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 the act of defecation.

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 with the help of traditional medicine.

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

Causes of fecal incontinence

Diagnosis 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 defecation process. Also, this condition is possible not only in cases where fecal incontinence occurs immediately before the moment of defecation, but also in cases where defecation occurs in the process of exiting gases from the body.

In most cases (up to 70% of cases of clinical practice), fecal incontinence occurs in children under 5 years of age. Often this phenomenon is preceded by a long delay in stool. If a similar phenomenon is observed in a child under 2-3 years old, 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 the case when fecal incontinence is observed in adults, the portrait of the patient is typical - as a rule, this is an elderly man over 65 years old. It should be noted that in males, encopresis occurs 1.5 times more often 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 fecal eruption as fecal smearing - a phenomenon characterized by a slight release of feces during gas emission or initial urge to go to the toilet.

Etiology of the disease

It is widely believed that this problem is typical for people of elderly and senile age. 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).

Along with this, the disorder can also develop in old age against the background of progressive senile (cyanotic) dementia. Such a violation negatively affects the lives of patients, being a kind of trigger leading to social isolation.

Mechanism and causes of encopresis development

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 holding or erupting feces. The sphincter plays a key role in the process of defecation. It has been established that the normal pressure in the sphincter area is 50-120 mm. rt. Art., and the average value is about 80 mm. rt. Art. This indicator in men is higher than in women, and therefore, with a significant change in pressure, a number of pathologies may appear, including, among other things, fecal incontinence.

The sphincter is in a state of constant tone, which is maintained by smooth muscles inside the rectum, as well as by the autonomic nervous system - which is why it is impossible to consciously manage 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 there is a simultaneous tension of the abdominal wall and the glottis. As a result of this reflex, the pressure in the abdominal cavity increases significantly, which, in turn, causes segmental contraction in the intestine and, as a result, the release of feces. This relaxes the muscles of the pelvic floor and lowers it, which allows feces to pass out of the body more easily.

Causes of fecal incontinence

Above, we examined the physiological process of defecation and how it normally occurs. Accordingly, the cause of violations of the process of calorie eruption may be hidden behind the 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 - in the pelvic floor and rectum.
Neurological and psychophysiological disorders. In some cases, fecal incontinence can be triggered by a neurotic problem - it can 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 calorie eruption, disruption of its work or the development of pathologies can also provoke the development of encopresis.

Among other reasons, it is also worth noting colectomy (postponed operations on the intestines), a decrease in the feeling of emptying of the intestines, as well as diseases of various nature, in which encopresis is one of the symptoms of the clinical picture.

Fecal incontinence as a concomitant symptomatology

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 impaired 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 in Alzheimer's disease, multiple sclerosis, encephalitis, various malformations of the genitourinary system, tumors and neoplasms, uterine prolapse, prostatitis and other diseases.

Diagnostics

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

anorectal manometry. This technique is based on determining the sensitivity of the rectum by determining the internal pressure in it and the force of compression of the sphincter, as well as the correspondence of the reaction of the sphincter to provoking nerve reactions.
MRI. It is used in most cases, because it allows you to get detailed images of the area under study, in particular - the rectum, sphincter and part of the intestine.
Proctography. This type of diagnosis allows you to establish the actual capacity of the rectum. It also allows you to establish exactly how the feces are located in the intestine, as well as the mechanism for the passage of feces from the moment it enters from the sigmoid colon to the sphincter.
Rectal ultrasound. A painless and commonly used procedure that 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 research involving the placement of a probe with a camera into the rectum. Allows you to study in detail the internal state of the rectum and establish the possible causes of the development of encopresis, in particular, it allows you to establish the presence of oncological diseases, inflammation and other neoplasms in the intestine.

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

Treatment of fecal incontinence with folk remedies

As a rule, the treatment of encopresis by folk methods consists in the use of agents that help strengthen the patient's immunity, as well as restore the normal physiological function of defecation. The most effective are the following methods and methods of folk treatment:

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

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

Disease prognosis

In the vast majority of cases, with timely and proper treatment, the prognosis is positive. A correctly chosen technique allows eliminating the disease in 90% of cases, while avoiding a recurrence 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 a preventive measure, the patient is advised to carefully monitor his own diet, avoid traumatizing the intestines and rectum in particular, and also do prescribed exercises and training aimed at strengthening the psychophysiological state of the body.

Advice for patients in this case is standard: before leaving the house, you should empty your intestines as completely as possible, always have a change of clothes and hygiene products with you to eliminate the consequences of arbitrary defecation, and also take drugs that can partially eliminate the smell of secretions and gases in the body.

