November
2007
Fecal Incontinence
Fecal Incontinence: #2 cause of nursing home placement. Adult diapers in 1988 $400 million in USA. This means an adult accidentally poops at least once a month. Minor fecal incontinence is while passing gas (flatulence/farting) some stool comes our, or a person has loose stools (like in diarrhea) and it comes out accidentally. Major fecal incontinence means feces comes out unwillingly.
Who knows how many people have fecal incontinence because most people are too embarrassed to admit to it. It is estimated to affect 11-15% of community-dwelling adults (like nursing homes, assisted living)
Risk factors: age, obesity, COPD, IBS, urinary incontinence, colectomy, mentation. Men and women have the same prevalence, but women are 2x more likely to admit to it. People with brain injury often have fecal incontinence. After childbirth, trauma to the anal sphincter or pudendal nerve can cause fecal incontinence for years. Surgeries such as for hemorrhoids & anal fistulas can lead to fecal incontinence. Rectal prolapse is risk. Diabetics with autonomic neuropathy, bacterial overgrowth syndrome, and reduced sphincter pressure can have fecal incontinence. History of radiation therapy can lead to proctitis. Ulcerative proctitis as well. Some cannot sense stool in the rectum: diabetics, MS, dementia, spinal cord injuries. With fecal impactions, liquid stool can seep around the hard stool and out the anus in elderly.
Continence relies on many factors. The bottom line is when stool stretches the rectum, the person should sense this. To poop or not poop is based on relaxing or not relaxing the external anal sphincter muscles.
Work up: history and physical examination by doctor. Endoscopy is often needed. Anorectal manometry measures the function of the anus and rectum which can give valuable information. Pudendal nerve terminal latency test, endorectal ultrasound, defecography, and EMG can be done.
Treatment: Medical therapy, biofeedback, and surgery. Depends on the underlying causes.
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drjohnhong 
senior citizen, GI 
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