Nocturnal fecal incontinence in an adult woman. How to treat fecal incontinence in adults? Should be removed from the menu

Normally, the muscles of the anus can retain the gaseous contents of the intestines and feces of varying consistency during physical activity, changes in body position, coughing, and sneezing until the appropriate moment. The absence or loss of the ability to control the act of defecation (excretion of feces) is called encopresis. The pathology can be congenital or acquired. It is diagnosed more often in females. In older people, fecal incontinence is usually combined with urinary incontinence.

The principle of the act of defecation

People are able to suppress the urge to defecate from about 2 years of age. Bowel emptying is controlled by the central nervous system.

Reaching the anus, feces usually already have the required density and volume (on average 200 ml). The sphincter muscles hold the stones, allowing bowel movements to occur exactly at the right time.

The muscles of the abdominal cavity and pelvic floor are also involved in the process of defecation.

Varieties

Encopresis varies in severity.

There are 3 degrees of defecation disorder:

• difficulty retaining gases;
• incontinence of loose feces and gases;
• inability to control bowel movements of any consistency.

When the first difficulties appear, you should immediately seek medical help.

Symptom of diseases

The causes of problems during the act of defecation can be congenital, arise as a complication of diseases, or become a consequence of injuries (brain, anus).

In the first case, pathology occurs when:

• anal canal defect;
• developmental disorders of the brain and spinal cord.

As a symptom of disease, encopresis occurs with constipation, rectal cancer, diarrhea, and hemorrhoids.

Loose fecal matter rapidly enters the rectum. They are more difficult to retain than formed stones, so encopresis is a common addition to the disorder.

Hemorrhoids that have arisen around the anal area complicate the obturator function of the spicter. Some of the stool will leak through the anus.

Constipation

A certain volume of stones of increased hardness collects in the rectum. Feces that are more liquid in consistency accumulate behind compacted formations and pass through them.

In the later stages of the malignant process in men and women, one of the symptoms is fecal incontinence. Feces may become dark in color (due to blood). The emptying procedure becomes painful.

A sign of dysfunction of the muscles and nerves of the anal area

The pathology may be a consequence of impaired tone of the sphincter and rectum muscles, nerve failure, and pelvic floor dysfunction.

Decreased muscle tone of the rectum and sphincter

Weakening or overstretching of the sphincter muscles impairs the ability to retain feces.

Inflammatory processes in the intestines, operations in the anus, radiotherapy can provoke the formation of scars in the rectum. This reduces its elasticity. The rectum stretches worse and loses the ability to control stool, which leads to encopresis.

Nerve failure

If the nerve endings located in the sphincter and rectum area do not work correctly, then the muscles will not contract and relax as necessary, and the person will no longer feel the urge to have a bowel movement.

This condition may be a consequence of the habit of not paying attention to the urge to defecate, as well as certain diseases (multiple sclerosis, diabetes).

Pelvic floor dysfunction

Problems with the muscles, ligaments, or nerves of the pelvic floor are factors that cause fecal incontinence.

Sometimes childbirth, which took place with trauma to the uterus and bladder, becomes a provoking factor for encopresis. Dysfunction begins to bother you immediately or after years.

Manifestation of neurological disorders

Fecal incontinence can be one of the symptoms of neurological disorders: manic-depressive or catonic syndrome, schizophrenia, psychosis. In this case, a change in the functioning of the central nervous system becomes the cause of the disorder.

Age-related disorders of the nervous system are often associated with fecal incontinence in the elderly.

Diagnostics

Dysfunction is established based on symptoms and diagnostic tests.

• defecography - an x-ray examination that informs about the ability of the rectum to perform its functions;
• anorectal manometry - to study pressure, response to nerve signals and the work of the sphincter muscles, as well as checking the susceptibility of the rectum;
• magnetic resonance imaging - selected to obtain images of the sphincter muscles;
• transrectal ultrasound – to study the condition of the muscles of the anus and rectum;
• sigmoidoscopy - examination of the rectum using a special tube. Helps identify inflammatory processes, scar changes, neoplasms;
• electromyography of the pelvic floor and rectum - clarifies how the nerves that regulate the functioning of these muscles function.

Only by finding out the cause of encopresis can a specialist prescribe effective treatment.

Principles of therapy

The basis of treatment is diet correction and drug therapy. Exercises may be prescribed to strengthen the pelvic floor muscles. In some cases, only surgery is effective.

Diet correction

To eliminate dysfunction, it is important to normalize the nature of the stool. You need to eat 4-5 times a day. Portions should be small.

Must be excluded from the menu:

• bread;
• pasta;
• raw vegetables and fruits;
• porridge (millet, semolina, rice, pearl barley);
• coffee;
• smoked meats;
• cocoa;
• chocolate products;
• garlic;
• canned food;
• citrus;
• bananas.

It is important to drink enough fluid (up to 2 liters per day).

The diet should contain:

• slimy soups;
• boiled vegetables;
• fermented milk products (yogurt, kefir);
• dried fruits (dried apricots, figs, prunes).

Drug treatment

For gastrointestinal dysfunction, therapy is aimed at eliminating the type of pathology.

Most often, 2 options for defecation disorders are corrected:

• diarrhea - drugs are prescribed that increase the amount of fecal matter (Citrucel, Fiberlax, Metamucil). Anti-diarrhea medications may be prescribed that reduce the urge to have a bowel movement and slow down peristalsis (Suprilol, Diara, Imodium);
• constipation - medications are prescribed that soften stones and speed up their evacuation. (Sodium picosulfate, Bisacodyl).

In case of neurological disorders, the underlying disease is treated.

Performing special gymnastics can strengthen the pelvic floor muscles.

Effective exercises will be:

• rapid contraction and relaxation of the pelvic muscles – 50-100 times a day;
• muscle tension as during urination (men) or defecation (women) – 20-50 times a day.

Gymnastics can be performed in any body position. She is invisible to others.

Neuromodulation

Neuromodulation (electrical stimulation, electrical stimulation) is performed using special electrodes. They are placed on the nerve endings of the rectum and anus and are regularly activated. The duration of one session is 10-20 minutes. The course of treatment is 2 weeks. Re-prescription of neuromodulation is possible after 3 months.

Surgery

If drug therapy is ineffective or encopresis caused by damage or anatomical disorders of the pelvic floor or anal sphincter, surgical correction is performed.

It could be:

• sphincteroplasty (connection of injured sphincter muscles);
• sphincterolevatoplasty (normalization of anal functions);
• sphincterogluteoplasty (restoration of the sphincter using tissue taken from the gluteus maximus muscle).

Sometimes a colostomy may be necessary. The operation involves removing part of the colon through an opening in the abdomen and creating a colostomy to drain gases, feces and mucus.

Treatment with folk remedies

Traditional medicine recipes can be used as part of complex treatment of fecal incontinence.

