Bowel incontinence or fecal incontinence refers to a condition where the person loses control over their bowel movement. This may be a temporary issue caused as a result of digestive trouble like diarrhea or maybe a more chronic problem caused by a number of factors. In the case of bowel incontinence caused by diarrhea, treatment may not be required and the issue should resolve as the diarrhea is treated. The first step to treating this condition is confirming a diagnosis of the same. A number of tests may be used for this. These are as follows:
Digital rectal exam
This is a physical examination where the doctor will need to insert a gloved finger into the rectum to check for abnormalities and evaluate the sphincter muscle strength.
Balloon expulsion test
This involves inserting a balloon into the rectum and filling it with water. The patient must then try to expel the balloon. If this takes longer than a minute, it may be considered a sign of a bowel disorder.
Anal manometry
A narrow, flexible tube with a balloon at the tip is inserted into the rectum. The balloon is then inflated to measure the functioning of the rectum and tightness of the sphincter muscles.
Anorectal ultrasonography
This involves inserting an instrument into the anus that helps the doctor see the structure of the sphincter with the help of video imagery.
Proctography
An X-ray video is taken while the patient passes stool on a special toilet to evaluate the rectum’s holding capacity and how well the stool is expelled by the body.
Proctosigmoidoscopy
This involves inserting a flexible tube into the rectum that allows the doctor to check for signs of inflammation, scar tissue or tumors in the last 2 feet of the colon.
Colonoscopy
In this case, a tube is inserted into the rectum that allows the doctor to check the entire length of the colon.
Magnetic resonance imaging (MRI)
This is an imaging procedure that creates pictures of the sphincter, thereby allowing the doctor to check for damage.
Treatment for bowel incontinence
Treatment may be prescribed depending on the findings of these tests. The treatment could include the following.
Medication
Oral medication such as anti-diarrheal medication or laxatives is usually the first course of treatment for bowel incontinence. In more severe cases, bulking agents may be injected directly into the rectum.
Exercise
A set of exercises may also be advised to strengthen the pelvic floor muscles and improve anal sphincter control. These exercises could take the form of biofeedback exercises and bowel training exercises. In some cases, a rectal balloon and anal manometry may be used in these exercises. Bowel training is a physical and mental exercise where the patient needs to make an effort to pass a stool at a specific time of the day.
Sacral nerve stimulation (SNS)
The sacral nerves play an important role in regulating the behavior of the anal sphincter muscles and rectal muscles. A small device may be implanted that send electrical impulses through these nerves to strengthen the bowel muscles.
Surgery
In the cases of incontinence caused by a rectal prolapse or sphincter damage as a result of childbirth, undergoing a surgery may be recommended. The different types of surgery that may be advised are:
- Sphincteroplasty
- Sphincter replacement
- Sphincter repair (dynamic graciloplasty)
- Colostomy (bowel diversion)
