Causes, diagnosis and treatment options.

What is fecal incontinence?

Fecal incontinence, also known as bowel incontinence, describes the inability to voluntarily hold back a bowel movement, which leads to uncontrolled loss of stool. This symptom can severely affect the lives of those affected and is often associated with social isolation and psychological stress. Fecal incontinence affects both men and women, although older people are more frequently affected.

Causes of faecal incontinence

The development of fecal incontinence can be caused by a variety of factors. The most common causes include

Muscle weakness: the sphincter muscle that controls the anus can be weakened, e.g. due to childbirth, surgery or age-related degeneration.
Nerve damage: Damage to the nerves that control the muscles of the anus can lead to incontinence. This nerve damage can be caused by diabetes, multiple sclerosis, strokes or spinal cord injuries.
Chronic constipation: Long-term constipation can overstretch the bowel and damage the nerves, resulting in reduced control over bowel movements.
Diarrhea: Diarrhea can aggravate fecal incontinence because liquid stool is harder to retain than solid stool.
Rectal diseases: Conditions such as hemorrhoids, fistulas or a rectocele (prolapse of the rectal wall) can also affect the ability to control bowel movements.

Diagnosis of fecal incontinence

Accurate diagnosis is the key to successful treatment of fecal incontinence. The diagnostic process involves several steps:

Medical history: the doctor will take a detailed medical history and ask about the symptoms, their frequency, intensity and triggering factors.
Physical examination: A rectal examination can help to assess muscle and nerve function and identify anatomical abnormalities.
Anorectal manometry: This examination measures the pressure in the anal canal and the strength of the sphincter muscles, which provides information about the function of the muscles.
Endoanal ultrasound: This is an imaging examination used to assess the structure and integrity of the sphincter muscles.
Defecography: An X-ray examination of the bowel movement that visualizes the process of defecation and reveals anatomical abnormalities.
MRI: An MRI scan can provide detailed images of the pelvic muscles and nerves to identify damage or structural problems.

Treatment options for fecal incontinence

Treatment for fecal incontinence depends on the cause, the severity of symptoms and the patient's individual needs. Possible treatment options include:

Lifestyle and dietary changes:

High-fiber diet: increasing fiber intake can help regulate stool and prevent diarrhea.
Hydration: Adequate fluid intake is important to support normal bowel function.
Toilet training: Regular visits to the toilet can help to train the bowel and prevent uncontrolled stool loss.

Drug therapy:

Antidiarrheals: these medications help to firm the stool and reduce the frequency of bowel movements.
Laxatives: In the case of chronic constipation, laxatives can provide relief and relieve the bowel.

Pelvic floor exercises:

Kegel exercises: Strengthen the pelvic floor muscles and improve sphincter control.
Biofeedback therapy: This technique helps patients to improve control of their pelvic floor muscles by providing visual or auditory feedback on their muscle activity.
Percutaneous tibial nerve stimulation (PTNS): An effective neuromodulation treatment for incontinence and chronic pain.

Surgical procedures:

Sphincteroplasty: a surgical procedure to repair or reinforce a damaged sphincter muscle.
Sacral nerve stimulation (SNS): An implanted device stimulates the nerves that control bowel function and can improve bowel continence.
Colostomy: In severe cases where other treatments fail, a colostomy may be necessary. This involves creating an artificial bowel outlet.

Psychological support:

As faecal incontinence is often associated with considerable psychological stress, psychological counseling can be helpful. It helps patients to deal with the social and emotional effects of the condition.

Conclusion

Fecal incontinence is a complex and often taboo subject, but it is treatable. Early diagnosis and individually tailored treatment can significantly improve the quality of life of those affected. It is important to address the issue openly and seek professional help in order to find suitable treatment options.