What diseases cause involuntary defecation? Fecal incontinence in the elderly: prognosis and prevention

Encopresis (fecal incontinence) is a disorder of the sphincter muscles in which the patient loses the ability to control bowel movements.

Most often this problem is encountered at a young age. The occurrence of encopresis in adults, as a rule, indicates the presence of pathologies, internal or external damage to the body.

In this article we will look at what fecal incontinence is, what causes it, and how to cope with the disease using traditional medicine.

General description and characteristics of encopresis Etiology of the disease Mechanism and causes of development of encopresis

Causes of fecal incontinence

Diagnostics Treatment of fecal incontinence with folk remedies Prognosis of the disease Prevention of encopresis and advice to patients General description and characteristics of encopresis

As we noted above, encopresis is a pathological condition of the body in which a person loses control over the process of defecation. Also, this condition is possible not only in cases where fecal incontinence occurs immediately before defecation, but also in cases where defecation occurs during the process of gases leaving the body.

In most cases (up to 70% of clinical cases), fecal incontinence occurs in children under 5 years of age. Often this phenomenon is preceded by a long stool retention. If a similar phenomenon is observed in a child under 2-3 years of age, then it cannot be called pathological, due to the incomplete formation of the child’s body and the physiological weakness of the rectum and the entire intestine as a whole.

In cases where fecal incontinence is observed in adults, the typical portrait of the patient is usually an elderly man over 65 years of age. Note that encopresis occurs 1.5 times more often in males than in women (fecal incontinence in women is more a pathology than a consequence of age-related changes in the body). In most cases of the disease in adults, it is not so much involuntary stool eruption that occurs, but stool smearing - a phenomenon characterized by a slight release of feces during gas or an initial urge to go to the toilet.

Etiology of the disease

It is widely believed that this problem is typical for elderly and senile people. Despite this, there is no clinical diagnostic evidence of this fact. This is also evidenced by statistics showing that in 50% of cases, fecal incontinence does not develop in old age, but among people of the middle age group (from 45 to 60 years).

At the same time, the disorder can develop in old age against the background of progressive senile (hydrocyanic) dementia. Such a violation negatively affects the lives of patients, being a kind of trigger leading to social isolation.

Mechanism and reasons for the development of encopresis

Before considering the causes of fecal incontinence, it is necessary to consider the mechanism by which this disease develops. In turn, knowledge of the mechanism will allow us to accurately characterize the reasons why encopresis progresses further.

The physiological mechanism of defecation is based on the coordinated work of the human nervous and muscular systems - the rectum contains a large number of nerve endings and muscles that are responsible for retaining or expelling feces. The sphincter is of key importance in the process of defecation. It has been established that normal pressure in the sphincter area is 50-120 mm. rt. Art., and the average value is about 80 mm. rt. Art. This indicator is higher in men than in women, and therefore, with a significant change in pressure, a number of pathologies may appear, including fecal incontinence.

The sphincter is in a state of constant tone, which is maintained by the smooth muscles inside the rectum, as well as by the autonomic nervous system - which is why it is impossible to consciously control or control this muscle.

The physiologically normal process of defecation occurs as a result of an irritating effect on the mechanoreceptors of feces, which accumulates in the ampulla after passing through the sigmoid colon. Next, the Valsalva reflex comes into play, in which simultaneous tension of the abdominal wall and glottis is observed. As a result of this reflex, the pressure in the abdominal cavity increases significantly, which, in turn, causes segmental contractions in the intestines and, as a result, the release of feces. At the same time, the muscles of the pelvic floor relax and it lowers, which allows feces to pass out of the body more easily.

Causes of fecal incontinence

Above we looked at the physiological process of defecation and how it occurs normally. Accordingly, the cause of disturbances in the fecal eruption process may be hidden behind a violation of one or more phases preceding the process itself. Let's take a closer look at the main causes of fecal incontinence:

Physiological and functional disorders. This category includes such phenomena as constipation (70-80% of all cases of fecal incontinence), muscle weakness or damage resulting from mechanical or organic trauma to the anus, pathology of the nervous system, hemorrhoids, functional disorder of muscle tissue, in particular pelvic floor and rectal areas.
Neurological and psychophysiological disorders. In some cases, fecal incontinence can be provoked by a problem of a neurotic nature - this could be severe fear, stress or other psychological trauma, which, in turn, provoked disorders of the nervous system. Since nervous regulation also takes part in the physiological process of feces, disruption of its functioning or the development of pathologies can also provoke the development of encopresis.

Among other reasons, it is also worth noting colectomy (intestinal surgery), decreased sensation of bowel movement, as well as diseases of various natures, in which encopresis is one of the symptoms of the clinical picture.

Fecal incontinence as a concomitant symptom

We noted above that encopresis may not be an independent disease, but a symptom that accompanies other ailments. In particular, fecal incontinence can occur as a result of hemorrhagic or ischemic stroke, due to disruption of nervous regulation and pathology of the higher nervous system, as well as dysfunction of the pelvic floor organs. In the latter case, fecal incontinence acts as a concomitant symptom of Alzheimer's disease, multiple sclerosis, encephalitis, various defects of the genitourinary system, tumors and neoplasms, uterine prolapse, prostatitis and other diseases.

