Fecal Incontinence: A condition like any other
When the bowel’s closure mechanisms fail, fecal incontinence (bowel weakness) occurs. Flatus incontinence involves the unintentional loss of intestinal gases (flatulence), while fecal incontinence refers to the unintentional loss of stool, which can vary in severity. It may manifest as minor soiling of underwear or a complete loss of control over bowel movements, including solid stool.
Fecal incontinence has a wide range of causes due to the complex interplay of different mechanisms that enable the storage and controlled evacuation of stool:
The final section of the intestine is the rectum, which stores stool until it is evacuated. Between the rectum and the anus is the anal canal, which is about three to six centimeters long. It is lined with the anoderm, a very thin and highly sensitive skin layer. This network of nerves detects whether gas, soft stool, or hard stool is present at the anal opening and ready for release. This sensitivity also explains why conditions affecting the anal area, such as anal fissures, can be extremely painful.
The anal canal is surrounded by two sphincter muscles:
- The internal sphincter is not under voluntary control. It relaxes reflexively in response to stretching stimuli caused by stool accumulation in the rectum.
- The external sphincter is under voluntary control, allowing an individual to decide, within limits, when and where to have a bowel movement.
- A third component involved in bowel closure is the hemorrhoidal zone, a ring-shaped cushion of blood vessels that helps maintain continence.
Fecal incontinence and the pelvic floor muscles
The pelvic floor muscles play a crucial role in continence. In women, the pelvic floor surrounds the urethra, vagina, and rectum; in men, it supports the urethra and rectum. Weakening or lowering of the pelvic floor can lead to both fecal and urinary incontinence. Hormonal changes due to menopause, pregnancy, previous childbirth, and aging contribute significantly to this issue. A comprehensive study (46 studies, 10,832 women from 21 countries)* found that nearly one in four women experience unintentional loss of gas or stool in late pregnancy, and one in five still experience symptoms one year postpartum. Additionally, perineal tears or episiotomies during childbirth can injure the anal sphincter, with damage often becoming apparent later in life due to age-related risk factors.
These factors explain why fecal incontinence is significantly more common in women than in men.
*Woodley SJ et al. Cochrane Review, published May 6, 2020
Fecal incontinence due to diarrhea or constipation
Liquid stool (diarrhea) can strain or overwhelm the bowel’s closure mechanisms. Most people have experienced fecal incontinence temporarily during an episode of acute diarrhea. The risk of chronic fecal incontinence increases with conditions that cause frequent diarrhea, such as inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. When the rectum becomes inflamed, its ability to store stool decreases, increasing the likelihood of incontinence.
Conversely, chronic constipation (obstipation) can also lead to fecal incontinence. Hardened stool can block the anus, causing liquid stool to bypass the blockage and leak out, resulting in soiling.
Fecal incontinence due to organ prolapse
A prolapse occurs when an organ protrudes abnormally from an opening, either naturally (such as the anus) or due to injury. In rectal prolapse, part or all of the rectal wall protrudes, sometimes extending outside the anus. Initially, this may occur only during bowel movements, but it can become permanent. This condition weakens the sphincter muscle, leading to fecal incontinence. Similarly, prolapse of female pelvic organs, such as the vagina or uterus, can disrupt the delicate closure mechanisms of the bowel, resulting in incontinence.
Other causes of fecal incontinence
- Advanced hemorrhoidal disease can impair the hemorrhoidal zone’s ability to assist in bowel closure.
- Long-term diabetes (diabetes mellitus) can damage nerves that control digestive functions, leading to incontinence.
- Neurological conditions, such as stroke, multiple sclerosis, dementia, or spinal cord injuries, can disrupt the nerve signals needed for bowel control.
- Anal surgery, including tumor removal, can affect continence if it damages sphincter muscles or nerves.
Medical treatment and hygiene for fecal incontinence
Since fecal incontinence has multiple causes, treatments vary widely and are tailored to the specific underlying issue. Available therapies include pelvic floor exercises, stool-regulating measures, medications, and surgical procedures. While complete resolution is not always possible, many interventions significantly improve quality of life. Seeking medical help is crucial.
Proper hygiene is also essential. Water alone may not be sufficient to remove stool residue from the skin. Using Deumavan Washing Lotion with lukewarm water is recommended. Stubborn stool remnants can be gently and painlessly removed using Deumavan Protective Ointment, applied to soft toilet paper or cotton pads. Regular application of this ointment in the intimate and anal areas helps prevent stool from sticking to the skin. Additionally, thorough hygiene helps prevent skin irritation and infections, particularly urinary and vaginal infections caused by intestinal bacteria.
Using skin-friendly incontinence materials and mattress protectors is also advisable.
