Anal incontinence is undoubtedly one of the digestive pathologies that most alters the patient’s quality of life, not because of its seriousness, but because of how disabling it can be for those who suffer from it. Curiously, doctors have given it little importance and many are still unaware of the diagnostic and therapeutic possibilities currently available.
We can define it as the repeated loss of voluntary control of anal continence which: is not incidental, can be for gases, liquids or solids and occurs in individuals over 4 years of age.
It occurs in 3 to 7% of the population, although most do not go to the doctor because of embarrassment or lack of knowledge of current techniques. And it is more frequent in: women, over 65 years of age and with difficulties in mobilization.
Incontinence can have several causes:
-Alterations or loss of strength of the anal muscles or sphincters: after anorectal interventions (fissures, fistulas, hemorrhoids), multiple or difficult childbirths, trauma and stretching of the pelvic nerves (constipation).
-Decreased rectal sensation: due to dementia, advanced age, spinal cord injury, stroke and multiple sclerosis.
-Decreased rectal capacity: due to infectious proctitis, actinic roctitis (after radiotherapy), inflammatory bowel disease and some rectal tumors.
The diagnostic tests to be performed are the following:
1. Detailed clinical history of the patient.
2. Physical examination including a digital rectal examination.
3. Psychological support.
4. Endoanal ultrasound to assess for sphincter injury.
5. Anorectal manometry to assess anorectal function.
Treatment
Depending on the type and severity of incontinence there are several possibilities that can be applied together or in isolation.
-Diet: fiber and bulking agents.
-Drugs: Loperamide.
-Anorectal biofeedback.
-Reconstructive or prosthetic surgery.
Of all these, perhaps the least known is biofeedback, which is a technique that is not uncomfortable for the patient and which is performed through a computer and by means of which a series of exercises are learned to improve the strength of the anal sphincters and then practiced at home.