Effective recipes are:

• infusion of calamus rhizomes - 20 g of dried and crushed berries should be poured with 200 ml of boiling water. It is necessary to insist for 1 hour. Drink 1 tsp. after every meal;
• fresh berries or rowan juice - use 1 tsp. berries or juice after meals 3 times a day;
• honey – eat 10 g of honey 3 times a day.

Contraindications for such therapy are gastrointestinal diseases in the acute stage and allergic reactions.

Constant contact of the skin of the anal area with fecal matter can cause irritation. Necessary:

• wash and gently dry the anus area after each case of encopresis;
• apply a cream that forms a moisture-protecting film on the skin (Relief, Aurobin, Fleming);
• use panty liners;
• refuse synthetic, too tight underwear, as well as thong panties.

Encopresis is a problem that can be a symptom of serious pathologies. Finding out the cause of fecal incontinence in men and women during the diagnostic process allows you to choose the optimal treatment option. Therapy can be medication or surgery. Surgery is rarely used. Eliminating the disorder allows you to normalize the quality of life.

Fecal incontinence is a condition that invariably has a severe impact on a person’s life, both in social and moral aspects. In long-term care facilities, the prevalence of fecal incontinence among residents is up to 45%. The prevalence of fecal incontinence is similar among men and women, at 7.7 and 8.9%, respectively. This indicator increases in older age groups. Thus, among people 70 years and older it reaches 15.3%. For social reasons, many patients do not seek medical help, which most likely leads to an underestimation of the prevalence of this disorder.

Of primary care patients, 36% report episodes of fecal incontinence, but only 2.7% have a documented diagnosis. Healthcare system costs for patients with fecal incontinence are 55% higher than for other patients. In monetary terms, this translates into an amount equal to US$11 billion per year. In most patients, proper treatment achieves significant success. Early diagnosis helps prevent complications that adversely affect the quality of life of patients.

Causes of fecal incontinence

• Gynecological trauma (childbirth, hysterectomy)
• Severe diarrhea
• Coprostasis
• Congenital anorectal anomalies
• Anorectal diseases
• Neurological diseases

The passage of feces provides a mechanism with a complex interaction of anatomical structures and elements that provide sensitivity at the level of the anorectal zone and the pelvic floor muscles. The anal sphincter consists of three parts: the internal anal sphincter, the external anal sphincter and the puborectalis muscle. The internal anal sphincter is a smooth muscle element and provides 70-80% of the pressure in the anal canal at rest. This anatomical formation is under the influence of involuntary nervous tonic impulses, which ensures the closure of the anus during the rest period. Due to the voluntary contraction of the striated muscles, the external anal sphincter serves as additional retention of feces. The puborectalis muscle forms a supportive cuff surrounding the rectum, which further strengthens existing physiological barriers. It remains in a contracted state during the rest period and maintains an anorectal angle of 90°. During defecation, this angle becomes obtuse, thereby creating conditions for the passage of feces. The angle is sharpened by voluntary contraction of the muscle. This helps retain the contents of the rectum. Fecal masses gradually filling the rectum lead to stretching of the organ, a reflex decrease in anorectal resting pressure and the formation of a portion of feces with the participation of the sensitive anoderm. If the urge to defecate appears at an inconvenient time for a person, the activity of the smooth muscles of the rectum, controlled by the sympathetic nervous system, occurs with simultaneous voluntary contraction of the external anal sphincter and puborectal muscle. To shift defecation over time, sufficient compliance of the rectum is required, as the contents move back into the expandable rectum, endowed with a reservoir function, until a more suitable moment for defecation.

Fecal incontinence occurs when the mechanisms that maintain fecal retention are disrupted. This situation of fecal incontinence can occur due to loose stools, weakness of the striated pelvic floor muscles or internal anal sphincter, sensory disturbances, changes in colonic transit time, increased stool volume, and/or decreased cognitive function. Fecal incontinence is divided into the following subcategories: passive incontinence, urge incontinence, and fecal leakage.

Classification of functional fecal incontinence

Functional fecal incontinence	Diagnostic criteria: Repeated episodes of uncontrolled stool passing in a person at least 4 years of age with age-appropriate development and one or more of the following: disruption of the functioning of muscles with intact innervation and no damage; minor structural changes in the sphincter and/or disruption of innervation; normal or disorganized bowel movements (stool retention or diarrhea); psychological factors. Excluding all of the following reasons: impaired innervation at the level of the brain or spinal cord, sacral roots or damage at different levels as a manifestation of peripheral or autonomic neuropathy; pathology of the anal sphincter caused by multisystem damage; morphological or neurogenic disorders considered as the main or primary cause of NK
Subcategories	Mechanism
Passive incontinence	Loss of sensitivity in the rectosigmoid region and/or impaired neuroreflex activity at the level of the rectoanal segment. Weakness or rupture of the internal sphincter
Incontinence with urge to stool	Disruption of the external sphincter. Change in rectal capacity
Fecal leakage	Incomplete bowel movement and/or impaired rectal sensation. Sphincter function preserved

Risk factors for fecal incontinence

• Elderly age
• Female
• Pregnancy
• Traumatization during childbirth
• Perianal surgical trauma
• Neurological deficits
• Inflammation
• Haemorrhoids
• Pelvic organ prolapse
• Congenital malformations of the anorectal area
• Obesity
• Condition after bariatric surgery
• Limited mobility
• Urinary incontinence
• Smoking
• Chronic obstructive pulmonary disease

Many factors contribute to the development of fecal incontinence. These include loose stool consistency, female gender, old age, and multiple births. The greatest importance is given to diarrhea. Urgency to stool is the main risk factor. With age, the likelihood of fecal incontinence increases, mainly due to weakening of the pelvic floor muscles and decreased anal tone at rest. Childbirth is often accompanied by damage to the sphincters as a result of trauma. Fecal incontinence and surgical delivery or traumatic birth through the birth canal are certainly interrelated, but there is no evidence in the literature of the advantage of cesarean section over non-traumatic natural birth in terms of preserving the pelvic floor and ensuring normal fecal continence.

Obesity is one of the risk factors for NC. Bariatric surgery is considered an effective treatment for advanced obesity, but after surgery, patients often experience fecal incontinence due to changes in stool consistency.

In relatively young women, fecal incontinence is clearly associated with functional bowel disorders, including IBS. The causes of fecal incontinence are numerous, and they sometimes overlap. Sphincter damage may go unnoticed for many years until age-related or hormonal changes, such as muscle atrophy and atrophy of other tissues, disrupt established compensation.

Clinical examination of fecal incontinence

Patients are often embarrassed to admit incontinence and complain only of diarrhea.

In identifying the causes of fecal incontinence and making the correct diagnosis, one cannot do without a detailed history and a targeted rectal examination. The medical history must necessarily reflect an analysis of the drug therapy being carried out at the time of treatment, as well as the characteristics of the patient’s diet: both can affect the consistency and frequency of stool. It is very useful for the patient to keep a diary recording everything related to the stool. These include the number of episodes of urinary incontinence, the nature of incontinence (gas, loose or hard stools), the volume of involuntary passage, the ability to feel the passage of stool, the presence or absence of urgency, straining and sensations associated with constipation.

