The term faecal incontinence refers to the inability to retain the contents of the bowel in the rectum. This results in the involuntary discharge of stool between visits to the toilet. Fecal incontinence is not a disease in its own right, but occurs as a symptom of various diseases.
Here you will find further information as well as selected specialists and centers for faecal incontinence.
It is estimated that around five percent of the German population suffer from involuntary defecation. This corresponds to four million people affected. The number of people with faecal incontinence increases with age. 30 percent of geriatric patients (patients in geriatric medicine) are affected by faecal incontinence.
In medical terminology, faecal incontinence is also referred to as anorectal incontinence or incontinentia alvi.
Fecal incontinence can be caused by various factors.
For example, a change in the consistency of bowel movements can lead to continence problems. These stool changes are particularly evident in chronic inflammatory bowel diseases such as ulcerative colitis or Crohn's disease.
Fecal incontinence often occurs temporarily with stomach and intestinal infections caused by bacterial or viral pathogens.
Stool inconsistency is a symptom that can have various causes © sewcream | AdobeStock
Malabsorption can also cause abnormal changes in the stool. People with malabsorption are unable to break down and absorb food components sufficiently. This leads to increased diarrhea. Impaired intestinal capacity also leads to involuntary bowel movements.
In addition, rectal tumors or collagenoses can limit the absorption capacity of the large intestine. Collagenoses are systemic chronic diseases characterized by changes in the connective tissue.
Many patients also suffer from faecal incontinence after operations that affect the posterior colon.
The pelvic floor also influences the excretion of stool: a prolapse of the pelvic floor or a dysfunction of the pudendal nerve can lead to nerve disorders. The person affected can then no longer consciously control the excretion of stool.
Another common cause of faecal incontinence is sphincter dysfunction. Such disorders can be caused by
Impaired sensitivity, such as occurs in people with
is another cause of anorectal incontinence.
Medically, fecal incontinence is divided into three degrees of severity.
Grade I faecal incontinence: There is uncontrolled leakage of bowel gas. Occasionally, so-called stool smearing also occurs. In this case, small amounts of stool are passed after the actual bowel movement, which appear as smears in the underwear.
Grade II faecal incontinence: In addition, no control over bowel movements with liquid stools.
Grade III faecal incontinence: Total loss of control over defecation. Those affected can no longer voluntarily hold back the bowel contents, regardless of consistency, so that solid stools are also lost. Grade III faecal incontinence is also associated with constant stool smearing.
The condition has a major impact on the quality of life of those affected, especially in grade III. They report
which often lead to family and social isolation, and in some cases even to loss of employment.
First of all, the doctor has a detailed discussion with the patient. He asks about the symptoms in detail. He will ask about toilet habits as well as the consistency and color of the stool. It is also of interest whether the patient can consciously delay bowel movements and whether he or she is even aware that the bowel is filled with stool.
This medical history is followed by a palpation examination and the doctor uses a stethoscope to listen to the bowel. The bowel sounds can provide indications of a transportation disorder in the bowel. Hardening can indicate inflammation or adhesions in the stool.
By palpating the rectum, the doctor determines the tension of the sphincter muscle. He can also detect or rule out polyps or tumors of the rectum.
An endoscopy of the colon and rectum helps to identify the cause. Just like proctoscopy, in which the anal canal is examined, it is part of the basic diagnostics for anorectal incontinence. For the endoscopy, the doctor inserts a thin tube with a camera into the anus. This allows him to assess the condition of the bowel and find inflammation, tumors or polyps.
Endosonography is another diagnostic procedure that is used for people with faecal incontinence. In this form of ultrasound examination, a small probe is inserted into the anal canal. This procedure is particularly useful for detecting injuries to the sphincter muscle.
The function of the sphincter muscle can also be tested using painless anal sphincter manometry. Tension and relaxation of the rectal muscles, on the other hand, are measured using anal manometry.
Functional processes during bowel movements can be analyzed using defecography. This involves filling the rectum with an X-ray contrast medium. An X-ray video film can then be taken during the bowel movement, which can also show protrusions and invaginations of the bowel wall.
If a nerve disorder is suspected, the doctor will also take an electromyogram.
The treatment of faecal incontinence depends on the cause.
If the incontinence is due to a change in stool consistency, simple dietary adjustments often help. A balanced intake of fiber and fluids is crucial here. Wheat bran or plantago seeds can also improve stool consistency.
A healthy, balanced diet improves stool consistency © Syda Productions | AdobeStock
Special toilet training can also help those affected to defecate.
If the incontinence is caused by a bowel disease, this should be treated. Patients with Crohn's disease or ulcerative colitis receive medication to curb inflammatory processes in the bowel.
Medication that slows down intestinal transit can improve stool consistency. This enables people with anorectal incontinence to hold their stool better.
Depending on the cause, surgical interventions may also be necessary for treatment.
The prognosis differs significantly from patient to patient. The cause and age also play a role.
However, suitable treatment measures can often alleviate the symptoms and improve the quality of life of those affected.