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The disease that we will try to deal with 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 children's encopresis, a lot of tactics of struggle have been developed, taking into account both the psyche of the sick child and physiology. However, what to do if such an attack overtook an adult? Why is this happening and is it possible to fight the failure on our own, without going to conventional medical institutions and without being exposed to the risk called “we treat one thing, we cripple another”?

Origins of adult encopresisCongenital causes:

malformations;

rectal defects.

Purchased: metabolic or dietary;

postpartum / postoperative trauma;

muscle hypotension;

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

rectal fistulas;

operating or domestic trauma of the pelvic organs;

rupture / fall of the rectum;

tumor of the anus;

diabetes;

brain damage;

infectious diseases that cause diarrhea;

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

Psychologically motivated encopresis 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: to emphasize the consumption of vegetable fiber (bran, germinated cereals, etc.), to participate in the diet of vegetable salads (carrots with sour cream, beets and vegetable oil) and fresh gifts of nature (apples, cabbage, kiwi), while 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, aged for at least 17-18 hours. The daily consumption of a set of dried fruits (dried apricots, figs, prunes) in one to one proportions will be extremely effective.
As one of the prerequisites - limiting access to situations that excite the nervous system, providing 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!
Within a month, it is necessary to do cleansing enemas from chamomile decoction twice a day. It can also be used for training enemas aimed at strengthening the reflex to defecate: enter 300 - 450 ml of chamomile decoction (22 - 38 degrees) into the rectum and walk, holding the liquid as long as possible.
Another workout, but on a rubber tube with a diameter of 0.8 - 1 cm, 5 cm long lubricated with petroleum jelly: it is also necessary to insert it into the anal canal, and then perform some kind of exercise with the sphincter - squeeze it, unclench it, walk around the room with the tube, trying first to hold it, and then push it out.
With encopresis, both the lower and upper regions of the gastrointestinal tract suffer, since such phenomena as impaired bile secretion and autointoxication are often observed in patients, therefore, the complex treatment of fecal incontinence in adults may include the use of choleretic folk remedies: an infusion of calamus rhizomes, honey in a teaspoon after eating, fresh rowan berries or juice from them, etc.
It also does not hurt to get rid of toxins, which will help you in the morning on an empty stomach with a glass of water with soda and lemon juice, natural juices before meals (apple or apricot), green tea, etc.

Important to remember Encopresis is a rather unpleasant disease, often betraying itself to others through smell. However, as in childhood, fecal incontinence in adults can be cured with folk remedies at home. The main thing is to start in a timely manner, not to give up, to act comprehensively and systematically. Be patient, be well-disposed, and stay on the path. Good luck and health!

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

Such a problem as fecal incontinence is more common in young children, as they, due to their age, cannot control their needs. But this can happen to adults too. In such a situation, you need to urgently consult a doctor.

Fecal incontinence - encopresis disease

The reasons for the appearance of such a 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 can be of varying severity.

Doctors divide this problem into three degrees:

1 degree - the inability to keep gases;
2 degree - incontinence of gases, liquid feces;
Grade 3 - inability to retain the liquid and solid state of feces.

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

Doctors distinguish 4 types of involuntary bowel movements:

Regular appearance of feces without corresponding urge.
Inability to retain stool when urge is present.
The inability to even partially retain feces at the time of coughing, physical activity or sneezing.
Age related incontinence.

What are the causes of the pathological condition

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

Anatomical pathologies:

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

Psychological disorders:

panic;
neuroses;
schizophrenia;
psychoses;
tantrums.

Injuries acquired after the birth process or with a brain injury. Diarrhea provoked 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 the treatment in this case is to eliminate alcohol dependence.

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

For example, perhaps due to serious medical conditions such as:

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

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

If you find at least some signs of the onset of this disease, even the slightest, you should immediately seek help from a neurologist, 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 the loss of control over the defecation process due to a malfunction of the external sphincter, as well as anal insufficiency. Chronic diseases, pathologies of the nervous system can lead to such consequences.

Emptying takes place:

in a dream;
in fainting spells;
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 complex. The passage of rehabilitation with a psychologist is where the patient is most often sent.

Encopresis in the older generation

In older people, encopresis is a very common problem. It happens in the course of improper activity of the cortical center responsible for the process of defecation.

In the elderly, this problem is not congenital, but it appears with the advent of age, which means that this is an already 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 a decrease in the 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 deviations.