A comprehensive physical examination includes examining the perineum for excess moisture, irritation, fecal matter, anal asymmetry, fissures, and excessive sphincter relaxation. It is necessary to check the anal reflex (contraction of the external sphincter to a prick in the perineal area) and make sure that the sensitivity of the perineal area is not impaired; note prolapse of the pelvic floor, bulging or prolapse of the rectum when straining, the presence of prolapsed and thrombosed hemorrhoids. Rectal examination is crucial to identify anatomical features. Very severe cutting pain indicates acute damage to the mucous membrane, for example, an acute or chronic fissure, ulceration or inflammatory process. A decrease or sharp increase in anal tone at rest and during straining indicates a pathology of the pelvic floor. During a neurological examination, attention should be paid to the preservation of cognitive functions, muscle strength and gait.

Instrumental studies of fecal incontinence

Endoanal ultrasound is used to assess the integrity of the anal sphincters, and anorectal manometry and electrophysiology may also be used if available.

There is no specific list of studies that should be carried out. The attending physician will have to weigh the negative aspects and benefits of the study, the cost, the overall burden on the patient with the ability to prescribe empirical treatment. The patient's ability to tolerate the procedure, the presence of concomitant diseases, and the level of diagnostic value of what is planned to be done should be taken into account. Diagnostic studies should be aimed at identifying the following conditions:

1. possible damage to the sphincters;
2. overflow incontinence;
3. pelvic floor dysfunction;
4. accelerated passage through the colon;
5. significant discrepancy between anamnestic data and the results of a physical examination;
6. exclusion of other possible causes of NK.

The standard test to check the integrity of the sphincters is endoanal sonography. It shows very high resolution when examining the internal sphincter, but with respect to the external sphincter the results are more modest. MRI of the anal sphincter provides greater spatial resolution and is therefore superior to the ultrasound method, both for the internal and external sphincters.

Anorectal manometry allows one to obtain a quantitative assessment of the function of both sphincters, rectal sensitivity and wall compliance. With fecal incontinence, pressure at rest and during contraction is usually reduced, which allows us to judge the weakness of the internal and external sphincters. In the case where the results obtained are normal, one can think about other mechanisms underlying NK, including loose stools, the appearance of conditions for fecal leakage and sensory disturbances. The rectal balloon test is designed to determine rectal sensitivity and elasticity of the organ walls by assessing sensory-motor responses to an increase in the volume of air or water pumped into the balloon. In patients with fecal incontinence, sensitivity may be normal, weakened or enhanced.

Carrying out a test with expulsion of a balloon from the rectum involves the test subject pushing out a balloon filled with water while sitting on a toilet seat. Expulsion within 60 seconds is considered normal. This test is usually used in a screening examination of patients suffering from chronic constipation to identify pelvic floor dyssynergia.

Standard defecography allows for dynamic visualization of the pelvic floor and detection of rectal prolapse and rectocele. Barium paste is injected into the rectosigmoid colon and then dynamic x-ray anatomy is recorded - the motor activity of the pelvic floor - of the patient at rest and during coughing, contraction of the anal sphincter and straining. The defecography method, however, is not standardized, so each institution performs it differently, and the study is not available everywhere. The only reliable method for visualizing the entire anatomy of the pelvic floor, as well as the anal sphincter area, without exposure to radiation is dynamic pelvic MRI.

Anal electromyography allows us to identify sphincter denervation, myopathic changes, neurogenic disorders and other pathological processes of mixed origin. The integrity of the connections between the endings of the pudendal nerve and the anal sphincter is checked by recording the terminal motor latency of the pudendal nerve. This helps determine whether sphincter weakness is due to damage to the pudendal nerve, a disruption in the integrity of the sphincter, or both. Due to the lack of sufficient experience and lack of information that could prove the high significance of this method for clinical practice, the American Gastroenterological Association opposes the routine determination of terminal motor latency of the pudendal nerve during the examination of patients with NK.

Sometimes stool analysis and determination of intestinal transit time help to understand the reasons underlying diarrhea or constipation. To identify pathological conditions that aggravate the situation with fecal incontinence (inflammatory bowel disease, celiac disease, microscopic colitis), an endoscopic examination is performed. It is always necessary to understand the cause, as this determines treatment tactics and ultimately improves clinical results.

Treatment of fecal incontinence

Often very difficult. Diarrhea is controlled with loperamide, diphenoxylate, or codeine phosphate. Exercises for the pelvic floor muscles, and in the presence of defects of the anal sphincter, improvement can be achieved after sphincter restoration operations.

Initial treatment approaches for all types of fecal incontinence are the same. They involve changes in habits aimed at achieving stool consistency, eliminating defecation disorders and ensuring access to the toilet.

Lifestyle change

Medicines and diet changes

Older people usually take numerous medications. It is known that one of the most common side effects of medications is diarrhea. First of all, you should review what the person is being treated with that can trigger NK, including over-the-counter herbs and vitamins. It is also necessary to determine whether there are components in the patient’s diet that aggravate the symptoms. This includes, in particular, sweeteners, excess fructose, fructans and galactans, and caffeine. A diet rich in dietary fiber may improve stool consistency and reduce the incidence of urticaria.

Container type absorbents and accessories

Not many materials have been developed to absorb feces. Patients tell how they get out of the situation with the help of tampons, pads and diapers - everything that was originally invented to absorb urine and menstrual flow. The use of pads in cases of fecal incontinence is associated with the spread of odor and skin irritation. Anal tampons come in different styles and sizes and are designed to block the leakage of stool before it happens. They are poorly tolerated, which limits their usefulness.

Toilet accessibility and “gut training”

Fecal incontinence is often a problem for people with limited mobility, especially the elderly and psychiatric patients. Possible measures: visiting the toilet on a schedule; making changes to the interior of the house to make visiting the toilet more convenient, including moving the patient’s sleeping place closer to the toilet; location of the toilet seat directly next to the bed; Place special accessories in such a way that they are always at hand. Physiotherapy and exercise therapy can improve a person's motor function and, due to greater mobility, make it easier for him to access the toilet, but, apparently, the number of episodes of fecal incontinence does not change from this, at least it should be noted that the results of studies on this topic are contradictory .

Differentiated pharmacotherapy depending on the type of fecal incontinence

Fecal incontinence due to diarrhea

At the first stage, the main efforts should be directed to changing the consistency of the stool, since formed stool is much easier to control than liquid stool. Adding dietary fiber to your diet usually helps. Pharmacotherapy aimed at slowing bowel movement or stool binding is usually reserved for patients with refractory symptoms that do not respond to milder measures.