Diagnostics

The diagnosis of fecal incontinence is preceded by clinical laboratory studies and general studies, which allow the doctor to determine the causes of the disease. Further research only allows us to confirm or refute the alleged cause of the disease, as well as establish the most suitable and acceptable treatment method. Among the diagnostic methods used to establish encopresis, the following should be noted:

Anorectal manometry. This technique is based on determining the sensitivity of the rectum by determining the internal pressure and compression force of the sphincter, as well as the correspondence of the sphincter’s reaction to provoking nervous reactions.
MRI. It is used in most cases because it allows you to obtain detailed images of the area being studied, in particular the rectum, sphincter and part of the intestine.
Proctography. This type of diagnosis allows you to determine the actual capacity of the rectum. It also makes it possible to establish exactly how feces are located in the intestines, as well as the mechanism of passage of feces from the moment it arrives from the sigmoid colon and to the sphincter.
Rectal ultrasound. A painless procedure used in most cases, which allows you to determine the condition of the rectum and sphincter using ultrasound.
Myography. Allows you to establish the condition and tone of the muscles of the pelvic floor, anus and smooth muscles of the rectum, as well as the nerve conduction of muscle fibers within the studied area.
Rectomanoscopy. A special type of study that involves placing a probe with a camera into the rectum. Allows you to study in detail the internal state of the rectum and establish possible causes of the development of encopresis, in particular, it allows you to determine the presence of cancer, inflammation and other neoplasms in the intestine.

As a rule, for diagnostic purposes, only a few types of studies are performed, based on the available medical history.

Treatment of fecal incontinence with folk remedies

As a rule, treatment of encopresis using folk methods consists of using agents that help strengthen the patient’s immunity, as well as restore the normal physiological function of bowel movements. The most effective are the following methods and methods of traditional treatment:

Power control. If you have fecal incontinence, you should follow a diet that includes plenty of fiber, fresh vegetables and fruits. It is not recommended to eat too fatty, hot and spicy foods, pasta. You should also focus on fermented milk products and dried fruits.
At first, you need to avoid situations that overstimulate the nervous system. This is necessary in order not to provoke uncontrolled bowel movements due to severe stress and disruption of the nervous system. In this case, herbal soothing infusions based on valerian, motherwort, mint, tincture based on angelica or fireweed, as well as a collection of lemon balm, St. John's wort and lavender flowers will help.
For 4 weeks, cleansing enemas of chamomile are done daily, 2 times a day. To do this, you need to take an enema, take 300-400 ml of warm chamomile decoction (30-35 degrees) and inject it into the rectum. The patient should try to hold it as long as possible.
Warm baths with herbs such as pine extract, chamomile, calendula, calamus and motherwort have a positive effect.

Note that it is advisable to use traditional medicine only after preliminary consultation with a doctor - the patient cannot know for sure the causes of fecal incontinence, and therefore may choose the wrong or inappropriate method.

Disease prognosis

In the vast majority of cases, with timely and correct treatment, the prognosis is positive. A correctly chosen technique allows you to eliminate the disease in 90% of cases, while avoiding relapse of the disease in the future. Despite this, prevention is a mandatory measure to achieve a positive prognosis.

Prevention of encopresis and advice to patients

Prevention of the disease is based on an elimination technique that involves eliminating the influence of triggers that provoked the development of encopresis. In other words, as preventive measures, the patient is recommended to carefully monitor his own diet, avoid trauma to the intestines and rectum in particular, and also do prescribed exercises and training aimed at strengthening the psycho-physiological state of the body.

Advice for patients in this case is standard: before leaving home, you should empty your bowels as completely as possible, always have a change of clothes and hygiene products with you to eliminate the consequences of voluntary bowel movements, and also take medications that can partially eliminate the smell of discharge and gases in the body.

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The disease that we will try to understand in this article is scientifically called encopresis - fecal incontinence, or, in other words, the inability (temporary or congenital) to control the act of defecation. Most often occurs in children under 4 years of age, much less often in adults. In relation to childhood encopresis, a lot of combat tactics have been developed, taking into account both the psyche of the sick child and physiology. However, what to do if such a misfortune overtakes an adult? Why does this happen and is it possible to fight the battle on your own, without going to conventional medical institutions and without running the risk called “we treat one thing, we cripple another”?

Origins of adult encopresisCongenital causes:

developmental defects;

rectal defects.

Purchased: metabolic or dietary;

postpartum/postoperative injuries;

muscle hypotension;

mental disorders (psychosis, schizophrenia, neurosis, hysteria);

rectal fistulas;

surgical or domestic trauma to the pelvic organs;

rectal rupture/fall;

anal tumor;

diabetes;

brain damage;

infectious diseases causing diarrhea;

serious illnesses, such as epilepsy, manic syndrome, dementia, etc.

Encopresis with a psychological background is more difficult to treat.