Since the cause may be hidden in the psychological state of a person, 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 be obtained both during natural childbirth and during caesarean section.

Often problems with the anal sphincter occur after the use of vacuum fetal extraction or as a result of the application of obstetric forceps. Perineotomy also causes 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 an uncontrolled bowel movement.

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

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

Basic principles of treatment

The very first thing you need to try to restore a constant bowel movement. This is where a fiber-rich diet can help. And in addition, you need to drink drugs such as imodium.
It is necessary to start training the sphincter. This will help prevent a relapse in the future. Auto-training 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, a patient has to undergo a colostomy. With its help, the patient creates a direct path between the wall of the abdominal cavity and the large intestine. That's just the anus has to be closed and defecation occurs in a specially attached container, which is fixed near the abdominal wall.
A visit to the clinic made on time can deprive you of a large number of problems. Everything can be fixed in a short time, unless, of course, everything is left to chance. 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, it is enough to follow a few simple rules and follow some recommendations:

It is important to undergo an examination and treat diseases in the proctological part during the examination.
Sexual intercourse through the anus should be avoided.
Do not tolerate defecation if desired.
It is advisable to train the muscles of the anal passage. It is enough to compress and relax the muscles in an accessible place and at the right time for 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 your or the health of your loved ones.

Medical treatments for encopresis

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

surgical intervention;
conservative methods.

Surgery has shown satisfactory results for many years. An operation may be prescribed in a situation where an involuntary bowel movement is caused by injury or a defect in the sphincter. Experts refer this procedure to the category of plastics.

Given 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. It implies the use of synthetic materials or silver wire. It is practically not used in modern medicine.
Fireman operation. For its implementation, the material of the thigh muscle is used. This procedure has a short-term positive effect.
In cases where incontinence problems are not associated with mechanical disorders, postanal reconstruction is performed.

In addition to surgical intervention, medications have proven themselves well to eliminate the problem of fecal incontinence. They are most often used in case of functional disorders of the digestive system. It can be diarrhea, frequent loose stools, a combination of incontinence along with constipation.

All drugs are divided into two groups. The task of the first is to eliminate the signs of the underlying disease. The purpose of the second group is to influence the muscle tone in the perineum and sphincter. Strychin tablets, subcutaneous injections of prozerin, ATP vitamins, group B showed high efficiency. 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 the general improvement of the patient's well-being and the normalization of the body.

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

Every day for at least a month, you should put an enema from a decoction of chamomile flowers. For the procedure, it is necessary to introduce 400 ml of the finished broth into the rectum. After that, you should walk around with him inside. The procedure time is as long as possible. The broth should be warm. The temperature ranges from 22 to 38 degrees. Such enemas are not only therapeutic, but also training in nature.

Another folk 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 smeared with petroleum jelly and inserted into the anal canal. After that, exercises are performed for the sphincter muscles. Exercises consist of sequential squeezing and unclenching 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 for the normalization of the gastrointestinal tract. The decoction of calamus roots proved to be the best. It is recommended to consume honey daily. A teaspoon is enough, rowan fruits and its juice are also good.

The active removal of toxins from the body is facilitated by a glass of water taken on an empty stomach with the addition of lemon juice. Excellent green tea, fresh fruit juice.

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 deficiency or poor protein tolerance, all dairy products are removed from the diet. It is not allowed to consume whole milk, cheese, butter, ice cream. It is also not recommended to eat fried, salty, spicy, smoked.

Diet foods should not be present in the diet. This means that sugar substitutes, sorbitol, xylitol, fructose and other components of the diet should be abandoned. It is best to organize the consumption of food in small portions, but at regular intervals. It can be 5-6 meals a day.

In the diet, you should add more cereals and dishes that contribute to the thickening of the stool. Be sure to daily intake of foods containing fiber: fresh vegetables and fruits. Bread is best purchased from coarse grains. Dietary fiber preparations can be used as a dietary supplement. With their help, the chair will become more plentiful 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 the intestinal microflora and digestion.

What predictions for the development of the disease do patients with encopresis

Fecal incontinence is a fairly common disease that is caused by a variety of reasons. With a timely appeal to a specialist, 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 goes 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, live a full life.
In the second stage, incontinence of unformed feces occurs. This situation requires the intervention of a specialist in order to adjust the diet, prescribe drugs that will help thicken and form feces. 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 reach the restroom in time. As a result, there is a gradual separation of the patient from the team. He avoids long mass events.
The third stage is characterized by the inability to retain even dense feces. In this situation, functional disorders of the sphincter muscles are possible. If medical 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 when fecal incontinence is caused by hemorrhagic or ischemic stroke are considered unfavorable for the prognosis. But it leads to a violation not only of the defecation process, but also paralysis, impaired speech and other problems.

