What is fecal incontinence?
Fecal incontinence - also called anal incontinence -- is the term
used when bowel movements cannot be controlled. Stool (feces/waste)
leaks out of the rectum at unwanted times - not at planned bathroom
breaks. This leakage occurs with or without your knowledge. Fecal
incontinence happens more often in women than in men and also is a
common occurrence in the elderly.
The term fecal incontinence is used if any of these situations
occur:
- Stool leaks out when passing gas
- Stool leaks out due to physical activity/daily life
exertions
- A person may "feel like he/she has to go" and not be able to
make it to the bathroom in time
- Stool is seen in the underwear after a normal bowel
movement
- There is complete loss of bowel control
Why does fecal incontinence happen?
Several factors affect continence of stool or the ability to
control bowel movement:
- Muscles in the rectum and anus (the very last two sections of
the intestines) must be working properly.
- The rectum must be able to stretch to hold the stool. A "rectal
sensation" has to be present to provide warning of the need to move
bowels. When properly working, this means a person gets a feeling
that it is time to go to the bathroom.
- The anal muscles, which are called sphincters, must have the
ability to squeeze the anus shut. If these muscles are not working
properly, stool can leave the body unexpectedly.
- The person lacks the physical and mental abilities to
"recognize the signal" that it is time to go to the bathroom to
move bowels, or the physical mobility to reach the bathroom.
- Stools are very watery or explosive or both.
If any of these body functions are not working properly, fecal
incontinence occurs.
What causes changes in these body
functions?
- Frequent diarrhea or constipation. These
conditions cause the muscles in the rectum and anus to weaken. When
these muscles weaken, the ability to hold stool within the body
also weakens.
- Muscle damage. Muscle damage can occur during
a difficult vaginal childbirth, when doctors have to use forceps or
make a small cut (an episiotomy) to make a larger opening. Muscle
damage can also result from anal or rectal surgery (but not from
hemorrhoid surgery.)
- Older age. Muscles in the rectum and anus
naturally weaken with age. Other nearby structures in the pelvis
area also loosen with age. This adds to the general weakness seen
in that area of the body, leading to problems with stool control.
Loose stool is more difficult to control than solid stool. When a
large amount of loose stool arrives rapidly in the rectum, there
may not be enough warning to reach the bathroom in time.
- Damage to nerves. If the nerves that control
the ability of the rectum and anus muscles to contract are damaged,
incontinence can result. Nerves that control "rectal sensation" can
also lead to incontinence if they are damaged. Nerve damage occurs
due to a difficult vaginal delivery, anal surgery, constipation
(resulting in bouts of frequent and severe straining), or the
presence of certain health conditions (eg, diabetes, multiple
sclerosis, stroke, spinal tumor).
- Inability of the rectum to stretch. If the
muscles of the rectum are not as elastic as they should be, excess
stool that builds up can leak out. Inflammatory bowel disease (such
as Crohn's disease) can also affect the rectum's ability to
stretch. The scars resulting from surgery and radiation therapy can
also stiffen the muscles of the rectum.
- Other medical conditions. Certain medical
conditions, such as rectal prolapse (the rectum falls down into the
anus) or rectocele (the rectum pushes into the vagina), or chronic
constipation where stool leaks around a large stool ball.
- Other causes: Laxative abuse, radiation
treatments, certain nervous system and congenital (inherited)
defects, inflammation and inflammatory bowel disease may result in
loss of ability to control stool.