Fecal incontinence is the inability or difficulty in holding stool and gas, which usually manifests involuntarily and at unwanted times. It can occur occasionally or constantly and is a cause of significant impairment and limitation of personal, social and working life.
Causes of fecal incontinence
The most common cause is trauma to the anal sphincter induced by vaginal delivery which can cause injury or weakness of the muscles that control defecation. The stress of childbirth may also cause damage to the sphincteric nerve structures.
Incontinence may occur after childbirth or many years later, when other factors are added or simply physiological aging of the muscular and ligamentous structures of the pelvis due to age.
Other possible causes include anal surgery for fistula, hemorrhoids and fissure, rectal surgery for cancer, rectal prolapse, rectocele, anal trauma, neurological diseases such as multiple sclerosis and metabolic diseases such as diabetes that can affect the nervous system.
Treatment of fecal incontinence
Mild fecal incontinence can be treated with dietary modifications, fiber or medications that increase stool consistency, and antidiarrheal drugs. Another medical treatment is biofeedback, which consists of a process of rehabilitation of anal and defecatory function.
In cases that do not respond to medical treatment, there is the minimally invasive surgical option of injecting products that increase the thickness of the anal sphincter. In the presence of lesions of the anal muscles, surgical repair may be necessary.
In more severe patients and in non-severe cases, when other treatments have not provided benefits, even in patients with anal sphincter rupture, a treatment with high efficacy is sacral root stimulation. Colostomy, which consists of making an anus contranatura with the large bowel through the abdominal wall, is the last resort and is nowadays a very rare treatment.
Sacral stimulation as a treatment
Sacral root stimulation or neuromudulation is a more innovative mini-invasive surgical treatment that can be performed under local anesthesia. The procedure involves electrically stimulating the sacral nerve that controls the anal sphincter by means of an electrode connected to a pacemaker-like pulse generator implanted in the buttock.
Over time, re-education of the neurological circuits that control anal function and defecatory activity occurs. In patients with double incontinence, fecal and urinary incontinence, both problems are usually corrected. Device placement is performed after a trial period to assess the efficacy of the treatment.