Fecal incontinence in women and men

Content

Fecal incontinence in the elderly

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

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

Encoprese does not pose a threat to life or health, but makes its quality much 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 causes that lead to the onset of the disease can be divided into:

Organic;
Psychological.

Organic causes of fecal incontinence include:

Anorectal diseasesHemorrhoids

Due to the fact that the hemorrhoids are located too close to the anus, it cannot fully clog.

A small amount of liquid stool or mucus may leak out through such an opening.

Due to such a simple phenomenon, incontinence can also occur. It is especially necessary to be afraid of chronic constipation, since a large amount of solid feces accumulates in the rectum, muscle strain occurs.

Muscles of the pelvic floor

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

It is very difficult to keep liquid feces even for a young person, and what can we say about elderly people.

sphincter muscle weakness

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

Decreased muscle tone in the rectum

Normally, 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 the retention of feces.

Dysfunctional pelvic floor disorder

This reason may include:

Prolapse of the rectum;
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 the elderly

Fecal masses are allocated constantly, regardless of the urge to defecate;
Feces are excreted during urges;
Incontinence occurs during exercise or coughing.
Fecal masses are secreted involuntarily due to age-related changes in the body.

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

Fecal masses come out during sleep or during strong experiences. To determine the treatment, it is necessary to accurately determine the type of disease.

Video: We train the intimate muscles of the pelvic floor, Kegel exercises

Treatment of stool incontinence

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

The patient needs to be prescribed a diet, where it will be clearly written how much and what foods to eat per day.

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

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

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 method of treatment. During it, the patient undergoes a course of drug treatment, gentle gymnastics and electrical stimulation.

Due to the characteristics of the body of each person, 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 prescribed products, which include vegetable fiber. Thanks to fiber, feces become larger, they are softer and easier to manage.

What to exclude from your daily diet:

Any dairy products;
Coffee sweets and drinks;
Salty, spicy and fried food;
All smoked products;
Hard fruits and vegetables;
Alcoholic drinks.

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

If the body does not absorb vitamins and minerals through natural products, then special vitamin complexes must be used.

Pelvic floor training

If the pelvic muscles are in good shape, then this is the key to good bowel function.

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

Exercises to train the muscles of the pelvic floor

These trainings consist in the fact that the patient himself must contract 50-100 times the pelvic muscles.

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 that delivers electrical impulses.

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

Surgical intervention

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

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

Sphincteroplasty. This type of intervention is selected in the event that involuntary fecal excretion has arisen due to a violation of the integrity of the sphincter. During the operation, all the muscles are connected and normal defecation resumes.
Muscle transposition. It is applied in the event that the previous type of operation could not eradicate the problem.
A colostomy is used for pelvic floor injuries. During such an operation, part of the rectum is displayed on the abdominal cavity, through which defecation will be carried out in the future.
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 actuated by a person from the outside. When he needs to go to the toilet, he uses the pump to loosen 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, it can be eliminated.

Video: Fecal incontinence in the elderly

Thank you

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

If we consider the symptoms of diseases from the point of view of the patient, then there are those that cause painful or unpleasant sensations, and there are those that cause severe discomfort, including psychological. One of the most unpleasant and traumatic symptoms is fecal incontinence. Given the fact of the presence of this symptom, the social perception of the patient by others is jeopardized, an oppressed 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 the occurrence, and to conduct an effective therapy that could restore the patient to his former health again, relieving him of physical and moral suffering. Fecal incontinence, most often, does not threaten the life of the patient, but it is socially significant, since it creates many problems for the patient and the people around him.

This problem can be relevant in 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 offer many ways to eliminate it.

What is fecal incontinence

The medical name for this pathology is incontinence or encopresis. Fecal incontinence is the fact that for some reason a person's ability to control the act of defecation is impaired. Very often it is combined with an adjacent 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 similar nerve centers. However, fecal incontinence is 15 times more common than urinary incontinence and affects mostly 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 responsible for the formation of conditioned reflexes, and may be due to 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 appearance of a conditioned reflex to the act of defecation is innate. In this case, the patient does not have the so-called rectoanal inhibitory reflex, which normally initiates the act of defecation.

