Fecal incontinence (FI) is the inability to defer defecation until you find the time and place to defecate. It is estimated to affect 10% of the population, but it is consulted much less frequently due to the complex that the patient has to discuss the problem.
It mainly affects women, since obstetric trauma (vaginal births, use of forceps or episiotomy) is the main factor causing it. Likewise, obesity and neurological diseases such as Parkinson’s, Ela, Alzheimer’s, among others, contribute to generate it. Diabetic polyneuropathy also affects sphincter innervation, causing fecal incontinence. In men it is less frequent, being associated with previous proctologic surgery such as hemorrhoids, fistulas and fissure.
Diagnosis of fecal incontinence
Diagnosis is made by physical and instrumental examination, with endoanal ultrasound, perineal MRI and manometry being the most reliable tests for correct statification. On the other hand, there are different levels of FI, so there are numerous questionnaires to measure the degree of this. This, together with the tests described above, will give an approximation of the appropriate medical or surgical treatment.
Treatment of fecal incontinence
Mild FI is treated with a diet that limits foods that can provoke diarrhea and with antidiarrheal drugs and fecal bolus increasers. On the other hand, biofeedback is a continence re-education therapy using a rectal balloon connected to a manometer and stimulating voluntary contraction by feeling the pressure of the balloon. The most recent cases show a significant improvement in the control of solid stool in 70-80% of patients.
Surgical treatment is reserved for those cases in which sphincter disruption is observed, and there are several techniques, the most common in general surgery being sphincteroplasty. Finally, in cases where the origin is neurological, neuromodulation of sacral roots is a resource with more than acceptable results. It consists of placing electrodes on the sacral roots to stimulate the nerves responsible for sphincter function.