Antidiarrheals for fecal incontinence

Conservative therapy for NK	Possible side effects
Dietary fiber in the form of dietary supplements	Increased gas discharge, bloating, abdominal pain, anorexia. Able to alter drug absorption and reduce the need for insulin
Loperamide	Paralytic ileus, rashes, weakness, cramps, constipation, nausea and vomiting. May increase the tone of the anal sphincter at rest. Cautious use in active inflammatory processes in the colon, as well as in infectious diarrhea
Diphenoxylate-atropine	Toxic megacolon, central nervous system effects. The anticholinergic effect of atropine may occur. Cautious use in active inflammatory processes in the colon, as well as in infectious diarrhea
Colesevelam hydrochloride	Constipation, nausea, nasopharyngitis, pancreatitis. Use cautiously if there is a history of colonic obstructive obstruction. May alter drug absorption
Cholestyramine	Increased gas formation and discharge of gases, nausea, dyspepsia, abdominal pain, anorexia, sour taste in the mouth, headache, rashes, hematuria, feeling of fatigue, bleeding gums, weight loss. May alter drug absorption
Colestipol	Gastrointestinal bleeding, abdominal pain, bloating, increased passage of gas, dyspepsia, liver dysfunction, skeletal muscle pain, rashes, headache, anorexia, dry skin. May alter drug absorption
Clonidine	Recoil syndrome in the form of arterial hypertension, dry mouth, sedation, manifestations from the central nervous system, constipation, headache, rash, nausea, anorexia. If there is no effect, the drug should be discontinued slowly
Laudanum	Sedation, nausea, dry mouth, anorexia, urinary retention, weakness, hot flashes, itching, headache, rash, central nervous system reaction in the form of depression, arterial hypotension, bradycardia, respiratory depression, development of addiction, euphoria
Alosetron	Constipation, severe ischemic colitis. The drug must be discontinued if there is no effect at a dose of 1 mg 2 times a day for 4 weeks

Patients with IBS-D deserve special attention, since their use of dietary fiber can increase abdominal pain and bloating, which makes them refuse this measure. If there is no improvement, they switch to pharmacotherapy that is more effective for this group of patients, including loperamide, TCAs, probiotics and alosetron.

Fecal incontinence due to constipation

Chronic constipation can lead to distension of the rectum as a result of a persistent tendency towards overcrowding and suppression of sensitivity. Both create conditions for overflow incontinence. This type of incontinence is especially common among older people. In case of overflow incontinence, it is advisable to increase the amount of dietary fiber in the diet as an initial measure, and only then, if necessary, can laxatives be prescribed.

Fecal leakage

Leakage is not the same as NDT. In this case, they mean the passage of a small amount of liquid or soft feces after normal bowel movements. The patient may talk about wetting in the perianal area, changes in the frequency of bowel movements, or symptoms more characteristic of dysfunction of the anal sphincters, which, upon an objective examination of the anorectal area, is not always regarded by the doctor as a violation of physiological functions. Leakage is more common in men with preserved anal sphincter function. It can be explained by hemorrhoids, poor hygiene, anal fistula, rectal prolapse, hypo- or hypersensitivity of the rectum. In patients suffering from leakage, proper diagnosis and treatment of the specific pathology can completely eliminate symptoms. If manifestations still remain, it is recommended to empty the rectal ampulla using an enema or suppositories every day, regardless of the urge to defecate. For enemas, it is better to use plain water, since repeated administration of sodium phosphate or glycerin can damage the mucous membrane and lead to rectal bleeding. The desired time for a regular procedure is the first 30 minutes after eating in order to enhance the normal reflexes characteristic of the colon after eating.

Rectally injectable blocking agents

Several means have been proposed to block the anal sphincter with the formation of an obstacle to the involuntary passage of feces. Among them are silicone, carbon-coated beads and, the newest, dextranomer in hyaluronic acid [(Solesta) Solesta]. A 2010 Cochrane systematic review found that, due to the small number of trials conducted, no clear conclusion could be reached regarding the effectiveness of injectables. Nevertheless, this approach remains the subject of close attention as it is promising and promises the emergence of new drugs that are truly capable of eliminating NK. Side effects include pain, bleeding and, rarely, abscess formation.

Non-pharmacological treatment options

Biofeedback method

The biofeedback method is one of the forms of psychotherapy based on the principle of reinforcement, in which information about a physiological process, which in a normal situation is transmitted at a subconscious level, is visually demonstrated to the patient so that he can influence the process, but already controlling it with his own by will. The essence of what is happening is to monitor the work of the striated muscles of the pelvic floor, so that the patient, taking this into account, voluntarily coordinates the performance of special exercises for strength training. Simultaneously with the development of strength, the ability to separate sensitive signals can be trained. According to the opinion of the majority of specialists dealing with this problem, this method of treatment is suitable for patients with mild to moderate manifestations of the disease, who meet the physiological criteria for dysfunction of the anal sphincters, who are ready for cooperation in work, are well motivated, and are able to put up with a certain severity of the feeling of rectal distension, retaining the ability to voluntarily compress the external sphincter.

Sacral nerve stimulation

Initially invented for the rehabilitation of patients with paraplegia, stimulation of the sacral nerves, instead of its main purpose, as it turned out later, promotes defecation. Later, promising results were obtained with NK. The first reports on this subject indicated the success of this technique in a large percentage of cases, which made sacral nerve stimulation a popular intervention and prompted the rapid development of the method.

Currently, publications have begun to appear on the results of long-term follow-up of patients, but they are much less optimistic and describe a smaller percentage of success. Among elderly patients, the number of postoperative complications reaches 30%. Complications include pain at the implant site, inflammation in the subcutaneous pocket, electrical sensation, and rarely battery displacement or failure, requiring repeat surgery.

Surgery

Surgical treatment is indicated when the cause of fecal incontinence is anatomical changes. Most often, sphincteroplasty is used to restore the sphincter by stitching the defect together with an overlap. After surgery, the edges of the wound often diverge, which significantly prolongs the healing time. Up to 60% of patients report improvement, but the long-term results of lap sphincteroplasty are poor. For patients with an extensive anatomical defect of the sphincter, for whom simple sphincteroplasty is unacceptable, graciloplasty and transposition of the gluteus maximus muscle have been developed. When performing graciloplasty, the gracilis muscle is mobilized, the distal tendon is split in half, and the muscle is enclosed around the anal canal. With dynamic graciloplasty, electrodes are applied to the muscle and connected to a neurostimulator, which is sutured into the abdominal wall, its lower part. Complications include inflammation, problems with stool passage, leg pain, intestinal damage, perineal pain and the formation of anal strictures.

If other options for surgical treatment have been exhausted, the option remains with implantation of an artificial anus. The artificial sphincter is passed around the natural sphincter through the perianal tunnel. The device remains inflated until it is time to defecate. During defecation, the artificial sphincter is deactivated (deflated). In general, a positive effect from the intervention is observed in approximately 47-53% of patients, that is, in those who tolerate the artificial sphincter well. The majority require surgical revision, and in 33% of cases, removal. Complications include inflammatory processes, destruction of the device or its malfunction, chronic pain syndrome and obstruction during the passage of feces. Colostomy or permanent stoma for fecal incontinence is considered an option for patients who have failed or where all other methods have been completely insufficient.