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

3. Loss of a conditioned reflex due to exposure to adverse or provoking factors. In this case, two possible development options are distinguished: primary and secondary. The primary is congenital in nature, the secondary is the result of violations of the patient's mental state, trauma or organic lesions of the spinal cord and brain, or the excretory system.

Secondary fecal incontinence deserves special attention. If we talk about psychogenic origin (namely, the vast majority of cases of the disease belongs to it), then we should highlight the main conditions in which this is possible.

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

Organic fecal incontinence develops with gross and often irreversible changes that have arisen due to various diseases. Fecal incontinence is much less common in the presence of other, treatable diseases.

In this case, it is customary to divide this symptom into 2 groups, according to the nature of the occurrence:
1 group- against the background of diseases related to the digestive tract and excretory system (rectal prolapse, trauma to the anus, accumulation of a large amount of solid feces in the rectum).

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

Practical classification of fecal incontinence

In practice, fecal incontinence is usually divided into degrees of severity:
I degree- Manifested in gas incontinence.
II degree- characterized by incontinence of unformed feces.
III degree- is expressed in the inability of the patient to hold dense fecal masses.

Epidemiology and statistics of fecal incontinence

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

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

Diagnosis of fecal incontinence

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

In modern medicine, the following instrumental diagnostic methods are provided:

Endorectal ultrasonography. Thanks to this method, it is possible to assess the thickness of the sphincters of the anus (external and internal). In addition, the method allows you to detect the presence of defects that cannot be detected by manual examination.
Anal manometry. This method consists in determining the resting pressure and the tension created in the anal canal. Anal manometry can be used to 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 an increase in this indicator), the act of defecation in the patient is disturbed, and this, in turn, leads to the absence of the urge to defecate, or vice versa - it causes urges that require immediate emptying of the intestine.

Treatment of fecal incontinence

The question of choosing the method of incontinence therapy is very important. It directly depends on the installation of the exact cause that led to this pathology, the patient's condition and his age. Surgical and conservative methods of treatment of fecal incontinence are used.

Surgical operations for fecal incontinence are classified as plastic, and have long been used in medicine. According to expert doctors, this technique is considered satisfactory. This method of treatment 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 localization. Depending on this, several types of operations are distinguished. If up to a quarter of the circumference of the sphincter is damaged, an operation called sphincteroplasty . For more severe lesions, 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- with the use of synthetic materials or silver wire (at present, it is practically abandoned).
2. Fireman operation - using the thigh muscle as a plastic material (its effectiveness, unfortunately, is short-lived).

With functional fecal incontinence, in some cases, surgical intervention is performed - postanal reconstruction.

For physicians, a more difficult task is the treatment of 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 surgical intervention is performed called postanal reconstruction .

A variety of non-surgical treatments for fecal incontinence have been developed, including:
1. Medical.
2. Non-drug.

Drug methods have found the widest application 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 unformed 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 muscles of the perineum and the condition of the anal sphincter. Of the medications used: strychnine in pills, prozerin in subcutaneous injections, vitamins of group B, ATP. If the patient suffers from increased excitability of the nervous system, then the appointment of tranquilizers is indicated.

Non-drug methods include:

Complex exercises aimed at training the anal sphincter (were developed by scientists Dukhanov, Kegel). The essence of these exercises boils down to the fact that a rubber tube, pre-lubricated with petroleum jelly, is inserted through the anus into the rectum. The patient on command compresses and relaxes the anal sphincter. Exercises are performed daily for 5 sessions. The duration of 1 session is 1-15 minutes. The therapy cycle is designed for 3-8 weeks. In parallel with these exercises, it is recommended to perform physical exercises aimed at strengthening the muscles of the gluteal region, abdominals and thigh adductors.
electrical stimulation - is carried out in order to stimulate the nerve endings responsible for the formation of a conditioned reflex to defecate.
Biofeedback. This technique has been practiced in the world for more than 30 years, but in Russia it has not yet become popular. Foreign colleagues note that this method, in comparison with others, gives not only the most positive results, but also the most persistent ones.
I would like to pay special attention to this technique. It is carried out with the use of biofeedback medical devices. The principle of operation of the biofeedback device is that the patient is given the task of reducing and the ability to delay the tension of the external sphincter in a given mode. Using a rectal sensor, an electromyogram is recorded, and the information is displayed on a computer in the form of graphs. The patient, upon receiving information about how correctly the task is performed, can consciously control and adjust the duration and strength of the contraction of the sphincter muscles. This, in turn, significantly increases the effectiveness of external sphincter training, and helps to restore the cortico-visceral pathways, which are responsible for the function of retaining intestinal contents. When 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 purpose of the psychotherapeutic method of influence is the formation and consolidation of a conditioned reflex to the situation 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 the development of medicine. However, isolated cases of cure by hypnosis are described in medicine. The method turned out to be effective in those cases when, against the background of complete health, there was an acute mental trauma or severe stress.
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)
Within the framework of 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 are accompanied by these pathologies.
As a result of a stroke, a patient develops a whole complex of disorders, which is associated with a violation 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 disorder (mainly with damage to the left hemisphere of the brain);
violation of perception (there is no adequate perception of the surrounding reality);
cognitive impairment (the ability to perceive and process information is reduced, logic is impaired, memory is reduced, the ability to learn is lost);
behavioral disorders (slow reactions, emotional instability, fearfulness, disorganization);
psychological disorders (sudden mood swings, causeless crying or laughter, irritability, depressive states);
violations of urination and defecation (there is no control over physiological functions, the tone of the sphincter of the anal canal is disturbed).
pain during defecation 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:

