Diagnosis of bowel incontinence or fecal incontinence depends of various factors. History of childbirth, age, sex and history of a rectal or anal surgery are important predictors of diagnosis and outcome of the condition.

The diagnosis of bowel incontinence includes detailed analysis of symptoms, digital rectal examination and so forth.1-5

Detailed analysis of symptoms of bowel incontinence

Detailed analysis of symptoms of the incontinence. The bowel incontinence may be one of the three classical types –

• Urge incontinence – the patient is unable to hold the stools after the urge or need to evacuate arises and needs to visit the toilet immediately
• Passive incontinence – the person has no sensation of a complete bowel evacuation. There is not urge or feeling of need to evacuate the bowels whatsoever.
• Leakage of stools – there is a constant leakage of stools.

Other questions include patterns of diet, and episodes of constipation, diarrhea and other abdominal symptoms.

History of difficult vaginal; childbirth, age of the patient, cognitive status or dementia and other mental health conditions need to be assessed during evaluation of a case of bowel incontinence.

All risk factors affecting rectal, anal and pelvic muscles, sphincters of the rectum and anus as well as nerve damage are thus, fully evaluated.

Digital rectal examination

A digital rectal examination is then performed. This involves insertion of a lubricated gloved finger into the anus gently to assess the insides of the rectal wall and the sphincter functions.

A local anesthetic gel is usually used and the condition is usually not severely painful.

Endoscopy of the rectum

An endoscopy of the rectum or Proctosigmoidoscopy may be prescribed. A thin long tube with a light and camera on its tip is inserted into the rectum and the inner walls are viewed for any abnormalities.

This is usually not painful but may be uncomfortable and many patients are sedated for the procedure.

The inner walls of the rectum may be visualized using a proctoscope as well.

Anal manometry

Anal manometry is another test that is recommended. This is a small device like a thermometer with a balloon attached to the end. The device is inserted into the rectum and the balloon is inflated. This is usually not painful or uncomfortable.

A machine is attached to the device. This machine reads the pressure readings taken from the balloon. Manometry is performed to assess the strength of the sphincter muscles, rectal muscles and the nerve functions of the rectum.

In addition, the balloon may be inflated to different sizes to determine when the rectum feels full. If the balloon is relatively large and still no sensation of fullness appears there may be a problem with the rectal nerve complexes.

Ultrasound for diagnosis of bowel incontinence

Ultrasound is sometimes prescribed to assess the rectum as well as abdominal pathologies that may be leading to bowel incontinence.

Defecography

Defecography or Proctography may also be recommended. This test involves drinking a harmless liquid called barium. Barium is used because it is visible on X-rays. Patient is asked to pass stool while X rays are taken. This reveals fecal impaction and obstructions in stool passage.

Anal electromyography

Anal electromyography is yet another test that checks for any damage to the nerves of the rectum that pass the message of fullness to the brain.

In this test small electrodes are inserted in the muscles around the anus. These detect the electrical signals from the rectal and anal muscles that are transmitted through the nerves to the brain.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) shows the detailed picture of the rectum and the sphincters and may be prescribed.