Treatment of fecal incontinence in adults: folk remedies and methods

First of all, it is necessary to follow a certain diet: emphasize the consumption of plant fiber (bran, sprouted grains, etc.), increase vegetable salads (carrots with sour cream, beets and vegetable oil) and fresh gifts of nature (apples) in your diet , cabbage, kiwi), at the same time giving up manna, rice and pasta, and also, preferably, fresh milk. Fermented milk products, on the contrary, will benefit the intestinal microflora, but it is better if they are home-made and left to stand for at least 17-18 hours. Eating a daily set of dried fruits (dried apricots, figs, prunes) in one to one proportions will be extremely effective.
As one of the mandatory conditions - limiting access to situations that excite the nervous system, ensuring a calm and peaceful environment; the patient must know that his condition is not hopeless, and must believe in his speedy recovery, showing patience and perseverance. We also recommend purchasing a collection to cure this ailment!
For a month, you need to do cleansing enemas from chamomile decoction twice a day. It can also be used for training enemas aimed at strengthening the reflex to defecation: insert 300 - 450 ml of chamomile decoction (22 - 38 degrees) into the rectum and walk, holding the liquid for as long as possible.
Another workout, but on a rubber tube with a diameter of 0.8 - 1 cm, 5 cm along the length lubricated with Vaseline: you also need to insert it into the anal canal, and then do some exercise with the sphincter - squeeze, unclench it, walk around the room with the tube, trying first hold it, and then push it out.
With encopresis, both the lower and upper areas of the gastrointestinal tract suffer, since such phenomena as impaired bile secretion and autointoxication are often observed in patients, therefore complex treatment of fecal incontinence in adults may include the use of choleretic folk remedies: infusion of calamus rhizomes, tea-sized honey spoon after meals, fresh rowan berries or juice from them, etc.
It also doesn’t hurt to get rid of toxins; taking a glass of water with soda and lemon juice on an empty stomach in the morning, natural juices before meals (apple or apricot), green tea, etc. will help you.

Important to remember Encopresis is a rather unpleasant disease that often reveals itself to others through smell. However, as in childhood, fecal incontinence in adults can be easily cured with folk remedies at home. The main thing is to start on time, not give up, and act comprehensively and systematically. Be patient, well-meaning and don't deviate from the path. Good luck and health!

Treatment of the intestines is a very important issue. No less significant are the problems described in “How to improve brain function?” Get well!

A problem such as fecal incontinence is more often typical of young children, since, due to their age, they cannot control their needs. But this can happen to an adult too. In such a situation, you need to urgently consult a doctor.

Fecal incontinence - encopresis disease

The reasons for this problem can be very serious. Being in such conditions is a physical and psychological feeling of discomfort at the same time.

Fecal incontinence, or encopresis in other words, varies in severity.

Doctors divide this problem into three degrees:

1st degree - inability to hold gases;
2nd degree - incontinence of gases, liquid feces;
3rd degree - inability to hold liquid and solid stool.

If even the 1st degree of severity occurs, you should immediately go to the clinic. The main thing is to notice and eliminate encopresis in a timely manner.

Doctors distinguish 4 types of involuntary bowel movements:

Regular appearance of feces without a corresponding urge.
Inability to hold stool when there is urge.
Inability to even partially retain stool during coughing, physical activity, or sneezing.
Incontinence associated with age-related changes.

What are the causes of the pathological condition

The origin of the reasons why this disease appeared is different. They can be either defects acquired at birth or acquired over time.

Anatomical pathologies:

problems with the rectum (for example, a condition after surgery for a tumor or hemorrhoids);
anal defect.

Psychological disorders:

panic;
neuroses;
schizophrenia;
psychoses;
hysterics.

Injuries acquired after childbirth or brain injury. Diarrhea caused by an acute infectious infection. Injuries of the rectum of the obturator apparatus. Neurological abnormalities caused by damage to the pelvis, tumors of the anus, diabetes mellitus. Alcohol addiction.

It should be said that alcoholism is a very common cause of fecal incontinence in men and treatment in this case consists of eliminating alcohol dependence.

Also, the causes of this problem may have a completely different origin.

For example, perhaps due to serious diseases such as:

manic-depressive syndrome;
epilepsy;
psychological instability;
catonic syndrome;
dementia.

Sometimes signs of encopresis appear after childbirth. In general, absolutely all damage to the anal apparatus can lead to such a case.

If you find at least some signs of the appearance of this disease, even the slightest, you should immediately seek help from a neurologist or proctologist.

Useful video on the topic

Childbirth, which can provoke damage to the intestines or pelvis, is a common cause of fecal incontinence in women and treatment in this case should be comprehensive.

Also a common cause is loss of control over the process of defecation due to a malfunction of the external sphincter, as well as anal insufficiency. Chronic diseases and pathologies of the nervous system can lead to such consequences.

Emptying occurs:

in a dream;
fainting;
under stress;
with other uncontrolled processes of loss of consciousness.

For an adult, unlike small children, this causes a lot of inconvenience and the feeling of comfort will immediately disappear.

Treatment in such a situation is usually prescribed comprehensively. Rehabilitation with a psychologist is where the patient is most often referred.

Encopresis in the older generation

Encopresis is a very common problem among older people. It happens due to improper activity of the cortical center, which is responsible for the process of defecation.

In old people, this problem is not congenital, but appears with the advent of age, which means it is already an acquired disease. Doctors can often witness a receptor inability to retain stool in the absence of the urge to have a bowel movement.

As a result of decreased function of the anal sphincter, such situations can occur five times a day. Encopresis is often associated with problems in the nervous system, as well as psychological abnormalities.

Since the cause may be hidden in a person’s psychological state, treatment is prescribed with medications and, in addition, a consultation with a psychotherapist is prescribed.

Sometimes it happens that the results do not bring positive dynamics for a long time, this is because the disease is already very advanced.