movement disorders in the limbs (upper, lower);
decrease 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 damage to the spinal cord);
incontinence of feces and urine.

4. Injuries, including birth

Seek doctors - and the barriers that prevent you from living a normal life will be removed. Stay healthy!

Before use, you should consult with a specialist.

Fecal incontinence is a medical condition characterized by a disorder in which a person cannot control bowel movements. Colon cleansing is spontaneous. The patient loses calm, 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, urgent medical attention.

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.

Fecal masses can be of different consistency - solid and liquid. The emptying process itself does not change from this. Fecal incontinence in women is diagnosed less frequently than in the strong 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, waiting for favorable conditions and manifests itself, violating the usual way of life.

There is an opinion that a pathological disorder is characteristic of old age. Fecal incontinence in the elderly is an optional sign of age, doctors have proven that the opinion is erroneous. Statistical data provide figures that explain the emergence of such opinions. Half of the patients are people over the age of 45. 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 it is laid down. Fecal mass output is managed by several systems. Their consistency leads to the normal functioning of the body.

In the rectum, a large number of nerve endings are concentrated, which are responsible for the work of muscle structures. The same cells are located in the anus. The muscles hold the stool in and push it out.
The rectum is located inside the intestine in such a way as to hold feces, send it in the right direction. The feces, once in the rectum, are already acquiring their final state. It is dense, compressed into voluminous ribbons. Anus closes his exit without control.
The compressed state of the bowel is preserved until the exit, when the person is ready for the act of defecation, he understands that he has come. In a normal state, a person can restrain the process until he can go to the toilet. The delay time can be calculated in hours.

If the process is disturbed, this state is not controlled, the feces exit occurs instantly. The muscles of the pelvis and anal region do not maintain 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. Men have a higher rate. The anal organ in a healthy state should be in good shape, a decrease in its functionality leads to a deterioration in defecation. The vegetative NS controls its activity. It will not be possible to consciously influence the sphincter. Stimulation of the exit of feces occurs at the level of irritation of receptors in the walls of the rectum.

Scientific Explanation of Excretion:

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

All processes lead to promotion, pushing feces to the anus. The process is slow and does not tolerate acceleration. The muscles of the pelvis enter a relaxed state, the muscles open the rectal outlet. Relaxes the internal and external sphincter. When a person cannot get into the sanitary room, he strains the internal receptors, the anorectal opening remains closed, 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 phenomena;
liquid stool;
weakness and damage to muscle mass;
nervous conditions;
decrease in muscle tone relative to the norm;
dysfunction of the pelvic organs;
hemorrhoids.

You can consider and analyze the reasons for fecal incontinence in detail.

Constipation. In the intestines, there is an accumulation of solid waste products from food processing. In the rectum, tissues are stretched, which relieve pressure on the sphincter. When constipated, a person has a desire to soften the feces. Loose stools accumulate over hard feces. There is leakage of them and damage to the anus.
Diarrhea. Diarrhea changes the state 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.
Problems of the innervation plan. The impulses are subject to two types of disturbance. In the first version, the problem is based on nerve receptors, the second - on deviations in the brain. Often this is characteristic of the senile state, when the activity of brain processes decreases.
Scars on the walls of the rectum. Due to the decrease in the strength of the walls of the esophageal membrane, enuresis and encopresis begin to appear. Unpleasant processes violate the state of an adult organ, scars are formed. Sometimes scars form after inflammation, surgery, radiation.
Hemorrhoidal venous seals. The knots do not allow the hole to close, the muscles become weak and inactive. In older people, hemorrhoids alter the entire bowel movement.

