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 your knowledge
    • 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

The following tests can be carried out to determine if you have fecal incontinence:

    • Anal manometry: Studies the strength of the anal sphincter muscles
      • A short, thin tube is inserted up into the anus and rectum to measure sphincter tightness
    • Endoluminal (anal) Ultrasound: Helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissue
      • A small probe is inserted up into the anus and rectum to take images of the sphincters
    • 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: Evaluates the end of the large bowel/colon, looking for any abnormalities
      • Sigmoidoscope is inserted into the rectum so the bowel can be viewed
    • Proctography/Defecography: An x-ray video is taken that shows how the rectum is functioning
      • A small amount of liquid barium is released through a tube into the colon and rectum
    • 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
    • Medication: Anti-diarrheal drugs and bulk laxatives to decrease movement of the stool through the intestine and firm it up
    • Surgery:
      1. 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
      2. Rectocele or rectal prolapse correction: Can be done surgically to reduce or eliminate fecal incontinence
      3. 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 defacate. 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.
      4. Sphincter repair (Dynamic Graciloplasty): Muscle from the inner thigh is taken and wrapped around the sphincter, restoring muscle tone to the sphincter
      5. 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
      6. Colostomy (Bowel Diversion): Stool is diverted through an opening in the abdomen. A special bag is attached to this opening to collect the stool. This is a last resort treatment

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
    • 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 test to definitively diagnose IBS

Treatment

Lifestyle:

      • Diet
        • Avoid trigger foods (ie: high-gas foods, gluten, certain carbs such as fructose, fructans, lactose, FODMAPs) *More on FODMAPs in the Diet Section
        • Eat fibre
        • Drink plenty of fluids
      • Stress reduction: Mindfulness, yoga and psychotherapy
      • Regular physical exercise

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