Fecal incontinence is defined as the inability to control solid and liquid bowel movements as well as gas. The incidence of this pathology is high, as it can affect up to one in four adults, especially women. In advanced ages, this incidence can increase up to 50%.
Despite this high incidence, fecal incontinence is a clearly underestimated problem, since there is a great lack of knowledge about the possible treatments, which, together with the stigma and shame that have classically accompanied this condition, means that people do not go to a doctor specializing in Proctology as often as they should.
Causes of fecal incontinence
The main cause of fecal incontinence is obstetric trauma, i.e. injuries to the perineal area during childbirth, although there are also other causes, such as previous surgical interventions (hemorrhoids, fissure, perianal fistulas, etc.) or trauma.
In addition to the direct mechanism of injury, there are other pathologies such as diabetes, circulatory disorders and diseases such as multiple sclerosis, which can also be the cause of fecal incontinence.
Diagnosis of fecal incontinence
It is crucial to make a correct diagnosis of this problem and, for this purpose, it is very important to take a good clinical history, looking for symptoms and causes, as well as to perform a correct physical examination.
Among the most important diagnostic tests, there is the 360º endoanal ultrasound, which consists of introducing an ultrasound terminal with a 360º rotating transducer, with which the sphincteric apparatus and the straight-anal canal can be visualized to look for possible alterations or tears of the internal anal sphincter and the external anal sphincter, as well as the presence of perianal fistulas or abscesses. This technique is a simple test that can be performed on an outpatient basis in the office, as it is generally very well tolerated by patients.
Depending on the possible cause of incontinence, other tests such as rectoanal manometry or dynamic pelvic MRI can be performed.
Treatment of fecal incontinence
There are several treatment modalities for this disorder, since, as discussed above, the cause may be multifactorial. In addition, sometimes several treatments can be carried out simultaneously in the same patient, or progressively.
First of all, hygienic-dietary measures, such as the use of antidiarrheals or increased fiber intake, should be instituted. However, if this does not work, there are other possibilities:
– Biofeedback: it manages to re-educate the sphincteric apparatus to achieve an improvement in its function.
– Sphincteroplasty: this is a surgery that consists of repairing the external anal sphincter.
– Neuromodulation of the posterior tibial nerve: is a less aggressive therapy that is carried out by electrical stimulation of the posterior tibial nerve at the ankle, during several sessions of approximately 30 minutes, and can be performed in the same office on an outpatient basis.
– Radiofrequency in the anal canal: it needs to be performed under anesthesia or sedation and complemented with other therapies, such as neurostimulation of sacral roots.
– Bulking or injection of Bulky agents: consists of applying substances to increase the sphincter and is used in case the internal anal sphincter has a defect or dysfunction. They can be temporary or definitive.
Therefore, it is essential to make a proper diagnosis of the problem and thus be able to find the ideal therapy or combination of therapies for each patient, designing a specific treatment for each situation.