It comes from certain principles:

adjustment of the regimen and diet;
medicines;
training the muscles of the intestinal systems;
stimulation of work with the help of 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 violation of the bowel movement.

Medicines

Among the drugs that help normalize 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 antidiarrheals intervene in the disease and produce additional healing effects:

Atropine, Belladonna. Anticholinergic drugs, they reduce the development of secretion, increase peristalsis. The motility of the intestinal walls returns to normal. It can be used at various stages.
Codeine. The tool 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. It is prescribed only on the advice of a doctor.
Lomotil. A medicine with this name reduces the movement of feces, creates conditions for its hardening.

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

Causes and treatment are studied by doctors. They will pick up special devices if medication formulations do not help.

The problem may arise in conditions of impossibility to contact a medical institution. 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 the villages, where grandmothers picked up healing herbs and created miraculous tinctures.

You can use folk remedies, but such an action should not be permanent. What reasons led to loose stools, why did the intestines malfunction? Answers to questions can be obtained after a complete examination and diagnostic procedure.

Enemas. For their implementation, chamomile decoctions are used. Take 50 g of medicinal herbs, place it in a liter of boiling water. On a slow fire, they are waiting for the complete dissolution of the components of chamomile. Then cool to room temperature and injected into the rectum. You need to keep 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, proportions of 20 g of grass, 200 ml of liquid. Water compositions can not be done a lot. 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 fresh and pressed into a drink. The norm of admission is one spoon no more than 3 times a day.
Honey products. Honey, 1 tablespoon per day, will become both a curative and a preventive method for eliminating the disease.

A change in bowel movements occurs during pregnancy. Women hope that everything will be over after childbirth. More often the illness continues to be observed, to amplify. The problem becomes not so much physiological as psychological.

Fecal incontinence after childbirth is due to the following reasons:

violation of the innervation of the muscles of the bladder;
deviations in the work of the muscles of the pelvic organs;
pathologies of the urethra;
dysfunction of the closure of the bladder and urinary systems;
pressure instability within the bladder.

Pathology goes along with another process - gas incontinence is observed. A large number of women turn to doctors after childbirth with such symptoms. They are trying to understand the reasons why gas incontinence appears after childbirth.

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

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

Part of the damage occurs with special medical methods of helping 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);
trauma of the birth process;
consequences of surgical interventions;
mental disorders (neurosis, depression).

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

epilepsy;
dementia;
catatonic syndrome.

What to do to eliminate unpleasant symptoms, the attending physician will tell you.

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

Operations to introduce a special gel into the canal. This type of therapy is used to fix the walls of the anus. The method does not promise a complete cure, a relapse may occur.
Fixation of internal organs. Operations are rarely used. Surgeons fix the channel of fluid emission, the cervix, the 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 an injury to the sphincter region or damage to the muscle tissue of the pelvis is the method of modern technology - sphincteroplasty. The surgeon stitches torn, stretched muscles. Another way is an artificial organ, it can be controlled by a person himself. The surgical cuff is inflated and deflated. Fecal incontinence after surgery can be covered by simple measures: clean, changeable clothes, taking medications that reduce the smell of stools accompanied by gas.

Fecal incontinence in the elderly

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. In a patient, the consequences are disorders of the pelvic organs.

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

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

What is diarrhea, almost everyone knows. Under certain conditions, a single aggravation becomes a frequent ailment. Knowing the causes and factors of its development will help to avoid pathology, to maintain the usual way of life.

Anvar Yuldashev - coloproctologist, EMC surgeon-oncologist tells

What is fecal incontinence?

Normally, anal sphincters (locking muscles) are able to retain solid, liquid and gaseous intestinal contents not only in various body positions, but also during physical exertion, coughing, sneezing, etc. Fecal incontinence is a violation of the ability to hold up to the right time 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, and becomes one of the complaints in other proctological diseases - with rectal prolapse, anal fissure, inflammatory bowel disease and many others.

There are three degrees of manifestation of sphincter insufficiency: at degree 1, patients do not retain gases, at degree 2, liquid fecal incontinence joins this symptom, at degree 3, patients cannot retain all components of the intestinal contents (gas, liquid and solid feces). There are special scales for assessing the severity of incontinence, the most convenient EMC coloproctologists consider the Wexener scale, Wexnerscore.

What are the causes of fecal incontinence?