Key aspects of patient management

• Fecal incontinence is actually a disabling disorder that dramatically reduces a person's quality of life.
• For the development of diagnostic and therapeutic tactics, the collection of anamnesis with a detailed elucidation of how the pathology of defecation was formed, and an anorectal examination are crucial.
• Treatment of all types of fecal incontinence begins with analysis and lifestyle correction. The goal is to outline measures aimed at improving stool consistency, coordinating bowel dysfunction, and ensuring toilet accessibility.
• Intrarectal occlusive agents and sacral nerve stimulation have been shown to reduce the number of incontinence episodes.
• Surgical interventions should be reserved for those rare cases that do not respond to conservative treatment methods, in particular for patients with obvious anatomical defects.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Each disease is characterized by a certain set of symptoms, which, based on laboratory and instrumental research methods, make it possible to reliably establish a diagnosis. Based on the degree of their severity and regression (decrease in severity), during the treatment process, one can judge the effectiveness of the treatment measures taken and make a prognosis regarding recovery.

If we consider the symptoms of diseases from the patient’s point of view, then there are those that cause painful or unpleasant sensations, and there are those that cause severe discomfort, including psychological. Some of the most unpleasant and morally damaging symptoms include fecal incontinence. Considering the fact of the presence of this symptom, the social perception of the patient by others is jeopardized, a depressed and depressed state develops in cases where it is not possible to eliminate the cause of this unpleasant manifestation of the disease in a short time.

Fecal incontinence is most often not an independent disease, but only a manifestation of other pathologies. Accordingly, when such a symptom is detected, the doctor faces two main tasks: to establish the exact cause of its occurrence, and to carry out effective therapy that could restore the patient to his former health, saving him from physical and mental suffering. Fecal incontinence, most often, does not threaten the patient’s life, but is socially significant, since it creates many problems for the patient and the people around him.

This problem can be relevant for people of any gender and age. Currently, cases of visiting doctors about fecal incontinence have become more frequent, so doctors are actively studying the problem and offering many ways to eliminate it.

What is fecal incontinence

The medical name for this pathology is incontinence or encopresis. Fecal incontinence is when a person, for whatever reason, is unable to control the act of bowel movement. Very often it is combined with a related symptom - the inability to control the act of urination. This is due to the fact that the nervous regulation of both processes occurs with the participation of nerve centers that are similar in nature. However, fecal incontinence is 15 times more common than urinary incontinence and primarily affects males.

The mechanism of development and causes of fecal incontinence
(pathogenetic classification)

The development of this symptom is associated with impaired regulation of the centers that are responsible for the formation of conditioned reflexes, and can be caused by one of three mechanisms. The classification of these disorders was proposed by the Russian scientist M.I. Buyanov in 1985, and is still used by our doctors:

1. The absence of mechanisms that contribute to the emergence of a conditioned reflex to the act of defecation is innate in nature. In this case, the patient does not have the so-called rectoanal inhibitory reflex, which normally initiates the act of defecation.

2. Slow formation of a conditioned reflex to the act of defecation.

3. Loss of a conditioned reflex resulting from exposure to unfavorable or provoking factors. In this case, two possible development options are distinguished: primary and secondary. Primary is congenital, secondary is a consequence of disturbances in the patient’s mental state, injuries or organic lesions of the spinal cord, brain, or excretory system.

Secondary fecal incontinence deserves special attention. If we talk about psychogenic origin (and this is precisely what accounts for the vast majority of cases of the disease), then we should highlight the main conditions in which this is possible.

This group includes:
1. Psychogenic fecal incontinence, which can result from neurotic and hysterical psychoses, pathocharacterological personality disorders, and dementia.
2. Against the background of mental illness (dementia, schizophrenia, epilepsy).

Organic fecal incontinence develops with severe and often irreversible changes that have arisen due to various diseases. Fecal incontinence is much less common due to other treatable diseases.

In this case, it is customary to divide this symptom into 2 groups, according to the nature of its occurrence:
1 group– against the background of diseases related to the digestive tract and excretory system (rectal prolapse, anal injuries, accumulation of large amounts of hard feces in the rectum).

2nd group- against the background of other diseases (birth injuries of the pelvis, tumors of the anus, neurological consequences of severe forms of diabetes mellitus, decreased muscle tone (localized in the perineal area), infectious diseases accompanied by diarrhea, Hirschsprung's disease, congenital defects of the anorectal area).

Practical classification of fecal incontinence

In practice, fecal incontinence is usually divided according to severity:
I degree- manifests itself in gas incontinence.
II degree– characterized by incontinence of unformed feces.
III degree– is expressed in the patient’s inability to hold dense stool.

Epidemiology and statistics of fecal incontinence

Obtaining accurate statistical data that would allow a reliable assessment of the degree of morbidity among the population is difficult. This is due to the moral and etiological problem and the lack of 100% access of such patients to the doctor. Most often, doctors come to the attention of patients who are hospitalized for other diseases, and only a small part of those patients who decide to see a doctor with the problem of fecal incontinence. It is assumed that it is possible to identify real data only through active identification, or through anonymous surveys, questionnaires, etc.

With diseases of the colon, fecal incontinence occurs in 3-7% of patients. Among patients in psychiatric clinics, this symptom is observed in 9-10% of cases. In the group of patients over 65 years of age, fecal incontinence occurs in approximately 1-4%.

Diagnosis of fecal incontinence

The issue of diagnosing fecal incontinence is not difficult, since the patient’s corresponding complaints allow an accurate diagnosis to be made in 100% of cases. The ongoing research is aimed at establishing the cause of this symptom and, depending on the data obtained, at developing further treatment tactics. Studies during therapy make it possible to evaluate the effectiveness of the chosen method and make a prognosis for further treatment.

Modern medicine provides the following instrumental diagnostic methods:

• Endorectal ultrasonography. Thanks to this method, it is possible to evaluate the thickness of the anal sphincters (external and internal). In addition, the method allows you to detect the presence of defects that cannot be detected by manual examination.
• Manometry of the anal canal. This method involves determining the resting pressure and tension created in the anal canal. Using anal canal manometry, you can assess the tone of the anal sphincters.
• Determination of volume-threshold sensitivity of the rectum. If there is a deviation from the norm (a decrease or increase in this indicator), the patient’s act of defecation is disrupted, and this, in turn, leads to the absence of the urge to defecate or, on the contrary, causes an urge that requires immediate bowel movement.

Treatment of fecal incontinence

The issue of choosing a method of incontinence therapy is very important. It directly depends on establishing the exact cause that led to this pathology, the patient’s condition and his age. Surgical and conservative methods of treating fecal incontinence are used.

Surgical operations for fecal incontinence belong to the plastic category, and have long been used in medicine. According to medical experts, this technique is considered satisfactory. This treatment method is used in cases where the cause of the disease is injury or sphincter defect .

