Fecal incontinent – what to do?

Fecal incontinent - what to do?

The causes of faecal incontinence are varied: poor diet, constipation, muscle weakness in old age or chronic illnesses can trigger faecal incontinence. Therapeutically, for example, changing your diet and strengthening the pelvic floor can help against faecal incontinence. In the following article, you will learn how to recognize faecal incontinence and what causes and promises relief if you are faecal incontinent.

What is faecal incontinence?

Faecal incontinence describes the inability to retain stool and digestive gases in the rectum until voluntary stool is passed. Up to three per cent of the German population is affected.


When do we speak of faecal incontinence?

In general, one speaks of faecal incontinence when intestinal gases or intestinal contents regularly and involuntarily escape from the rectum and cannot be held back until going to the toilet.

Fecal incontinence must be distinguished from defecation (encopresis). Defecation describes – sometimes even arbitrary – passing of stool of normal consistency in places not intended for this in the socio-cultural environment of the person affected.

This is how the diagnosis works.

To diagnose faecal incontinence, a visit to the doctor is necessary. When diagnosing faecal incontinence, the patient’s symptoms in the medical consultation are crucial for the doctor.

A physical examination with a rectal-digital exam, in which the tension of the sphincter muscle is measured, is also helpful in the diagnosis. The muscle tension of the sphincter can also be measured using measuring devices, such as continence tests. A healthy person can typically retain around 800 ml of fluid.

Depending on the case, imaging studies such as examining the rectum can also be helpful.


How does defecation normally work?

When stool enters the rectum, stretch receptors are activated there. This causes the internal sphincter to automatically relax. Meanwhile, the muscle tension of the external sphincter, which we can control voluntarily, increases. The feeling creates an urge to defecate. The stool is only emptied when the external sphincter and pelvic floor relax.

Symptoms and classification of fecal incontinence

Fecal incontinence is medically classified into three levels of severity based on the severity of its symptoms:

  • Grade 1: Uncontrolled passage of intestinal gases
  • Grade 2: Uncontrolled passage of liquid stools
  • Grade 3: Uncontrolled passage of solid stools

There are also two special forms of fecal incontinence:

  • Stool smearing  describes the passage of small amounts of stool.
  • Urge  syndrome  is defined as the need to go to the toilet immediately as soon as there is an urge to defecate because the stool in those affected can no longer be retained after it has entered the rectum.

Typical causes of fecal incontinence

There are many different causes of fecal incontinence:

  • As we age, a common cause of fecal incontinence is  chronic constipation  combined with a declining ability to voluntarily control the pelvic floor and sphincter muscles. In these cases of pelvic floor weakness, urinary incontinence often occurs at the same time   .
  • During a natural birth or during surgery, muscular  injuries to the sphincter  can occur, which can cause fecal incontinence.
  • Ulcers in the rectum,  such as  colon cancer , can damage muscles and nerves in the rectum and thus promote fecal incontinence.
  • Chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis can cause faecal incontinence. This may be due to limited voluntary control over the sphincter muscle caused by chronic rectum inflammation. The tendency increases the risk of incontinence to severe diarrhoea and inflammatory fistulas between the intestines and the skin.
  • In neurological diseases of the nerves, such as paraplegia or after a stroke, voluntary contraction of the pelvic floor muscles can be restricted, which can result in faecal incontinence. 
  • After consuming alcohol, the general muscle tension in the body decreases with that of the sphincter muscle and the pelvic floor. This is why it is harder to hold back stool when you are under the influence of alcohol.
  • In children, malformations of the muscles or the nervous system can already be present at birth, which can often be symptomatically accompanied by faecal incontinence. These include for example, malformations of the intestine (atresia), muscle diseases and forms of spina bifida (meningomyeloceles).


What to do with faecal incontinence?

The topic of “incontinence”, in general, is stressful and shameful for those affected and their relatives. It is all the more important to get professional help. Of course, this also applies to faecal incontinence.

General measures such as stool regulation, in cooperation with the family doctor and physiotherapist through muscle exercises and targeted nutrition, can be the first step in treatment. In addition, nursing measures and medical aids such as pads and diapers are essential to support in everyday life with faecal incontinence.

Aid for faecal incontinence

There are many medical products for adults that help lead an essentially everyday life despite faecal incontinence. These include, for example, pads, anal tampons and diapers for adults, which can be bought in drugstores, for example.

Which therapy helps?

Pelvic floor training and pelvic floor gymnastics help to strengthen the external sphincter with targeted exercises. These exercises encourage voluntary contraction of the pelvic floor muscles. Biofeedback training can be as helpful as pelvic floor exercises as a further treatment option.

If faecal incontinence occurs mainly with loose stools, medications such as loperamide can help by slowing down bowel movements. In the case of constipation, on the other hand, faecal incontinence can be treated with medication that supports bowel movements ( laxatives ).


Treatment by surgical procedures

As a last resort, there are also surgical procedures. Muscle tears in the inner and outer sphincters can be sewn up, for example, so that the muscles can be functional again.

If it is not the muscles but the nerve supply to the rectum that triggers faecal incontinence, a pacemaker can be implanted, for example. This stimulates the nerves of the sphincter and activates the muscle in this way.

Nutrition: What to eat if you have faecal incontinence?

In general, flatulent foods should be avoided for faecal incontinence. Nutritional advice can also be helpful for faecal incontinence to give individual tips. For example, constipation or a tendency to diarrhoea can be specifically prevented.

Those affected who tend to have diarrhoea or urge incontinence should, for example, avoid fibre or at least consume it with sufficient liquid. In the case of constipation, on the other hand, it is advisable to eat fibre in a targeted manner to stimulate intestinal movements.

Which doctor treats faecal incontinence?

In general, it is advisable to go to the doctor to treat you first if you have symptoms of faecal incontinence. Initial examinations can already be carried out there, and therapy recommendations can be given. These include, for example, a change in diet, medication to regulate stool or a referral to a physiotherapist.

If these treatment measures do not sufficiently improve, a proctologist typically treats faecal incontinence.

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