Problems after childbirth

Childbirth leads to serious consequences. Injury can occur both during natural childbirth and during caesarean section.

Often problems with the anal sphincter occur after the use of vacuum extraction of the fetus or as a result of the application of obstetric forceps. Perineotomies also cause an inability to retain stool.

If the child is large or there are two children, the baby walks forward with his feet - these are other reasons why encopresis occurs in the future. The older the woman, the higher the likelihood of uncontrolled bowel movements.

The level of hormones decreases with age, which means that muscle tissue loses its properties and elasticity, as a result of which the sphincter becomes more vulnerable. Excess weight and chronic diseases can also trigger illness during pregnancy and labor.

After six months, many women manage to get their health in order. But there are those for whom this problem does not leave for a very long time.

Basic principles of treatment

The very first thing you need to do is try to restore a regular bowel movement routine. A diet high in plant fiber will help here. And in addition you need to take medications like Imodium.
It is necessary to start training the sphincter. This will help prevent relapse in the future. Autotraining will help raise the sensitivity of the intestine to the presence of feces in it to the desired level. These methods help in 70 percent of cases.
If the above methods do not bring results, then you will have to resort to surgery. In rare cases, the patient may have to have a colostomy. With its help, a direct path is created for the patient between the wall of the abdominal cavity and the colon. But the anus has to be closed and defecation occurs in a specially attached container, which is secured near the abdominal wall.
A timely visit to the clinic can save you from a large number of problems. Everything can be fixed in a short time, if, of course, you don’t let everything take its course. Do not be afraid to contact competent specialists who will certainly help you.

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Prevention of fecal incontinence

The development of this disease can be prevented by simply following a few simple rules and following some recommendations:

It is important to undergo examination and treat diseases related to proctology.
Sexual contact through the anus should be avoided.
Do not tolerate defecation if desired.
It is advisable to train the muscles of the anus. It is enough to squeeze and relax your muscles in an accessible place and at a time that suits you.

There is also a general set of exercises that involves the development of all muscles.

Even at the slightest sign, consult a doctor; do not neglect yours or the health of your loved ones.

Medical treatments for encopresis

Fecal incontinence is medically called encopresis. Very often it occurs against the background of other diseases. Therefore, in order to carry out effective drug treatment, it is necessary to conduct a comprehensive diagnosis and identify all health-related problems. Depending on the underlying causes, medical treatment methods come down to:

surgical intervention;
conservative methods.

Surgical intervention has shown satisfactory results for many years. Surgery may be prescribed in a situation where involuntary bowel movements are caused by injury or a sphincter defect. Experts classify this procedure as plastic surgery.

Taking into account the degree of damage to the sphincter and the length of the defective area, operations are divided into types.

Sphincteroplasty is an operation that is performed in case of damage to no more than a quarter of the sphincter circumference.
Sphincterogluteoplasty is a procedure that is required for large amounts of damage. During the operation, material from the gluteus maximus muscle is used to restore sphincter function.
Operation Tirsha. Involves the use of synthetic materials or silver wire. It is practically not used in modern medicine.
Fireman's operation. To carry it out, material from the thigh muscle is used. This procedure has a short-term positive effect.
In cases where incontinence problems are not associated with mechanical disorders, post-anal reconstruction is performed.

In addition to surgery, medications have proven effective in eliminating the problem of fecal incontinence. They are most often used in cases of functional disruption of the digestive system. This may be diarrhea, frequent loose stools, a combination of incontinence along with constipation.

All drugs are divided into two groups. The first task is to eliminate the signs of the underlying disease. The purpose of the second group is to influence muscle tone in the perineum and sphincter. Strychine tablets, subcutaneous injections of proserine, ATP and group B vitamins have shown high effectiveness. In case of increased muscle excitability, the use of tranquilizers is recommended.

Traditional medicine recipes

When diagnosing encopresis, along with medications, it is recommended to use traditional medicine methods. They are aimed at overall improvement of the patient’s well-being and normalization of the body’s functioning.

For effective treatment, it is necessary to normalize nutrition and try to minimize situations that lead to nervous excitement. Optimally - a peaceful environment, complete calm.

Every day for at least a month you should give an enema from a decoction of chamomile flowers. To carry out the procedure, you need to inject 400 ml of the prepared broth into the rectum. After this, you should walk around with it inside. The procedure time is as long as possible. The broth should be warm. Temperatures range from 22 to 38 degrees. Such enemas are not only therapeutic, but also training in nature.

Another popular method is training on a special tube. It is necessary to take a tube with a diameter of about 1 cm. For a length of 5 cm, it is lubricated with Vaseline and inserted into the anal canal. After this, exercises are performed for the sphincter muscles. The exercises consist of sequential squeezing and unclenching of the muscles. Then you need to walk around the room, trying to first hold the tube and then push it out.

For complex therapy, folk choleretic decoctions are used. They are necessary to normalize the functioning of the gastrointestinal tract. A decoction of calamus roots has proven itself best. It is recommended to consume honey daily. A teaspoon is enough; rowan fruits and its juice also work well.

The active removal of toxins from the body is facilitated by taking a glass of water with the addition of lemon juice on an empty stomach. Green tea and fresh fruit juice have proven themselves to be excellent.

