Incontinence
There are many causes of fecal incontinence. They are grouped into two main categories: sensory and motor.
- Sensory incontinence is neurological in origin.
- Motor incontinence is by far the most frequent form.
It is related to a loss of muscle function. An obstetrical trauma, during childbirth or surgery, is often the cause of a weakening of the sphincters. Subsequently, tone and strength of contraction decrease over the years, progressively leading to a loss of continence.
At first, this decrease manifests itself as difficulty holding in gas (gas incontinence) and sometimes as stains on the underwear (soiling). At a more advanced stage, liquid incontinence occurs. At first, it is only continence time that is affected: in the presence of liquid stool, the person can only hold it for a few moments. Solid stool incontinence indicates a much greater deterioration of sphincter function.
Most patients present with mild incontinence: gas and liquid continence time is limited. Medical treatment significantly improves the situation and surgery is not necessary in the vast majority of cases.
Medical treatment
- Hygiene (wipes, protective skin cream)
- Changing the nature of the stool
- Avoiding foods that cause flatulence and diarrhea
- Eliminating other causes of flatulence (e.g.: no chewing gum)
- Adding fibre supplements (Metamucil) to help form solid stool
- Perform anal continence exercises
- Morning and evening until symptoms disappear (six months in general)
- Once a day after the initial six-month period (permanently)
Bowel continence exercises
Duration: 10 minutes, morning and evening
Technique:
- Contract your anal sphincter continuously for 30 seconds
- Release after 30 seconds
- Repeat 10 times
Perineal rehabilitation
When basic exercises are insufficient, or in the presence of urinary incontinence, perineal rehabilitation should be considered. Several techniques are used, in particular biofeedback, which facilitates sphincter control with the help of visual feedback. Perineal rehabilitation can also be used in cases of proctalgia fugax—a painful cramp of the large “levator ani” muscle (levator of the anus).
Surgical treatment
Surgical treatment is reserved for cases of motor incontinence, usually following obstetrical or surgical trauma. Medical treatment should be tried first, especially if the incontinence is mild or moderate. Anorectal manometry (measurement of resting pressure and force of contraction) and ultrasound of the sphincters are also performed to delineate the anatomy. If the conditions are favourable, surgery can then be performed.
Although multiple techniques have been developed over the decades, the safest method remains anal sphincter reconstruction. This method is the simplest and most effective, especially if the sphincter ring has been cut in one place and the anal ring is breached. The anatomy can then be reconstructed by dissecting the sphincters and suturing them like a double-breasted jacket.