• • 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

• • 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

• • 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

Physical exam, including rectal exam

Anal Manometry: 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: 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: Measures the functions of the pudendal nerves, which are involved in bowel control

Anal Electromyography (EMG): Determines if nerve damage is the cause and examines the coordination between the rectum and anal muscles

Flexible Sigmoidoscopy/Proctosigmoidoscopy: 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: 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): To evaluate the pelvic organs

Dietary Changes: 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): 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: Anti-diarrheal drugs and bulk laxatives to decrease movement of the stool through the intestine and firm it up

Surgery

Sphincteroplasty: 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: Can be done surgically to reduce or eliminate fecal incontinence

Sphincter replacement: 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): Muscle from the inner thigh is taken and wrapped around the sphincter, restoring muscle tone to the sphincter

Sacral nerve stimulation: 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): Stool is diverted through an opening in the abdomen and a special bag is attached to this opening to collect the stool

• • A last resort treatment