In addition to medications and exercises to strengthen the sphincter muscles, patients are prescribed a diet. The main task is to normalize nutrition for the proper functioning of the digestive system.

First of all, it is necessary to exclude from the diet those foods that can cause diarrhea: caffeine, alcohol. In case of lactose intolerance or poor protein tolerance, all dairy products are removed from the diet. It is not allowed to consume whole milk, cheese, butter, or ice cream. It is also not recommended to eat fried, salty, spicy, smoked foods.

The diet should not contain dietary products. This means avoiding sugar substitutes, sorbitol, xylitol, fructose and other dietary components. It is best to organize food consumption in small portions, but at regular intervals. This can be 5-6 meals a day.

You should add more cereals and dishes to your diet that help thicken your stool. Be sure to daily consume foods containing fiber: fresh vegetables and fruits. It is better to purchase bread from coarse grains. Dietary fiber preparations can be used as a dietary supplement. With their help, the stool will become larger and more manageable. Despite the ban on dairy products, kefir and other fermented milk drinks should be present in the diet. They have a good effect on intestinal microflora and digestion.

What are the prognosis for the development of the disease in patients with encopresis?

Fecal incontinence is a fairly common disease that is caused by a wide variety of reasons. If you contact a specialist in a timely manner, the prognosis for its development is the most optimal.

If you do not pay attention to the disease and let it take its course, then encopresis begins to develop. It is moving into more serious stages.

In total, there are 3 stages of the disease.

The first stage is characterized by gas incontinence. This is an unpleasant symptom, but it does not have a direct impact on a person’s life. The patient can perform normal activities and live a full life.
At the second stage, incontinence of unformed feces occurs. This situation requires the intervention of a specialist in order to adjust the diet and prescribe medications that will help thicken and shape the stool. It is recommended to perform gymnastics for the sphincter muscles. This stage of the disease is already noticeable to others, since the patient may not have time to get to the restroom in time. As a result, there is a gradual separation of the patient from the team. He avoids long public events.
The third stage is characterized by the inability to hold even dense feces. In this situation, functional disorders of the sphincter muscles are possible. If medicinal methods and gymnastics do not help, then surgical intervention is indicated.

Despite the fact that the social standard of living of the patient is seriously affected, encopresis can be cured. Situations where fecal incontinence is caused by hemorrhagic or ischemic stroke are considered unfavorable for the prognosis. But it leads to disruption of not only the process of defecation, but also paralysis, speech impairment and other problems.

Fecal incontinence in women and men

Content

Fecal incontinence in older people

Encopresis, or in other words, fecal incontinence, is the spontaneous release of feces from the anus.

This problem can affect any person, regardless of his gender and position in society.

Encopresis does not pose a threat to life or health, but makes its quality significantly worse.

People affected by this problem can become outcasts in society, and sometimes even in their own family.

Causes of fecal incontinence in the elderly

All the reasons that lead to the occurrence of the disease can be divided into:

Organic;
Psychological.

Organic causes of fecal incontinence include:

Anorectal diseasesHemorrhoids

Due to the fact that hemorrhoids are located too close to the anus, it cannot be completely blocked.

A small amount of loose stool or mucus may leak through this opening.

This simple phenomenon can also cause incontinence. You especially need to be wary of chronic constipation, since a large amount of hard feces accumulates in the rectum and muscle strain occurs.

Pelvic floor muscles

Because of this, the sphincter ceases to cope with its functions. Solid feces, of course, will not come out, but liquid feces can easily flow down the walls.

It is very difficult to retain liquid feces even for young people, let alone for older people.

Sphincter muscle weakness

Fecal incontinence occurs due to injury to the sphincter. Most often this happens after rolls.

Decreased rectal muscle tone

Under normal conditions, the rectum is elastic and can handle any amount of stool. If various inflammatory processes occur in it, then it loses this feature.

In addition, due to surgical diseases, scars may occur, which can also affect fecal retention.

Dysfunctional pelvic floor disorder

This reason may include:

Rectal prolapse;
Decreased muscle tone;
Sagging of the pelvic floor.

Psychological reasons include:

There is no reflex that is responsible for defecation;
Various mental disorders.

Types of fecal incontinence in older people

Feces are constantly excreted regardless of the urge to defecate;
Feces are released during the urge;
Incontinence occurs during exercise or coughing.
Feces are released involuntarily due to age-related changes in the body.

Fecal incontinence in older men occurs mainly due to nervous pathologies.

Fecal matter is passed during sleep or during strong emotions. To decide on treatment, it is necessary to accurately determine the type of disease.

Video: Training the intimate muscles of the pelvic floor, Kegel exercises

Treatment of stool incontinence

At the first stage of treatment, it is necessary to establish normal functioning of the gastrointestinal tract.

The patient must be prescribed a diet that clearly states how much and what foods to eat per day.

After normalization of the digestive system, the doctor prescribes furazolidone and imodium.

In order for the treatment to give a positive result, it is necessary, in parallel with drug treatment, to perform special exercises to train the pelvic muscles.

Thanks to simple exercises, you can restore the normal activity of the sphincter and the anal apparatus as a whole.

In case of serious damage to the anus, the patient is prescribed surgical intervention.

There is also a conservative treatment method. During it, the patient undergoes a course of medication, gentle exercises and electrical stimulation.

