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Bowel incontinence or fecal incontinence is a treatable condition. It affects 2 to 7% of the general population and nearly 25% of the institutionalized population.
Most patients are women usually due to injury to the pelvic floor muscles and the anal sphincters after a complicated vaginal childbirth or frail elderly men with weakened muscles of the rectum and damaged nerve complexes.
The actual prevalence of the condition is far more than the known figures since many patients with this embarrassing condition do not contact their healthcare provider.
Further, bowel incontinence is a symptom of an underlying condition rather than a disease in itself. It is essential that the condition is detected early and treated to prevent further complications.
The treatment plan also depends on the underlying cause of the condition and the pattern of the symptoms. According to the general principles of therapy, the physicians try the least intrusive treatments first before more invasive methods.
The first steps include dietary changes and exercise programmes. More invasive methods include medication or surgery and are considered only if other treatment options are unsuccessful.
Treatment includes the following methods: continence products, diet modification, medicines and so forth. 1-7 –
These include anal plugs that are a good way to prevent episodes of soiling. The plugs are made of foam and designed to be inserted into the anus. Since the plug is made of foam it expands like a mushroom when it comes in contact with any moisture from the bowel. This prevents any further leakage.
These can be worn for up to 12 hours and may be removed by pulling the attached string. It may feel uncomfortable initially but the symptoms usually resolve with time.
Another option is an adult diaper or a disposable pad. These soak the liquid stools and protect the skin. These are useful in mild bowel incontinence.
When bowel incontinence is associated with diarrhoea or constipation, the symptoms may be reduced using changes in diet. Those with soft or loose stools may be given a low fibre diet.
Patients with constipation need high fibre in diet to soften and produce formed stools. Patients are asked to maintain a food diary to record the effect of the dietary changes on the symptoms of incontinence.
Patients with diarrhea associated with bowel incontinence are advised to take reduced insoluble fibre in diet. Insoluble fibre sources in diet include wholegrain breads, bran, cereals and nuts.
Patients are advised to avoid fibre from fruits and raw vegetables as well and limit foods with resistant starch such as pulses, whole grains, corn and green bananas. Foods with high fat content also need to be avoided.
Patients who have predominant constipation need high-fibre diet. These include fruits, vegetables, beans, whole grains, seeds, nuts, oats etc. These patients are also advised to drink plenty of water to soften the stools.
Some medications, like Loperamide, may be used to treat diarrhea. This slows down the movement of the stools and may be needed for long periods of time in patients with diarrhea.
Laxatives may be prescribed to treat constipation in patients with bowel incontinence. Bulk-forming laxatives are usually recommended.
Patients of bowel incontinence may need pelvic floor muscle training. These are important for all women after vaginal childbirth. These exercises strengthen any muscles that may have been stretched and weakened during childbirth.
These exercises are needed at least exercises three times a day, for six to eight weeks after delivery. The basic tenet of these exercises includes squeezing and holding the pelvic muscles in the taut position while sitting, standing or lying positions.
The breath is held while the muscles are held tight and then again let off as the muscles are relaxed.
This is recommended for people who have reduced sensation in their rectum as a result of nerve damage. These include:
establishing a regular time for bowel evacuation
making the constituency of the stools amenable for easy evacuation
stimulating the bowel for movement
Stool consistence may be improved by dietary modification. A time is set aside in the daily routine for bowel evacuation. Sometimes a hot drink or a meal may help in bowel evacuation stimulation.
This is a method of bowel retraining that uses a small electric probe within the anus. This probe sends back information about the movement and pressure of the muscles in the rectum to a computer. Exercise programmes are then prescribed to improve the bowel function.
Some patients may also benefit from enemas. This is useful in patients with faecal impaction. The enema involves insertion of a small tube in the anus and irrigation of the rectum with a special solution to wash the walls out.
Surgery for bowel incontinence is the last resort and is needed only in very severe cases.
Open surgeries like sphincteroplasty may be undertaken to correct the torn or damaged sphincter muscles. In this surgery the muscle edges are overlapped and sewn back together to make the sphincter stronger.
Some patients may require replacement of the sphincter muscles called stimulated graciloplasty. The sphincter is created using a sample of muscle from the thigh of the patient.
Endoscopic heat therapy is tried in some patients. This technique uses heat via a thin probe over the sphincter muscles to encourage scarring of the tissue and tighten the sphincter.
Bulking agents like collagen or silicone can be injected into the muscles of the sphincter and rectum to strengthen them. Sacral nerve stimulation and tibial nerve stimulation may also be undertaken in patients with weak sphincter muscles.
Some patients may need a radical surgery called the colostomy. In this the lower bowel or colon is cut and brought out through the wall of the abdomen after creating an opening and a bag, known as a colostomy bag is attached to the opening to collect the stool.
Emotional and psychological support to the patient and family is important and assessment and treatment of depression and other mental health conditions play a vital role in therapy.
Those with cognitive impairment need behavioural and functional analysis and cause-specific behavioural interventions may be tried.
Patients also require skin care, odour control, disposable gloves and other laundry advice to maintain hygiene.