What is incontinence?
Incontinence is the impaired ability to control gas or stool. Its severity
ranges from mild difficulty with gas control to severe loss of control over
liquid and formed stools. Incontinence to stool is a common problem, but often
it is not discussed due to embarrassment. Both bladder and bowel incontinence
are problems that tend to increase with age.
What causes incontinence?
There are many causes of incontinence. Injury during childbirth is one of the
most common causes. These injuries may cause a separation in the anal muscles
and decrease in muscle strength. The nerves supplying the anal muscles may
also be injured. While some injuries may be recognized immediately following
childbirth, many others may go unnoticed and not become a problem until later
in life. In these situations, past childbirth may not be recognized as the
cause of incontinence.
Anal operations or injury to the tissue surrounding the anal region similarly
can damage the anal muscles and hinder bowel control. Infections around the
anal area may destroy muscle tissue leading to problems of incontinence. In
addition, as people age, they experience loss of strength in the anal muscles.
As a result, a minor problem in a younger person may become more significant
later in life.
Diarrhea may be associated with a feeling of urgency or stool leakage due
to the frequent liquid stools passing through the anal opening. If bleeding
accompanies lack of bowel control, consult your physician. These symptoms may
indicate inflammation within the colon (colitis), a rectal tumor, or rectal
prolapse - all conditions that require prompt evaluation by a physician.
How is the cause of incontinence determined?
An initial discussion of the problem with your physician will help establish
the degree of control difficulty and its impact on your lifestyle.
Many clues to the origin of incontinence may be found in patient histories.
For example, a woman's history of past childbirths is very important. Multiple
pregnancies, large weight babies, forceps deliveries, or episiotomies may contribute
to muscle or nerve injury at the time of childbirth. In some cases, medical
illnesses and medications play a role in problems with control.
A physical exam of the anal region should be performed. It may readily identify
an obvious injury to the anal muscles.
Causes of incontinence:
- Obstetric injuries
- Injury to anal muscles
- Anal infections
- Diminished muscle strength with age
Frequently, additional studies are required to define the anal area more completely.
In a test called manometry, a small catheter is placed into the anus to record
pressure as patients relax and tighten the anal muscles. This test can demonstrate
how weak or strong the muscle really is. A separate test may also be conducted
to determine if the nerves that go to the anal muscles are functioning properly.
In addition, an ultrasound probe can be used within the anal area to provide
a picture of the muscles and show areas in which the anal muscles have been
injured.
What can be done to correct the problem?
After a careful history, physical examination and testing to determine the cause
and severity of the problem, treatment can be addressed. Mild problems may be
treated very simply with dietary changes and the use of some constipating medications.
Your physician also may recommend simple home exercises that may strengthen
the anal muscles to help in mild cases.
In other cases, biofeedback can be used to help patients sense when stool is
ready to be evacuated and help strengthen the muscles. Injuries to the anal
muscles may be repaired with surgery. Diseases which cause inflammation in the
rectum, such as colitis, may contribute to anal control problems. Treating these
diseases also may eliminate or improve symptoms of incontinence. Sometimes a
change in prescribed medications may help.
In the past, patients with no hope of regaining bowel control required a colostomy.
Today, this procedure is rarely required. In addition, current search into the
development of an artificial anal muscle may soon find a place in treating patients
with difficult control problems.
Treatment of incontinence may include:
- Dietary changes
- Constipating medications
- Muscle strengthening exercises
- Biofeedback
- Surgical muscle repair
Reference: American Society
of Colon and Rectal Surgeons
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