Due to the characteristics of each person’s body, it is impossible to select a specific list of products that will help get rid of this problem.

Therefore, the attending physician prescribes an individual diet for each patient.

Diet for fecal incontinence

Most often, products containing plant fiber are prescribed. Thanks to fiber, stool becomes larger, softer and easier to manage.

What to exclude from your daily diet:

Any dairy products;
Coffee sweets and drinks;
I eat salty, spicy and fried foods;
All smoked products;
Hard fruits and vegetables;
Alcoholic drinks.

People who suffer from fecal incontinence need to drink as much water as possible. Every day you need to drink at least 2 liters of water. Tea and juices are not included in this amount.

If the body does not absorb vitamins and minerals through natural products, then it is necessary to use special vitamin complexes.

Pelvic floor muscle training

If the pelvic muscles are toned, then this is the key to good intestinal function.

To begin such activities, it is necessary to find out the true causes of fecal incontinence.

Exercises to train the pelvic floor muscles

These trainings involve the patient independently contracting the pelvic muscles 50-100 times.

To achieve the desired result, you need to systematically perform such exercises for 3 months.

Electrical stimulation

During such procedures, a special device is inserted under the skin, which delivers electrical impulses.

The electrodes of this device must be placed on the nerve endings of the rectum. Thanks to the impulses, the process of defecation is normalized.

Surgical intervention

This method is used only if all of the above are not beneficial.

Assessing the condition of each patient, the doctor individually selects the method of surgical intervention.

Sphincteroplasty. This type of intervention is selected if involuntary fecal excretion occurs due to a violation of the integrity of the sphincter. During the operation, all muscles are reconnected and normal bowel movements are resumed.
Transposition of muscles. It is used if the previous type of operation could not eradicate the problem.
Colostomy is used for pelvic floor injuries. During such an operation, part of the rectum is brought out into the abdominal cavity, through which bowel movements will subsequently be carried out.
Implantation of an artificial sphincter is a modern type of surgical intervention. A special rubber cuff is placed near the anus, and a pump is built into the rectum itself, which is activated by a person from the outside. When he needs to go to the toilet, he uses a pump to relax the cuff and then tighten it again.

Conclusion

No one is immune from the problem of fecal incontinence, but with the help of modern medicine you can get rid of it.

Video: Fecal incontinence in the elderly

Thank you

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, and 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

Fecal incontinence as a symptom of other diseases

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 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

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.

Fecal incontinence is a medical condition characterized by a disorder in which a person is unable to control bowel movements. Bowel cleansing occurs spontaneously. The patient loses calm and becomes psychologically unbalanced.

Fecal incontinence has a special medical term - encopresis. The disease is usually associated with the development of organic pathology. All factors are significant and require elimination and urgent consultation with a doctor.

Fecal incontinence in adults is an unpleasant and dangerous phenomenon. A person loses the ability to control internal processes; bowel cleansing is not controlled by the brain.

Feces can be of different consistencies - solid and liquid. The emptying process itself does not change. Fecal incontinence in women is diagnosed less frequently than in the stronger half of humanity. Statistics give figures - one and a half times less. But this does not allow women to be calm and confident that they are not afraid of such a pathology. The disease is nearby, waits for favorable conditions and manifests itself, disrupting the usual way of life.

There is an opinion that the pathological disorder is characteristic of old age. Fecal incontinence in the elderly is an optional sign of age; doctors have proven that this opinion is wrong. Statistics provide figures that explain the emergence of such opinions. Half of the patients are people over 45 years of age. Age is only one of the reasons that leads to illness.

To understand why fecal incontinence occurs, you need to understand the process of managing bowel movements. Who controls at what level of physiology this is laid down. Several systems control the output of feces. Their coordination leads to the normal functioning of the body.

The rectum contains a large number of nerve endings that are responsible for the functioning of muscle structures. The same cells are located in the anus. The muscles hold the feces and push them out.
The rectum is located inside the intestine so as to hold feces and send it in the right direction. Feces, once in the rectum, already acquire their final state. It is dense, compressed into voluminous ribbons. The anus closes its exit without control.
The compressed state of bowel movement is maintained until it is released, when the person is ready for the act of defecation and understands that it has occurred. In a normal state, a person can restrain the process until he can go to the toilet. The delay time can be hours.

If the process is disrupted, this condition is not controlled, feces are released instantly. The muscles of the pelvis and anal area do not support intestinal tone.

The sphincter plays an important role in the process. More precisely, the pressure in his area. Normally, it varies from 50 to 120 mmHg. For men, the norm is higher. The anal organ in a healthy state should be in good shape; a decrease in its functionality leads to worsening bowel movements. Its activity is controlled by the autonomic nervous system. It will not be possible to consciously influence the sphincter. Stimulation of fecal output occurs at the level of irritation of receptors in the walls of the rectum.

Scientific explanation for passing stool:

simultaneous vibration of the peritoneal muscles and closure of the main opening (slit passage);
increased pressure on the sphincter;
delayed compression of intestinal segments;

All processes lead to advancement, pushing feces towards the anus. The process is slow and cannot be accelerated. The pelvic muscles enter a relaxed state, the muscles open the rectal outlet. The internal and external sphincter relaxes. When a person cannot get into the sanitary room, he strains the internal receptors, the anorectal opening remains closed and tight. The degree of tissue tension stops the urge to go to the toilet.

