Incontinence
What is faecal incontinence?
It can present in a wide range of forms, from minor soiling to loss of large amounts of faeces.
In a broader sense, it can also include involuntary leakage of faecal gases and wind.
Normally, the sphincter muscles of the rectum, the muscles of the pelvic floor, the pelvic floor muscles, the function of the rectal reservoir, the rectal flexion at rest, which straightens only during defecation, play a role in maintaining the ability to hold the stool.
The incidence of faecal incontinence
It often develops as a result of birth injuries.
This is why constipation affects women about twice as often as men, due to injuries to the vaginal septum during vaginal birth.
Hormonal changes around the menopause also weaken the muscles of the pelvic floor, which is also a predisposing factor in women, often associated with urinary incontinence.
It is very difficult to quantify the incidence of the disease.
The problem remains largely hidden, as patients are reluctant to talk about it even to their doctor.
However, if we look at the older age group, the incidence of faecal incontinence is actually quite high.
Causes of faecal incontinence
The disease can have different causes, but most often it is caused by a defective functioning of the pelvic floor’s pelvic floor.
This can include a dysfunction of the spinal cord (which can be caused by any spinal injury), muscle injury, or a tear in the perineum, or a pelvic floor injury (for example, during vaginal delivery, due to inadequate barrier protection or lack of a barrier incision).
Ultrasound scans have also shown, for example, that after vaginal births, up to 30 per cent of the time some kind of damage to the muscle layer is visible.
Most of these, of course, remain asymptomatic, and faecal incontinence occurs in only 1 to 2 per cent, usually only when massive diarrhoea occurs.
Dilatation and storage capacity of the rectum is reduced in inflammatory bowel disease following irradiation.
Surgical injuries (for example, as a complication of haemorrhoid or fistula surgery, if the muscle layer is damaged) can also lead to faecal incontinence.
Muscle injuries during anal sex can also lead to faecal incontinence
The underlying cause may also be a nervous disorder, i.e. a nerve involvement caused by neurological diseases (such as multiple sclerosis and some immune diseases) caused by diabetes.
Often, in the case of a low-lying rectal tumour, the tumour can reach the muscle ring, or the removal of a slightly higher tumour will also remove the reservoir that provides the dilatation function.
Some degree of closure failure may also be caused by advanced stages of haemorrhoids.
However, this is not true faecal incontinence, but the enlarged haemorrhoidal cushions are no longer able to close the mucosa perfectly and often protrude outside the sphincter, causing a discharge on the laundry.
Patients experience this as incontinence, and it can only be distinguished from true incontinence and treated after an examination.
In the elderly and in patients who are incapacitated and require nursing care, hard clumps of faeces may remain in the rectum (if the bowel movement disorder or constipation is very severe) and fluid may leak past them.
In this case, mechanical removal of the blockage is necessary.
This is when defecation occurs.
This last stage of the process is the one that, after learning, can be controlled voluntarily by relaxing and moving the ring of the external sphincter.
If we decide to postpone defecation because the moment is not right, the faeces can be returned to the upper rectum by this mechanism.
At any point in this single mechanism, a disturbance can occur that can cause problems with bowel movement or defecation.
Diagnosis of faecal incontinence
It is important that the disorder is investigated very thoroughly.
In order to do this, the doctor must listen to the symptoms and identify the type of disorder.
The investigation includes a colonoscopyas the first step is to rule out the possibility of a tumour or inflammatory bowel disease.
If these diseases can be excluded, a so-called functional manometric to check the pressure conditions in the rectum.
The strength of the muscles can be measured separately, and the function of the nerve that innervates the muscles can also be tested.
It is also necessary to assess the state of the rectum 3D rectal ultrasound.
Treatment of faecal incontinence
Whether a disease can be completely cured always depends on the underlying cause.
It is important to adjust the diet, and exclude diarrhoea-causing foods from the diet.
Instead, we aim to starch the stools.
It is also necessary to ensure regular bowel movements.
In addition to improving the consistency of the stool, an important part of the treatment is functional muscle training, i.e. strengthening weakened muscles with biofeedback.
This is a conditioned learning process in which well-coordinated, well-isolated voluntary muscle function is acquired.
The patient learns when and how to squeeze and the ability to relax can be improved.
During learning and practice, the patient can see the muscle function values on a screen or a pressure gauge, and this visual feedback promotes and reinforces the ability to consciously operate the muscle and is very motivating to achieve better results.
Electro-stimulation methods based on the same technique are now available.
If, despite the above treatments, incontinence persists, which severely compromises quality of life, the Peristeen enema device is now available, which the patient can use while sitting on the toilet.
It empties the colon for 12 to 24 hours, thus eliminating faecal leakage and all its consequences (unpleasant smell, skin around the rectum that rises up)