The nature of the operation depends on two indicators: the extent of the defect and its location. Depending on this, several types of operations are distinguished. If up to a quarter of the sphincter circumference is damaged, an operation called sphincteroplasty . For more severe damage, an operation called sphincterogluteoplasty , where a flap of the gluteus maximus muscle is used as a plastic material. Other types of surgical interventions for organic fecal incontinence are also used:
1. Operation Tirsha- using synthetic materials or silver wire (nowadays it has practically been abandoned).
2. Operation Fireman – using the thigh muscle as a plastic material (its effectiveness, unfortunately, is short-lived).

For functional fecal incontinence, in some cases, surgical intervention is performed - post-anal reconstruction.

For physicians, a more difficult task is to treat fecal incontinence in cases where it is not associated with mechanical disorders. If the muscle fibers of the sphincters are not damaged, then plastic surgery most often does not bring the desired result. However, in some cases, a type of surgery called post-mortem reconstruction .

Currently, many non-surgical treatments for fecal incontinence have been developed, which include:
1. Medication.
2. Non-medicinal.

Medication methods are most widely used in cases where fecal incontinence is associated with functional disorders of the digestive tract and excretory system (diarrhea, a combination of incontinence and constipation, frequent loose stools). They include 2 groups of drugs: those that are aimed at treating the underlying disease and those that have a direct effect on the tone of the perineal muscles and the condition of the anal sphincter. The following medications are used: strychnine in pills, proserine in subcutaneous injections, B vitamins, ATP. If the patient suffers from increased excitability of the nervous system, then the prescription of tranquilizers is indicated.

Non-drug methods include:

• Complex exercises aimed at training the anal sphincter (were developed by scientists Dukhanov and Kegel). The essence of these exercises boils down to the fact that a rubber tube, pre-lubricated with Vaseline, is inserted through the anus into the rectum. The patient contracts and relaxes the anal sphincter on command. Exercises are performed daily for 5 sessions. The duration of 1 session is 1-15 minutes. The treatment cycle lasts 3-8 weeks. In parallel with these exercises, it is recommended to perform physical exercises aimed at strengthening the muscles of the gluteal region, abdominal muscles and adductor muscles of the thigh.
• Electrical stimulation – carried out with the aim of stimulating the nerve endings responsible for the formation of a conditioned reflex to defecation.
• Biofeedback. This technique has been practiced in the world for more than 30 years, but has not yet become popular in Russia. Foreign colleagues note that this method, compared to others, gives not only the most positive results, but also the most lasting.

  I would like to pay special attention to this technique. It is carried out using biofeedback medical devices. The principle of operation of the biofeedback apparatus is that the patient is given the task of contracting and being able to hold the tension of the external sphincter in a given mode. An electromyogram is recorded using a rectal sensor, and the information is displayed on a computer in the form of graphs. The patient, upon receiving information about how correctly the task is being performed, can consciously control and adjust the duration and strength of contraction of the sphincter muscles. This, in turn, significantly increases the effectiveness of external sphincter training and helps restore the corticovisceral pathways, which are responsible for the function of retaining intestinal contents. Using this method, it is possible to achieve positive results in 57% of cases.

• Psychotherapeutic methods. Psychotherapy is indicated in cases where there are no gross violations of the obturator apparatus of the rectum caused by organic changes. The goal of the psychotherapeutic method of influence is to form and consolidate a conditioned reflex to the environment and place where it is possible to defecate. The use of hypnotic influences most often does not give the desired results, therefore it is little used at the present stage of development of medicine. However, isolated cases of cure by hypnosis have been described in medicine. The method turned out to be effective in cases where acute mental trauma or severe stress occurred against the background of complete health.
• Dietary measures aimed at normalizing digestion.
• Acupuncture. This method is effective in combination with others. It is most often used when the cause of fecal incontinence is increased nervous excitability.

Prognosis for fecal incontinence

With the organic or functional form of encopresis (fecal incontinence), in most cases it is possible to completely restore, or significantly improve, the manifestations of anal sphincter insufficiency. In cases where fecal incontinence is caused by mental illness, hemorrhagic or ischemic stroke, the prognosis is considered unfavorable.

Fecal incontinence as a symptom of other diseases

In this section, we will consider the distinctive features of fecal incontinence, which occurs as a symptom of other diseases, that is, not directly related to damage to the anal sphincter. It is important to note that in this case, treatment should be aimed at the underlying disease.

Fecal incontinence can occur with the following diseases:

1. Stroke (hemorrhagic, ischemic)
In this article, we will not consider in detail the immediate causes, course and treatment of stroke. Let us draw your attention only to what symptoms accompany these pathologies.
As a result of a stroke, the patient develops a whole complex of disorders, which is associated with a disruption of the blood supply to a certain area of ​​the brain. Depending on the affected area, certain symptoms are expressed to a greater or lesser extent.

The patient may have the following disorders:

• movement disorders or paralysis (impaired coordination of movement, difficulty walking, complete impairment of movement on one or both halves of the body);
• swallowing disorder;
• speech impairment (mainly with damage to the left hemisphere of the brain);
• disturbance of perception (there is no adequate perception of the surrounding reality);
• cognitive impairment (the ability to perceive and process information decreases, logic is impaired, memory decreases, the ability to learn is lost);
• behavioral disorders (slow reactions, emotional instability, fearfulness, disorganization);
• psychological disorders (sharp mood swings, unreasonable crying or laughing, irritability, depression);
• disorders of urination and defecation (no control over physiological functions, impaired tone of the anal sphincter).
• pain during bowel movements and urination;
• false urge to urinate and defecate;
• fecal incontinence;
3. Spinal cord disorders
This group of disorders occurs when the spinal parts of the nervous system located in the spine are damaged. The causes of this group of disorders may be: meningitis, sigingomyelia, spinal cord malformations, multiple sclerosis, amyotrophic sclerosis, spinal cord tuberculosis, spinal cord tumors, spinal cord injuries.

This pathology is characterized by the occurrence of the following symptoms:

• disturbance of movement in the extremities (upper, lower);
• decreased or complete absence of sensitivity (tactile, temperature, pain; can be observed on one or both halves of the body, above or below the level of spinal cord damage);
• fecal and urinary incontinence.
4. Injuries, including birth injuries
This group of diseases is associated with traumatic exposure, which affects the anal sphincter and, as a result, fecal incontinence occurs. In the case of severe injuries, this group of diseases is characterized by a complex of symptoms that depends on the size of the injury and the depth of the lesion. With birth injuries, pathology develops during difficult births, most often not in medical institutions. In both cases, patients are subject to surgical treatment followed by rehabilitation, which is selected individually. It is important for patients or their relatives who are faced with the problem of fecal incontinence to know that only the correct identification of the causes that led to this problem can be the key to successful treatment. In any case, this problem should only be solved by qualified and highly specialized doctors. A timely visit to a doctor will help speed up healing and return the patient to normal social life.

Contact your doctors - and the obstacles that prevent you from living a normal life will be eliminated. Stay healthy!

Before use, you should consult a specialist.

Anvar Yuldashev, coloproctologist, oncologist surgeon at EMC, says:

What is fecal incontinence?