Causes of fecal incontinence

There are a number of factors that cause fecal incontinence in adults.

The most common reasons:

constipation;
loose stools;
weakness and damage to muscle mass;
nervous conditions;
decreased muscle tone relative to normal;
dysfunction of the pelvic organs;
hemorrhoids.

You can consider and analyze the causes of fecal incontinence in detail.

Constipation. Solid waste from food processing accumulates in the intestines. The tissue in the rectum stretches, which relieves pressure on the sphincter. When constipated, a person has a desire to soften stool. Liquid stool accumulates above solid feces. They leak out and damage the anal passage.
Diarrhea. Diarrhea changes the condition of the stool, this becomes a factor in the development of pathology. Treatment of fecal incontinence becomes the first and necessary action to eliminate symptoms.
Innervation problems. Impulses are subject to two types of disturbance. In the first option, the problem is based on nerve receptors, the second - on abnormalities in the functioning of the brain. This is often characteristic of the senile state, when the activity of brain processes decreases.
Scars on the walls of the rectum. Due to a decrease in the strength of the walls of the lining of the esophagus, enuresis and encopresis begin to appear. Unpleasant processes disrupt the condition of the adult organ, and scars form. Sometimes scars form after inflammation, surgery, or radiation.
Hemorrhoidal venous seals. The knots prevent the hole from closing, the muscles become weak and inactive. In older people, hemorrhoids change the entire bowel movement process.

It is based on certain principles:

adjustment of regime and diet;
medicines;
training the muscles of the intestinal systems;
stimulation of work using electrical equipment;
operational activities.

Each principle will be analyzed by a specialist. Treatment of encopresis is aimed at eliminating the problem - the cause that caused the disruption of the bowel movement.

Medicines

Among medications that help normalize the functioning of the digestive system, Imodium tablets are considered one of the most popular. In medical language they are called Loperamide.

Drug groups:

antacids;
laxatives;
therapeutic.

Other anti-diarrhea drugs intervene in the disease and produce additional healing effects:

Atropine, Belladonna. Anticholinergic drugs, they reduce the development of secretion and increase peristalsis. Motility of the intestinal walls returns to normal. Can be used at various stages.
Codeine. The drug relieves pain, as it is one of the derivatives of the opium group of drugs. More often it happens that it is included in the group of dangerous contraindications. Prescribed only on the recommendations of a doctor.
Lomotil. A medicine with this name reduces the movement of feces and creates conditions for its hardening.

The most common are activated carbon tablets. The substance is named after the active element of its composition. Coal absorbs liquid and expands feces in volume. In addition, the medicine removes toxic substances from the body.

Doctors are studying the causes and treatment. They will select special devices if medication formulations do not help.

The problem may arise when it is impossible to go to a medical facility. Then you have to turn to the advice of healers, healers from the people. At home, the disease has been eliminated for many centuries. Treatment of fecal incontinence was carried out in villages, where grandmothers selected medicinal herbs and created miraculous tinctures.

You can use folk remedies, but such an action should not be permanent. What reasons led to loose stools, what caused intestinal malfunctions? Answers to questions can be obtained after a full examination and diagnostic procedure.

Enemas. Chamomile decoctions are used to carry them out. Take 50 g of medicinal herb and place it in a liter of boiling water. Over low heat, wait for the chamomile components to completely dissolve. Then cool to room temperature and insert into the rectum. You need to hold the medicine inside for a very long time, you can help with the help of medical devices or hands.
Infusions for internal use. The base is calamus grass. It is steamed in boiling water, the proportions are 20 g of herb, 200 ml of liquid. You can’t make a lot of water compositions. A liter of healing infusion is sufficient for a course of 7 days. Drink 1 spoon after meals.
Rowan juice. The fruits of the tree help when eaten fresh and pressed into a drink. Dosage rate: one spoon no more than 3 times a day.
Honey products. Honey, 1 tablespoon per day, will be both a therapeutic and preventive method of eliminating the disease.

Changes in bowel movements occur during pregnancy. Women hope that everything will end after childbirth. More often, the disease continues to occur and intensify. The problem becomes not so much physiological as psychological.

Fecal incontinence after childbirth is due to the following reasons:

impaired innervation of the bladder muscles;
deviations in the functioning of the muscles of the pelvic organs;
pathologies of the urethra;
dysfunction of the bladder and urinary systems;
instability of pressure inside the bladder.

The pathology occurs along with another process - gas incontinence is observed. A large number of women consult doctors after childbirth with such symptoms. They are trying to understand the reasons why gas incontinence occurs after childbirth.

There is not just one reason for the phenomenon, it is a whole complex:

Trauma to the anus during labor.
The birth of a large fetus against the background of external and internal ruptures.

Some injuries occur during special medical methods of assisting a woman in labor - the use of surgical equipment.

Gas incontinence after childbirth may have other explanations:

violation of the anatomical structure of the organs responsible for defecation (fistulas, cracks, wounds);
organic damage (diseases of the spinal cord or brain);
birth trauma;
consequences of surgical interventions;
mental disorders (neuroses, depression).

There are also medical pathologies that, with fecal incontinence, often become noticeable after childbirth.

epilepsy;
dementia;
catatonic syndrome.

Your doctor will tell you what to do to eliminate unpleasant symptoms.

