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Fecal Incontinence

Q: What is Fecal Incontinence?
Normally, stool is stored in a part of the large bowels (known as the rectum) until the woman decides to empty her bowels. The rectum is a flexible tube, whose exit is controlled by muscles of the anal sphincter complex, and the levator ani (also known as the pelvic floor muscles). The stool is held in the rectum because the rectal tube expands, while the anal sphincter and pelvic floor muscles contract, preventing the exit of rectal contents. Normally, these muscles can prevent rectal contents from leaking, even during strenuous straining and coughing activities. Sometimes these storage mechanisms fail, and the result is unintended leakage of stool. This is called Fecal Incontinence.

Q: Are there different types of Fecal incontinence?
Fecal incontinence can involve loss of solid stool, or liquid stool

Q: What causes Fecal incontinence?
For solid stool incontinence, one possible cause may be weakness of the pelvic floor muscles, and/or weakness or disruption of the anal sphincter complex. Pelvic organ prolapse, especially rectocele can contribute to constipation and fecal incontinence. There are many different possible causes of liquid fecal incontinence, many of which are diet related. Evaluation of liquid fecal incontinence  should begin with a careful, detailed evaluation by your primary care doctor. 

Q: How is Fecal incontinence diagnosed?
In women who complain of stool loss, there is a test called a Defagram (also called Defecography) which can help to diagnose the Fecal incontinence. The Defagram is a type of XRAY study which  can show the movement of the rectal contents during straining and defecation attempts. This test is also good at identifying anatomic conditions that may affect bowel emptying function.

Q: Is Fecal incontinence life threatening?
Usually not, but because Fecal Incontinence can have many different causes, it is important to have this problem evaluated by a doctor in order to rule out a serious underlying problem.

Q: Are there nonsurgical treatments for Fecal incontinence?
Once the life-threatening causes of fecal incontinence are ruled out, nonsurgical treatments can include stool bulking agents like fiber supplements, as well as Pelvic Floor Physical Therapy, and injectable anal mucosal bulking agents.

Q: What are the surgical options for treating Fecal incontinence?
Surgical treatment of Fecal incontinence is often guided by the results from a Defecography study, and sometimes also a dynamic, rectal contrast pelvic MRI. Ideally, surgical therapy should begin with correcting any significant prolapse that may be present. Often, correction of significant prolapse can lead to improved bowel emptying, which can reduce or correct the leakage problem. Other surgical therapies include a technique known as sacral neuromodulation (which is a kind of pacemaker for the bowels), and anal sphincteroplasty, which is a reconstruction of the anal sphincter complex. 

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