross-linking of polymer chains, brought about by chemical additives, ultraviolet radiation or heat. ... Wikibooks Cookbook has more about this subject: Smoking Smoking is the process of preserving, cooking, or flavoring food by exposing it to the smoke from burning or smoldering plant materials, most often wood. ... For other uses, see Meat (disambiguation). ... For other uses, see Spice (disambiguation). ... This article does not cite any references or sources. ... Dairy products are generally defined as foodstuffs produced from milk. ... A sweetener is a food additive which adds the basic taste of sweetness to a food. ...


Foods that add bulk to stool are Bananas, rice, applesauce, tapioca, toast, and marshmellows. Your fiber supplement, Fibercon, may also help with this. Try taking an extra dose for a trial period. If incontinence worsens, then return to original dose.


Remember, while on Xeloda, if you develop diarrhea greater than 4 times a day to report this to Dr. Heckman's office. If diarrhea occurs like this on the weekend, stop the Xeloda and report this to Dr. Heckman on Monday.


Report problems with skin breakdown to Janet. We have various skin barrier products that will protect your skin and help heal it.


Medication

Medication consists primarily of antipropulsive drugs. An antipropulsive is a drug which is used in the treatment of diarrhea. ...


Surgery

Surgical procedures used to treat otherwise intractable fecal incontinence include: “Surgeon” redirects here. ...

  • Artificial anal sphincter (also known as "artificial bowel sphincter" and "neosphincter").[2] The usual surgical approach is through the perineum but because in many cases of fecal incontinence the perineum is damaged, for women an alternative approach is through the vagina.[3]
  • Temperature-controlled radiofrequency energy (SECCA)[4]
  • Antegrade continent enema stoma. This procedure is often necessary in addition to others when fecal incontinence is complicated by neuropathy and/or an incomplete internal anal sphincter.
  • Sacral nerve stimulation, the newest of these surgical procedures, involves implanting an electric device that causes contraction of the anal sphincter. To defecate, the person holds a small magnet against the skin over the device, temporarily turning off the device and allowing the sphincter to relax. This procedure requires an intact anal sphincter. [1]

Graciloplasty and artificial anal sphincter both significantly improve continence, with artificial anal sphincter being superior,[5] however both methods have high rates of complications.[5][6] A colostomy is a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. ... Male Anatomy The anus, in anatomy, is the external opening of the rectum. ... The Gracilis muscle is a muscle of the human body. ... In humans the thigh is the area between the pelvis and buttocks and the knee. ... In human anatomy, the perineum, also called the taint, or gooch, is generally defined as the surface region in both males and females between the pubic symphysis and the coccyx. ... The vagina, (from Latin, literally sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ... Neuropathy is usually short for peripheral neuropathy, meaning a disease of the peripheral nervous system. ...


See also

Anal leakage is a medical condition of fecal incontinence. ... Encopresis is involuntary fecal soiling in children who have usually already been toilet trained. ... Soiling in children is the involuntary passage of stools in conjunction with constipation (abnormal if > 4 years of age, Boys : Girls = 3 : 1) It is a common problem among children. ...

External links

The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. ... The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. ...

References

  1. ^ Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (1999). "Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index.". Dis. Colon Rectum 42 (12): 1525–32. PMID 10613469. 
  2. ^ Schrag HJ, Ruthmann O, Doll A, Goldschmidtböing F, Woias P, Hopt UT (2006). "Development of a novel, remote-controlled artificial bowel sphincter through microsystems technology.". Artif Organs 30 (11): 855–62. doi:10.1111/j.1525-1594.2006.00312.x. PMID 17062108. 
  3. ^ Michot F, Tuech JJ, Lefebure B, Bridoux V, Denis P (2007). "A new implantation procedure of artificial sphincter for anal incontinence: the transvaginal approach.". Dis. Colon Rectum 50 (9): 1401–4. doi:10.1007/s10350-007-0314-6. PMID 17665251. 
  4. ^ Felt-Bersma RJ, Szojda MM, Mulder CJ (2007). "Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement.". Eur J Gastroenterol Hepatol 19 (7): 575–80. doi:10.1097/MEG.0b013e32811ec010. PMID 17556904. 
  5. ^ a b Ruthmann O, Fischer A, Hopt UT, Schrag HJ (2006). "[Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence]" (in German). Chirurg 77 (10): 926–38. doi:10.1007/s00104-006-1217-0. PMID 16896900. 
  6. ^ Belyaev O, Müller C, Uhl W (2006). "Neosphincter surgery for fecal incontinence: a critical and unbiased review of the relevant literature.". Surg. Today 36 (4): 295–303. doi:10.1007/s00595-005-3159-4. PMID 16554983. 
Aminosalicylic acid (C7H7NO3) is also known as para-aminosalicylic acid, p-aminosalicylic acid or 4-aminosalicylic acid; abbreviated 4-ASA, PAS or P. It is sold in the US by Jacobus Pharmaceutical as Paser®. 5-aminosalicylic acid is a closely related compound that also has medical uses. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ... Mesalazine (INN, BAN), also known as Mesalamine (USAN) or 5-aminosalicylic acid (5-ASA), is an anti-inflammatory drug used to treat inflammation of the digestive tract (Crohns disease) and mild to moderate ulcerative colitis. ... Olsalazine is an anti-inflammatory drug used in the treatment of Inflammatory Bowel Disease and Ulcerative Colitis. ... Balsalazide is an anti-inflammatory drug used in the treatment of Inflammatory Bowel Disease. ... Binomial name Saccharomyces boulardii Henri Boulard Saccharomyces boulardii is a tropical strain of yeast first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard. ... Binomial name Linnaeus The Carob tree (from Arabic: خروب kharoub and Hebrew: חרוב Charuv), Ceratonia siliqua, is an evergreen shrub or tree native to the Mediterranean region, cultivated for its edible seed pods. ...

  Results from FactBites:
 
Fecal Incontinence | AHealthyMe.com (1607 words)
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, as when it is limited to a slight occasional soiling of underwear, but for other people it involves a considerable loss of bowel control and has a devastating effect on quality of life and psychological well-being.
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.
Fecal incontinence (3822 words)
Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum.
Fecal incontinence is often a sign of late-stage Alzheimer's disease, in which both dementia and nerve damage play a role.
If fecal incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel training program and exercise therapies aimed at helping you restore muscle strength.
  More results at FactBites »


 
 

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