Normally, the anal sphincters (locking muscles) are able to retain solid, liquid and gaseous intestinal contents not only in various body positions, but also during physical activity, coughing, sneezing, etc. Fecal incontinence is an impairment of the ability to retain and control the passage of gas and stool. In the practice of a coloproctologist, this is a fairly common problem, but it is rarely the direct reason for visiting a doctor, but becomes one of the complaints in other proctological diseases - rectal prolapse, anal fissure, inflammatory bowel diseases and many others.

There are three degrees of manifestation of sphincter insufficiency: at grade 1, patients cannot retain gases; at grade 2, liquid feces incontinence is added to this symptom; at grade 3, patients cannot retain all components of intestinal contents (gases, liquid and solid feces). There are special scales for assessing the severity of incontinence; EMC coloproctologists consider the Wexner scale, Wexnerscore, to be the most convenient.

What are the causes of fecal incontinence?

There are many causes of fecal incontinence. The most common of these is injury to the muscles and nerves of the pelvic floor, the muscles, ligaments and tissues that support the uterus, vagina, bladder, and rectum during a difficult vaginal birth or so-called “obstetric injury.”

Surgeries on the anal canal and perineum or trauma to them can cause problems with holding stool. Often, incontinence is complicated by an incorrectly performed operation to excise an anal fissure or remove hemorrhoids, which resulted in damage to the muscles of one or both anal sphincters.

Various proctological diseases (chronic constipation, hemorrhoids with prolapse of internal hemorrhoids, irritable bowel syndrome, as well as various inflammatory diseases of the colon (usually ulcerative colitis)) can cause dysfunction of the muscles of the anus and rectum. Some people, especially older people, may develop decreased tone of the anal muscles, increasing with age.

Diarrhea (diarrhea) may be accompanied by a sudden urge to defecate (empty the bowel), as well as leakage of loose stool.

Disease or injury that affects the nervous system and leads to disruption of the nerve endings of the anal canal and sphincters (for example, stroke, diabetes, multiple sclerosis), as well as general poor health caused by chronic diseases, increase the risk of developing incontinence.

How to determine the cause of incontinence?

At the appointment, the coloproctologist will ask questions regarding the patient’s life history to find out the circumstances that could cause incontinence. If the patient is a woman, it is necessary to know the birth history. Multiple pregnancies, large fetuses, and perineal incisions (episiotomy) can cause muscle and nerve damage during childbirth. In some cases, a concomitant chronic disease or constant use of certain medications may play a role in the development of incontinence, and in this regard, consultation with doctors of related specialties may be required. There are important questions that need to be answered as fully as possible:

When did fecal incontinence start? Does the patient associate the appearance of signs of incontinence with any life events (emotional factors, changes in lifestyle, surgical operations)?

How often do incontinence episodes occur? Are they preceded by an urge or does the patient feel no leakage?

What is the degree of incontinence - is it impossible to hold gas or stool? How much stool is leaked?

What restrictions in daily activities does the problem cause?

Is there a connection between taking any medications or foods and having episodes of incontinence?

The doctor will conduct an examination of the perineum and a digital examination of the anal canal and rectum, during which insufficient function of the anal canal muscles can be immediately determined. In addition, an ultrasound examination of the anal canal or MRI of the same area can be used to determine its structure and possible defects.

Instrumental examination methods include anal manometry (a method for studying the tone of the anorectal muscle and the coordination of contractions of the rectum and anal sphincters, based on recording pressure in the rectum and anus), defecography (an X-ray or MRI method for studying the physiology and function of the rectum and pelvic floor muscles during time of attempted defecation), if necessary, colonoscopy or rectosigmoidoscopy to diagnose proctological diseases, neoplasms and injuries. Often, the help of a neurologist and electromyography are required to determine the speed of nerve impulses along the pudendal nerves (pudendus). Also, if necessary, stool and blood tests are performed to identify pathogens of intestinal infections to determine the causes of diarrhea.

How is fecal incontinence treated?

After a thorough history taking, examination and examination of the patient, aimed at determining the cause and severity of the problem, the method of treatment is determined. Treatment is prescribed by the attending physician individually, taking into account all the characteristics of the patient and his lifestyle. There are many types of treatment; as a rule, a complex of therapeutic measures is used, which includes the following several items. Some of them, for example diet, are included in any complex, some are the method of choice.

1. Diet correction

It is recommended to exclude from the diet dairy products (milk, cheese, ice cream), fatty, spicy foods, coffee, alcohol, diet products (sweeteners, including sorbitol, xylitol, mannitol, fructose, used in diet drinks and sugar-free chewing gum and candies) ; Eat small meals several times a day, consume more dietary fiber from vegetables, fruits, or whole grains, or use fiber-based supplements. Fiber increases stool bulk, making it softer and easier to manage.

2. Medications to consolidate stool, which help reduce the number of bowel movements or reduce the rate of movement of intestinal contents.

3. Going to the toilet on a schedule, even if you don’t want to. This method is especially suitable for older patients who have a decreased ability to recognize the urge to defecate, or who have limited mobility that prevents them from using the toilet independently and safely. These people need assistance in going to the toilet after eating, and prompt response to their desire to go to the toilet if they have the urge to defecate.

4. Exercises to strengthen the muscles of the anus and pelvic floor.

5. Biofeedback therapy (exercises with biofeedback) to train the muscles that control bowel movements.

6. Electrical stimulation of the anal muscles by implanting devices that stimulate the sphincter. The most well-known and actively used method in the practice of foreign coloproctologists - sacral nerve stimulation or neuromodulation - is used in the EMC Surgical Clinic.

7. Surgical correction of anal muscle defects. The indication for surgical treatment is a violation of the anatomical structure of the anal sphincter, as well as 2-3 degrees of insufficiency as a result of other diseases of the rectum and anal canal (rectal prolapse, hemorrhoids, etc.). Sphincterplasty involves reconnecting sphincter muscles that were damaged during childbirth or as a result of other trauma. In Western medicine, implantation of an artificial anal sphincter is used, but the method is not registered in the Russian Federation.

In cases where it is impossible to normalize the bowel movement using conservative methods or restore the sphincter functions surgically, they resort to the formation of a colostomy - removing the lumen of the colon to the abdominal wall. The discharge is collected in a colostomy bag, which fits tightly to the skin. This surgery may make it easier to control bowel movements.

The content of the article:

Fecal incontinence is a condition that requires a comprehensive examination. Encopresis is rarely hereditary. If you experience several episodes of involuntary bowel movements over the course of 1 month, you should immediately consult a doctor. Finding out the cause without the intervention of a specialist and self-medicating is impractical and unsafe.

Causes of fecal incontinence in children

Involuntary defecation, like urination, in a child is justified only in infancy. As we grow older, the functions of the digestive tract and the ability to respond to physiological urges also develop. Uncontrolled bowel movement ceases to be a normal phenomenon - it becomes a pathology.