There are many causes of fecal incontinence. The most common of these is trauma to the muscles and nerves of the pelvic floor, muscles, ligaments and tissues that support the uterus, vagina, bladder, rectum in difficult vaginal delivery or the so-called "obstetric trauma".

Operations on the anal canal and perineum or their trauma can cause a violation of the holding of the stool. Often, incontinence is complicated by an incorrectly performed operation to excise an anal fissure or remove hemorrhoids, as a result of which the muscles of one or both anal sphincters were damaged.

Various proctological diseases (chronic constipation, hemorrhoids with prolapse of internal hemorrhoids, irritable bowel syndrome, as well as various inflammatory diseases of the large intestine (usually ulcerative colitis)) can cause dysfunction of the muscles of the anus and rectum. Some people, especially the elderly, may develop a decrease in the tone of the anal muscles, which increases with age.

Diarrhea (diarrhea) may be accompanied by a sudden urge to defecate (emptying the intestines), as well as leakage of loose stools.

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 clarify the circumstances that could cause incontinence. If the patient is a woman, it is necessary to know the history of childbirth. Multiple pregnancies, large fetuses, and incisions in the perineum (episiotomy) can cause muscle and nerve damage during childbirth. In some cases, a concomitant chronic disease or the constant use of certain medications may play a role in the development of incontinence, in connection with which it may be necessary to consult doctors of related specialties. 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, lifestyle changes, surgery)?

How common are incontinence episodes? Are they preceded by urges or does the patient feel no leakage?

What is the degree of incontinence - unable to hold gas or stool? How much stool is leaking?

What restrictions in daily activities does the problem cause?

Is there an association between taking any medications or foods and episodes of incontinence?

The doctor will perform a perineal examination and a digital examination of the anal canal and rectum, during which insufficient function of the muscles of the anal canal 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 an attempt to defecate), if necessary, colonoscopy or rectosigmoscopy to diagnose proctological diseases, neoplasms and injuries. Often, the help of a neurologist and electromyography is required to determine the speed of the nerve impulse along the pudendal nerves (n.pudendus). Also, if necessary, tests of feces and blood are carried out in order 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 several of the following positions. Some of them, such as 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 foods (sweeteners, including sorbitol, xylitol, mannitol, fructose used in diet drinks and sugar-free chewing gum and candy); eat several small meals a day, eat more dietary fiber from vegetables, fruits, or whole grains, or use dietary fiber supplements. Fiber increases stool volume, making it softer and better manageable.

2. Medications to fix stools, which help reduce the number of bowel movements, or slow down the rate of passage of intestinal contents.

3. Visiting 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 those who have limited mobility that prevents them from using the toilet independently and safely. Such people need to be assisted in going to the toilet after eating, as well as promptly responding to their desire to go to the toilet if they have an urge to defecate.

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

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

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

7. Surgical correction of anal muscle defects. An 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.). Sphincter repair is the reunion of sphincter muscles 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 defecation regimen by conservative methods or restore the functions of the sphincter surgically, they resort to the formation of a colostomy - the removal of the lumen of the large intestine to the abdominal wall. The secretions are collected in a colostomy bag that fits snugly against the skin. This operation can 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. By the degree of regression or severity of symptoms, one can judge the effectiveness of treatment methods and predict recovery. Urinary incontinence and fecal incontinence are considered to be one of the most unpleasant symptoms that drastically worsen the patient's quality of life and jeopardize the social perception of others around them.

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 life of the patient, but 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 there is parallel incontinence of urine and feces. This is due to the fact that both processes are regulated by similar nerve centers. However, according to statistics, fecal incontinence occurs 15 times more often 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 a defecation reflex, the slow formation of this reflex, or its loss due to provoking factors. That is, fecal incontinence can be either primary, that is, be congenital, or secondary, resulting from damage to the brain or spinal cord, mental disorders, pathologies of the excretory system, or trauma.

Most often, doctors are faced with fecal incontinence of psychogenic origin, that is, hysterical and neurotic psychoses, such pathocharacterological disorders as dementia or mental illness - schizophrenia and epilepsy lead to this symptom. Much less often, incontinence occurs against the background of diseases of the digestive tract (anus trauma, rectal prolapse) or other diseases (decrease in the tone of the muscles of the perineum, severe forms, tumors of the anus and birth injuries of the pelvis).

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

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

However, in the case when 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 muscles of the anal sphincter. Among the non-pharmacological methods, biofeedback, psychotherapeutic methods, acupuncture and dietary measures have become widespread. Take care of your health!

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