PHS Canada

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Bowel

Bowel

INCONTINENCE (FECAL/BOWEL)

About
    • 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
    • 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
    • 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

    • 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
Treatment

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)

    • 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
    • Colon/lower bowel disorder
Potential Causes
    • 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
    • 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

    • To rule out other conditions
    • Stool examined for bacteria, parasites or bile acid (if you have chronic diarrhea)

 

Flexible sigmoidoscopy

    • With a flexible lighted tube, the lower part of the colon (the sigmoid) is examined

 

Colonoscopy

    • 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

    • Avoid trigger foods (ie: high-gas foods, gluten, certain carbs such as fructose, fructans, lactose, FODMAPs
    • Eat fibre
    • Drink plenty of fluids
    • IBS Diet

 

Stress reduction

    •  

Oral Medications

    • 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