What is fecal incontinence?

Fecal incontinence is an anorectal condition defined as the involuntary loss of stool (liquid or solid), including the loss of gas, for at least 3 months in individuals over 4 years of age.

This condition can lead to social restrictions, the constant need to locate a restroom due to leakage, odor, fear, embarrassment, psychological issues, anxiety, depression, low self-esteem, and problems in sexual life.

Continence involves a complex interaction between the pelvic floor muscles, the sphincters (internal and external), rectal length, stool consistency, and cognitive activity. The insufficiency of one or more of these elements or the failure of compensatory mechanisms can impact full continence of stool and gas.

Incidence

Its incidence ranges from 5% to 15% of the general adult population and affects women more frequently. Studies show that about 25% of patients do not report fecal incontinence to their doctors, which would increase this rate.

Risk Factors

The most common causes of fecal incontinence are structural, such as obstetric injuries—which often go beyond muscle rupture—and anorectal surgeries (hemorrhoidectomy, fistulas, sphincterotomy, pelvic radiation, among others). Non-structural causes include diarrhea from various origins such as infectious colitis, irritable bowel syndrome, post-cholecystectomy, and side effects of medications. Additionally, some physical and/or cognitive disabilities, advanced age, diabetes, and depression are predictive factors for this condition.

Types

passive incontinence: the patient has absent or reduced sensation of the urge to defecate before the incontinence episode
urge incontinence: the patient feels the urge to defecate but cannot reach the bathroom in time
mixed incontinence: a combination of passive and urge fecal incontinence

Treatment

To achieve appropriate treatment, it is necessary to identify the mechanisms responsible for fecal incontinence.

Conservative approaches such as physical therapy intervention are recommended before any potential surgical treatment. Conservative interventions include behavioral therapy involving diet control, medication use, lifestyle changes (bowel management), and pelvic floor rehabilitation. If clinical therapies fail, surgical correction may be indicated.

By Einstein Editorial Board