What is Fecal or Anal Incontinence?More than 5.5 million Americans have anal incontinence. The problem can range from occasional leakage of a small quantity of stool while passing gas to a complete loss of bowel control.
It is more common in older people and in women. If you have anal incontinence and have not discussed your symptoms with a physician or family members, you are not alone.
People with chronic or recurring anal incontinence may have few or frequent accidents. The symptoms may range from the inability to hold gas, "silent" leakage of stool during daily activities or exertion, or being unable to reach the toilet in time. Other intestinal symptoms can include diarrhea, constipation and abdominal discomfort.
What can you do if you have anal incontinence?While your primary care physician may be able to assist you, full treatment of anal incontinence will likely require a specialist in treating conditions that affect the colon, rectum and anus. The physicians of the Colon & Rectal Clinic (CRC) understand the emotional and social consequences of anal incontinence.
Your CRC doctor will talk to you about your symptoms and perform a physical examination, including a rectal examination. One or more tests may be performed to identify the cause for incontinence. The physicians of CRC do what they can to minimize discomfort during these tests that can include:
- Anal manometry: A short flexible tube, passed into the anus and rectum, measures the strength of the anal sphincter and rectal sensation.
- Anorectal ultrasonography: By placing a small, balloon-tipped ultrasound probe into the rectum, pictures of the anal sphincters are taken as the ultrasound probe is withdrawn.
- Defecocraphy: Liquid barium is placed in the colon and rectum with a small rectal tube while you lie on a table. After the rectal tube is removed, you will be asked to sit on a specially designed toilet as an x-ray video is made.
- Proctosigmoidoscopy: A long, slender tube with a tiny video camera attached is passed into your rectum to examine the last 2 feet of your colon. This test can identify inflammation, tumors or scar tissue that may cause anal incontinence.
- Anal electromyography (EMG): Tiny needle electrodes will be inserted into muscles around your anus to identify nerve damage.
What are the treatment options for anal incontinence?Fortunately, effective treatments are available for anal incontinence that can help improve or restore bowel control. Depending on the cause of your incontinence, your CRC physician may recommend:
- Dietary Changes: Avoid spicy, fatty and greasy foods; cured or smoked meat; and dairy products (especially if you are lactose intolerant). Caffeinated beverages and products containing artificial sweeteners can act as laxatives (e.g., sugar-free gum and diet soda).
- Medications: For constipation, your doctor may suggest a diet of fiber-rich foods and prescribe fiber supplements. For diarrhea, your doctor may recommend medications or fiber supplements that help bind stool. Most physicians agree that use of loperamide (Imodium) is the best first line treatment for anal incontinence. If you leak large amounts of stool frequently, consider applying a moisture-barrier cream to prevent direct contact between irritated skin and feces. Non-medicated talcum powder or cornstarch also may help relieve anal discomfort. If you use pads or adult diapers, make sure they have an absorbent wicking layer on top to move moisture away from your skin.
- Exercises: Bowel retraining programs and exercise therapies may help to improve muscle strength in the vicinity of the anus.
- Surgery: Examples where surgery may be the best treatment for anal incontinence include women with anal sphincter damage caused by childbirth, or in patients with rectal prolapse. The most common surgical procedure is a sphincteroplasty, which repairs a damaged or weakened anal sphincter. A colostomy, diverting stool through an opening in the abdomen instead of through the rectum, is the last resort to treat fecal incontinence.
Do not suffer in silence and embarrassment. There are many options to help patients with anal incontinence. Make an appointment with one of the board-certified physicians at the Colon & Rectal Clinic nearest you for an evaluation.