Stool incontinence can be divided into two types: passive, which occurs without warning, and urge, which occurs when an active attempt is made to hold the stool.
Fecal Incontinence (FI) is embarrassing to patients and very difficult to talk about, even to health care providers. However the problem is much more common that one might think. In fact, the estimated prevalence of FI in noninstitutionalized US adults is 8.3% (95% confidence interval, 7.1-9.5) and consists of liquid stool in 6.2%, solid stool in 1.6%, and mucus in 3.1%. It occurs at least weekly in 2.7%. This means that one in twelve Americans suffer from at least some soiling, with the majority of those having small amounts of liquid soilage. For many patients, even a small amount of soiling is unacceptable to accept without treatment. Treatment options for FI include behavioral, medical, and procedural approaches and are often implemented in a stepwise fashion. First, patients need a good history and physical examination. Based on this alone, 80% of patients will be given treatments which are effective. First line therapies often are behavioral. A low residue diet may be employed and stool softeners and laxatives may be eliminated or adjusted. Medication to slow bowel motility and spasm can be tried. Pelvic floor strengthening exercises may be taught and sometimes muscle stimulators can be employed to some success.
If these don’t treat patients effectively then the next step can often include more specific evaluation of the anal sphincter with ultrasound and anal manometry, which measures pressures along the sphincter length.
The most common causes we see for FI include anal sphincter tears and dysfunctional bowel motility patterns. For these we most often offer surgical approaches for sphincter repair and reinforcement and/or sacral neuromodulation (SNM). SNM is a minimally invasive procedure where a small electrical current is used to reset the nerves which control bowel function. Unlike surgery, there is a minimal recovery time for SNM.
Please understand that every patient needs an individualized approach to both the workup and treatment of this relatively common but under-reported condition. The providers at The Women’s Health Group give each patient with this sensitive issue a complete and thorough workup and treatment plan.
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