The task of parents is not to justify the fact of the development of fecal incontinence, not to explain it by any factors, but to rush to the pediatrician. After examination and questioning, he will refer you to a pediatric gastroenterologist or independently prescribe the necessary, and most importantly, competent treatment.
Childhood encopresis (as well as enuresis) is most often detected in preschool age, when the child undergoes a medical examination before entering an educational institution. Since upon reaching 6-7 years of age, children should already be able to control digestion and know how to behave correctly when they have the urge to defecate, the question of the psychological climate within the family is raised. They find out how favorable the situation is and whether violence is occurring there. Treatment of pathology requires the mandatory participation of a psychologist.

One of the reasons for fecal incontinence in a child:

Infection suffered in infancy (mainly associated with intestinal damage);
maternal illness during pregnancy;
smoking, alcoholism, difficult psychological conditions and exhausting work of a woman bearing a child;
intrauterine fetal hypoxia.

The listed factors have a detrimental effect on the body into which organs are just being laid. Underdevelopment of the sphincters of the digestive canal is an understandable complication in this case.

Also, children born as a result of problematic labor are more predisposed to encopresis. Its course can be complicated by entanglement of the umbilical cord, incorrect presentation and position of the fetus in the womb, and the need to use obstetric forceps. It has been revealed that children born during physiological labor rather than caesarean section are more likely to suffer from fecal incontinence.

Additional reasons:

Conflict situation in the family;
social and pedagogical neglect;
suffered fear, emotional shock;
congenital or acquired mental disorders - epilepsy, schizophrenia, neuroses, psychoses, hysteria, as well as combinations of these pathologies;
a tendency to shock - fecal incontinence in childhood is one of the manifestations of protest.

Taking into account these factors, at the stage of consultation and examination by a specialist, you need to inform about the features and difficulties that arose during pregnancy and/or childbirth.

Causes of fecal incontinence in adults

The etiological factors of fecal incontinence in children and adults are not particularly different. The only difference is that a child, due to his age, is more prone to demonstrative behavior, and therefore defecation can serve as a response even to a parental prohibition. In adults, encopresis occurs for the following reasons:

Malignant neoplasm of the rectum. Growing into the sphincter tissue, the tumor affects the nerve fibers. As a result, intestinal sensitivity and the patient’s ability to timely control the urge that arises are reduced. Removing a tumor (even if it is operable) does not promise an improvement in the process of defecation. Therefore, the best option for the patient is to create favorable conditions, first of all, the use of diapers, especially if they are going to be away from home. Considering the specifics of the pathology, it is preferable for the patient to minimize his stay in public places.

Digestive tract diseases. In gastroenterology, there are pathologies that lead, among other things, to scarring of rectal tissue. These include nonspecific ulcerative colitis, Crohn's disease. Pathologies affect the loss of elasticity of the rectum - it cannot withstand the urge to defecate and the influence of feces.

Constipation, metabolic disorders. A predisposing factor is a chaotic diet, the presence in the diet of an excessive amount of cereals, baked goods, potatoes, and fatty milk. Insufficient blood supply to tissues also leads to insufficiency of the digestive tract. First, constipation develops, then stretching of the intestines with feces, weakening of the sphincters and, as a result, it becomes difficult to restrain the urge to defecate.

Severe intoxication, condition after drug use. Alternate relaxation of all muscle groups leads to involuntary bowel movements.

Condition after complex surgical interventions, especially if the patient has drains removed.

Spinal cord injuries, previous stroke, condition after a spinal fracture, lack of sensitivity in the hip area. The patient does not feel the urge, cannot respond to them, defecation occurs involuntarily.

Fecal incontinence in women in half of all studied cases is the result of difficult childbirth, more often if an episiotomy was performed. Weakening of the pelvic floor muscles occurs due to multiple pregnancies and a large volume of amniotic fluid. Involuntary defecation in women occurs due to prolonged pressure of the enlarged uterus on the intestines, which creates a load on the sphincters and worsens their tone.

Also, encopresis in women occurs as a result of unprofessional tactics of obstetricians. Sometimes only during labor does the need for a caesarean section arise. However, gynecologists with little practice are not ready to admit that surgical intervention is required and continue to supervise the birth process. Then, due to the discrepancy between the size of the fetus and the proportions of the woman, her perineum is damaged.
Despite suturing directly in the delivery room, in the future there is a high probability of incontinence of urine, feces, and intestinal gases. In addition, recovery takes a very long time (up to 1 year).

The development of fecal incontinence in men, in addition to the tumor process and previous operations on the intestines, is facilitated by the following factors:

1. Hemorrhoids of severe forms. Inflammation of hemorrhoids, in turn, can be a consequence of excessive physical activity. Therefore, fecal incontinence also occurs among men. Also, increased physical activity is a separate risk factor for fecal incontinence.

2. Excessive use of laxatives. A particularly common cause of involuntary bowel movements in men over 60 years of age, when it is necessary to stimulate bowel function with medications.

3. Frequent enemas also cause involuntary bowel movements in men and women. Constant irritation of the intestinal walls negatively affects the motility of the digestive canal. As a result, it becomes more difficult to control it.

Abnormalities of intestinal development– a less common, but also relevant cause of fecal incontinence. Predisposing factors include disturbances in the structure of the brain and spinal cord. Also among the causes of uncontrolled bowel movements is diarrhea due to food poisoning or intestinal infection. The impact on the pathological condition is reduced to eliminating the root cause - immediately after relief of diarrhea, episodes of fecal incontinence do not occur.

Causes of fecal incontinence in older people

Among older people, fecal and urinary incontinence is the most common physical condition. Encopresis develops due to 3 main problems associated with natural aging of the body.

1. Problems with the functioning of the digestive tract. The main cause of fecal incontinence in older people is associated with disruption of intestinal metabolic processes. Low gastrointestinal motility contributes to the accumulation of food mass - constipation develops. A favorable condition is a sedentary lifestyle. Constipation is a precursor to fecal incontinence. Elderly people have difficulty influencing the sphincters - feces move and are evacuated involuntarily. Often - after the release of intestinal gases.

2. Mental disorders. In every 10 elderly people, irreversible changes occur in the centers of the brain. They entail disorders of memory, thinking, and coordination of movements. Also, against the background of a mental disorder, disruptions in the innervation of the intestine occur. However, the primary reason is problems with brain activity. Such pathologies include Alzheimer's disease, Parkinson's disease, senile dementia, manic-depressive syndrome, schizophrenia, and marasmus. Relatives need restraint in providing care for such a person, since encopresis is accompanied by other, no less severe symptoms.

3. Atrophy, weakness of the muscular system, characteristic of the aging process, leads to sphincter insufficiency. It becomes difficult to hold back your bowels during the urge.

The list of the most common causes of fecal incontinence in old age can be supplemented by impaired elasticity of the rectal muscles, its prolapse, and chronic intestinal diseases throughout life.

A specialist can reliably establish the causes of fecal incontinence in a patient of any gender and age, based on the results of instrumental and auxiliary types of research.