Bowel
INCONTINENCE (FECAL/BOWEL)
About
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- When bowel movements cannot be controlled
- Stool (feces/waste) leaks out of the rectum at unwanted times with/without awareness
- Happens more often in women than in men, and often amongst older people
Potential Causes
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- Frequent diarrhea/constipation
- Muscle damage
- Older age
- Nerve damage
- Inability of the rectum to stretch
- Reduced rectal storage capacity
- Rectal prolapse (rectum falls into the anus) or rectocele (rectum pushes into the vagina)
- Chronic constipation
- Laxative abuse
- Radiation treatments
- Certain nervous system/congenital defects
- Inflammatory bowel disease
Symptoms
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- The feeling of needing to go and not being able to make it to the bathroom in time
- Stool leaks out when passing gas
- Stool leaks out due to physical activity/daily life exertions
- Stool is seen in the underwear after a normal bowel movement
- Complete loss of bowel control
Diagnosis
Questions will be asked about your condition
Physical exam, including rectal exam
Anal manometry
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- A short, thin tube is inserted up into the anus and rectum to measure sphincter tightness
- Studies the strength of the anal sphincter muscles
Endoluminal (anal) Ultrasound
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- A small probe is inserted up into the anus and rectum to take images of the sphincters
- Helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissue
Pudendal Nerve Terminal Motor Latency Test
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- Measures the functions of the pudendal nerves, which are involved in bowel control
Anal Electromyography (EMG)
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- Determines if nerve damage is the cause and examines the coordination between the rectum and anal muscles
Flexible Sigmoidoscopy/Proctosigmoidoscopy
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- Sigmoidoscope is inserted into the rectum so the bowel can be viewed
- Evaluates the end of the large bowel/colon, looking for any abnormalities
Proctography/Defecography
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- A small amount of liquid barium is released through a tube into the colon and rectum
- An x-ray video is taken that shows how the rectum is functioning
Magnetic Resonance Imaging (MRI)
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- To evaluate the pelvic organs
Treatment
Dietary Changes
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- Eliminate foods that can cause loose stools from your diet ie: beans, cabbage family vegetables, dairy products, dried fruit, spicy foods, artificial sweeteners
Bowel Retraining (Biofeedback)
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- Developing a “going-to-the-bathroom” pattern to gain greater control over bowel movements
- Have a trained therapist teach you certain exercises to increase anal muscle strength
Oral Medication
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- Anti-diarrheal drugs and bulk laxatives to decrease movement of the stool through the intestine and firm it up
Surgery
Sphincteroplasty
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- Repairs a damaged or weakened anal sphincter that occurred during childbirth
- Doctors identify an injured area of muscle and free its edges from the surrounding tissue
- They then bring the muscle edges back together and sew them in an overlapping fashion, strengthening the muscle and tightening the sphincter
Rectocele or rectal prolapse correction
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- Can be done surgically to reduce or eliminate fecal incontinence
Sphincter replacement
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- A damaged anal sphincter can be replaced with an artificial anal sphincter
- The device is essentially an inflatable cuff, which is implanted around your anal canal
- When inflated, the device keeps your anal sphincter shut tight until you’re ready to defecate
- To go to the toilet, you use a small external pump to deflate the device and allow stool to be released
- The device then reinflates itself
Sphincter repair (Dynamic Graciloplasty)
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- Muscle from the inner thigh is taken and wrapped around the sphincter, restoring muscle tone to the sphincter
Sacral nerve stimulation
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- A small device (a neurotransmitter) is implanted under the skin in the upper buttock area
- The device sends mild electrical impulses through a lead that is positioned close to a nerve located in the lower back (the sacral nerve), which influences the bladder, the sphincter and the pelvic floor muscles
Colostomy (Bowel Diversion)
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- A last resort treatment
- Stool is diverted through an opening in the abdomen
- A special bag is attached to this opening to collect the stool
IRRITABLE BOWEL SYNDROME (IBS)
About
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- Colon/lower bowel disorder
Potential Causes
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- Unknown
- What is known is that the colon muscle in those with IBS contracts more readily than in those without it and those with the condition have a lower pain threshold
- Triggers include
- Certain foods
- Medications
- Stress
Symptoms
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- Abdominal pain/cramps, usually in the lower half of the abdomen
- Bloating
- Constipation in some, diarrhea in others
- Excess gas
- Harder/looser bowel movements than usual
Diagnosis
Medical history is evaluated
Physical exam
Blood tests and stool samples
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- To rule out other conditions
- Stool examined for bacteria, parasites or bile acid (if you have chronic diarrhea)
Flexible sigmoidoscopy
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- With a flexible lighted tube, the lower part of the colon (the sigmoid) is examined
Colonoscopy
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- Entire colon is examined with a colonoscope
- If necessary, small amounts of tissue can be taken for biopsy and polyps can be identified and removed
*There is no definitive test to diagnose IBS
Treatment
Diet
Stress reduction
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- Mindfulness
- Yoga
- Psychotherapy
- Regular physical exercise
Oral Medications
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- Fibre supplements/laxatives: For constipation-predominant IBS
- Anti-diarrheals
- Bile acid binders: Cholestyramine, colestipol or colesevelam
- Anticholinergics: To relieve bowel spasms
- Tricyclic antidepressants
- Inhibit the activity of neurons that control the intestines to help reduce pain
- Pain medications
- Pregabalin/gabapentin for severe pain/bloating
- Medications specifically for IBS
- Can help ease diarrhea and relax the colon