What is rectal incontinence?
Rectal incontinence, also known as bowel incontinence, is the inability to control defecation, which causes stool to leak unexpectedly from the rectum. Rectal incontinence begins with the occasional leakage of feces during the passage of gas and ends with a complete loss of the ability to control the intestine.
Rectal incontinence may occur as a result of diarrhea, constipation, or muscle or nerve damage.
Whatever the cause, rectal incontinence can be embarrassing. Do not hesitate to talk to your doctor about it; medicines can improve rectal incontinence and your quality of life.
What are the symptoms of rectal incontinence?
Rectal incontinence can be a temporary condition during an occasional bout of diarrhea, but for some people, rectal incontinence is chronic or recurring. People with this condition may not be able to stop the urge to have a bowel movement, which occurs so suddenly that they cannot get to the bathroom in time. This condition is called urge incontinence.
Another type of rectal incontinence occurs in people who do not feel the need to pass a stool. This condition is called passive incontinence.
Rectal incontinence is often associated with other bowel problems, such as:
- Gas and bloating
What are the causes of rectal incontinence?
- Muscle damage. An injury to the anal sphincter may make it hard to hold stools properly. This type of damage could occur during childbirth, especially if you had an episiotomy or forceps delivery during childbirth.
- Nerve damage. An injury or damage to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to rectal incontinence. Nerve damage may occur after childbirth or as a result of constant straining during bowel movements and spinal cord injuries. Some diseases, such as diabetes and multiple tuberous sclerosis, can affect and damage these nerves leading to rectal incontinence.
- Chronic constipation may cause dry, hard stools to form in the rectum and become so large that it is difficult to pass through the anus. The muscles of the rectum and intestine stretch and eventually become flaccid; This allows liquid stool to pass through the digestive tract, circulate around impacted stool, and leak out. Chronic constipation may also cause nerve damage., which leads to rectal incontinence.
- Diarrhea. It is easier to hold hard stool in the rectum than soft stool. Soft stool or diarrhea can cause rectal incontinence or worsen the condition.
- Hemorrhoids. When swelling occurs in the rectum, causing hemorrhoids, it may prevent the anus from closing completely, allowing stool to leak out.
- Loss of storage capacity in the rectum. The rectum naturally expands to accommodate the stool. In the event of rectal scarring or hardening of the anal walls because of surgery, radiotherapy, or irritable colon disease, the rectum cannot expand properly, which eventually causes the stool to leak out.
- Surgery. Surgery to treat hemorrhoids, as well as more complex operations involving the rectum and anus, can cause nerve and muscle damage, which eventually leads to rectal incontinence.
- Rectal prolapse. Rectal incontinence may result from rectal prolapse in which the rectum hangs inside the anus.
- Rectocele. In women, rectal incontinence may occur when the rectum protrudes through the vagina.
What are the risk factors related to rectal incontinence?
- Age. Although rectal incontinence can occur at any age, it is most common in adults over the age of 65.
- Female gender. Rectal incontinence can be a complication of childbirth. Moreover, women who hormone replacement therapy for menopause are more likely to develop rectal incontinence.
- Nerve damage. People who have long-term diseases such as diabetes or multiple sclerosis, which can damage the nerves that help control bowel movements, may be at risk of rectal incontinence.
- Rectal incontinence is often present in the later stages of Alzheimer’s disease and dementia.
- Physical disabilities. It may be hard to get to the toilet in time if the patient is physically disabled. An injury that causes physical impairment may also damage rectal nerves, which leads to rectal incontinence.
How is rectal incontinence diagnosed?
There are several tests available to help determine the cause of rectal incontinence:
- Digital rectal examination. Your doctor inserts a covered lubricated finger into your rectum to assess the strength of your sphincter and check for any abnormalities in the rectal area. During the examination, your doctor may ask you to bend down to check for rectal prolapse.
- Balloon expulsion test. The doctor inserts a small balloon into the rectum and fills it with water. Then they ask you to go to the bathroom and expel the balloon. If it takes more than three minutes to do it, then you most likely have a bowel disorder.
- Anal manometry. The doctor inserts a narrow, flexible tube into the anus and rectum and may inflate a small balloon at the top of the tube. This test helps measure the strength of your anal sphincter and the sensitivity and function of your rectum.
- Anal ultrasound. The doctor inserts a narrow, tube-like instrument into the anus and rectum. The tool produces video images that allow your doctor to evaluate the structure of your sphincter muscle.
- Anal and rectal imaging. Video X-ray images are created while you have a bowel movement in a specially designed toilet. This test aims to measure the amount of stool your rectum can hold and assesses how well your body is expelling stool.
- Colonoscopy. The doctor inserts a flexible tube into the rectum to examine the entire colon.
- Magnetic resonance imaging. An MRI scan provides clear images of the sphincter muscle to determine if the muscles are healthy and can also provide images during a bowel movement.
How to treat rectal incontinence?
- Anti-diarrheal drugs if rectal incontinence is caused by chronic diarrhea
- Laxatives if rectal incontinence is caused by chronic constipation
- Diet changed. Since what you eat and drink can affect the consistency of your stool, your doctor may recommend diet changes to help relieve rectal incontinence.
- Exercising. If rectal incontinence is caused by muscle damage, your doctor may recommend a program of exercise and other treatments to restore muscle strength. These treatments can improve anal sphincter control and awareness of the urge to have a bowel movement.
- Surgery. Rectal incontinence treatment may require surgery to correct an underlying problem, such as rectal prolapse or sphincter damage from childbirth. The surgical procedures to treat rectal incontinence include the following:
- Sphincteroplasty. This procedure repairs a damaged or weak anal sphincter that was injured during childbirth. Doctors define the affected muscle area and free its edges from adjacent tissues. Then the doctor brings the edges of the muscle together again and sews them in an overlapping fashion, which strengthens the muscles and tightens the sphincter.
- Treatment of rectal prolapse, hernia, or hemorrhoids. Surgical correction of these problems will reduce or eliminate rectal incontinence.
- Sphincter replacement. The doctor may replace a damaged anal sphincter with an artificial anal sphincter. The device is an inflatable bracelet that is implanted around your anal canal. When inflated, the device keeps your anal muscles tightly closed until you are ready to have a bowel movement. When you need to go to the toilet, use a small external pump to deflate the device and allow stool to pass. Then the device reinflates itself.
- Sphincter repair. In this surgery, doctors take a muscle from the inner thigh and wrap it around the sphincter, restoring the tightness of the sphincter muscle.
- Colostomy. This surgery bypasses stool through an opening in the abdomen. Doctors attach a special bag to this opening to collect stool. In general, a colostomy is only used by doctors after other treatments have failed.
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