The methods were developed by specialists based on the experience of doctors in studying the causes of fecal incontinence.

Operations to introduce a special gel into the canal. This type of therapy is used to strengthen the walls of the anus. The method does not promise a complete cure; relapse may occur.
Fixation of internal organs. Operations are rarely used. Surgeons secure the fluid emission channel, cervix, and bladder. After the intervention, a long recovery period will be required.
Loop method. One of the most frequently performed methods of surgical intervention. To eliminate urinary and fecal incontinence, a support is created from a loop of special medical material.

Treatment after injury to the sphincter region or damage to the pelvic muscle tissue consists of the method of modern technologies - sphincteroplasty. The surgeon stitches torn, stretched muscles. Another way is an artificial organ, which can be controlled by the person himself. The surgical cuff is inflated and deflated. Fecal incontinence after surgery can be hidden by simple measures: clean, changeable clothes, taking medications that reduce the smell of stool accompanied by gases.

Fecal incontinence in the older generation

Treatment for encopresis depends on the age of the patient. Fecal incontinence in the elderly is a common problem.

The main manifestation is observed after a stroke. The patient suffers from pelvic organ disorders.

Because of this, the functioning of internal systems begins to deteriorate:

constipation;
urinary retention;
incomplete exit of feces and urine from the intestines;
gas incontinence;
pain during bowel movements and urine output;
false desire to visit the toilet;
impotence.

Almost every person knows what diarrhea is. Under certain conditions, a single deterioration becomes a frequent illness. Knowing the causes and factors of its development will help you avoid pathology and maintain your usual lifestyle.

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 reduced 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 functions of the sphincter 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.

Each disease has symptoms, based on which and on the basis of laboratory tests it is possible to establish an accurate diagnosis. The degree of regression or severity of symptoms can be used to judge the effectiveness of treatment methods and predict recovery. Urinary and fecal incontinence are considered one of the most unpleasant symptoms that sharply worsen the patient’s quality of life and jeopardize the social perception of others.

In the vast majority of cases, fecal incontinence is not an independent disease, but only a manifestation of an existing pathology. In this case, the doctor needs to find out the cause of the disease and select the optimal treatment in order to save the patient from moral and physical suffering as soon as possible. This symptom, of course, does not threaten the patient’s life, but it creates a lot of problems both for himself and for the people around him.

In medicine, fecal incontinence is called encopresis or incontinence. It occurs when the patient, for some reason, ceases to control the act of defecation, and quite often parallel incontinence of urine and feces is observed. This is due to the fact that both processes are regulated by nerve centers that are similar in nature. However, according to statistics, fecal incontinence is 15 times more common than uncontrolled urination and often affects men.

There may be several reasons for the appearance of these symptoms: the absence of mechanisms that contribute to the appearance of the defecation reflex, the delayed formation of this reflex, or its loss due to provoking factors. That is, fecal incontinence can be either primary, that is, congenital, or secondary, resulting from damage to the brain or spinal cord, mental state disorders, pathologies of the excretory system, or trauma.

Most often, doctors are faced with fecal incontinence of psychogenic origin, that is, this symptom is caused by hysterical and neurotic psychoses, pathocharacterological disorders such as dementia or mental illnesses - schizophrenia and epilepsy. Much less often, incontinence occurs due to diseases of the digestive tract (anal injuries, rectal prolapse) or other diseases (decreased tone of the perineal muscles, severe forms, tumors of the anus and birth injuries of the pelvis).

Diagnosing fecal incontinence is not at all difficult, because specific patient complaints allow a diagnosis to be made in 100% of cases, but to determine the causes of the symptom, doctors take tests and conduct studies that allow them to prescribe the necessary therapy.

Treatment of fecal incontinence with parallel urinary incontinence largely depends on identifying the causes of the disease, the age and condition of the patient. Quite often, doctors recommend surgical intervention for such patients, which falls into the category of plastic surgery and has been used in practice for quite a long time. This solution to the problem is resorted to when the cause of incontinence is a sphincter defect.

However, in cases where the sphincter muscles are not damaged and incontinence is not associated with mechanical disorders, it is much more difficult to cope with the disease. Most often, doctors resort to non-surgical methods: drug and non-drug therapy. Treatment with drugs is aimed at eliminating the underlying disease, as well as increasing the tone of the anal sphincter muscles. Among non-drug methods, biofeedback, psychotherapeutic methods, acupuncture and dietary measures have become widespread. Take care of your health!

What diseases cause involuntary defecation? Fecal incontinence in the elderly: prognosis and prevention

Fecal incontinence - encopresis disease

What are the causes of the pathological condition

Useful video on the topic

Encopresis in the older generation

Problems after childbirth

Basic principles of treatment

Prevention of fecal incontinence

Medical treatments for encopresis

Traditional medicine recipes

What are the prognosis for the development of the disease in patients with encopresis?

What is fecal incontinence

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

Practical classification of fecal incontinence

Epidemiology and statistics of fecal incontinence

Diagnosis of fecal incontinence

Treatment of fecal incontinence

Prognosis for fecal incontinence

Fecal incontinence as a symptom of other diseases

Causes of fecal incontinence

Medicines

Fecal incontinence in the older generation

What is fecal incontinence?

What are the causes of fecal incontinence?

How to determine the cause of incontinence?

How is fecal incontinence treated?

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