Definition
We speak of "fecal incontinence" to indicate a partial or total loss of control of the anal sphincter, with subsequent involuntary release of:
- Liquid stools
- Solid faeces
- Intestinal gases
Symptoms
Often, when we talk about fecal incontinence, we tend to forget that even involuntary gas intestinal emissions are a characteristic symptom.
In addition to flatulence, fecal incontinence is distinguished by the release of modest - sometimes conspicuous - amounts of fecal material, whose consistency varies according to the cause that has favored it.
Many adults, throughout their lives, claim to have had a single episode of fecal incontinence, often in the context of diarrhea: in such circumstances, incontinence should not be interpreted as a dangerous symptom, nor as a lit warning light serious diseases. One or two episodes of fecal incontinence should not provoke unnecessary alarmism, even if the opinion of the doctor is always and in any case advised.
Different speech when fecal incontinence occurs again and again over a few days. In such circumstances, the symptoms accused by the patient may vary depending on the factor that arises at the beginning:
- Loss of control of faecal material emission
- Flatulence
- Stimulation to defecation completely unnoticed
- Stimulation to defecation felt but inability to control the anal sphincter
- Impossibility to postpone the impulse to defecation
- Diarrhea / constipation / fecal impaction
- Abdominal swelling
- Soiling of undergarments (so-called " fecal soiling ")
Warning!
It is good to distinguish fecal incontinence properly called pseudo-incontinence. Some symptoms, in fact, could initially lead to suppose such a condition, when instead it deals with something else. The presence of anal mucosal and / or yellowish secretions and the perception of anal moisture could in fact be a lit indicator of different anal diseases (eg infections, rectal prolapse, anal fistula, hemorrhoids etc.) or, more simply, synonymous with poor intimate hygiene personnel.
Complications
For most patients with fecal incontinence, the heaviest complication associated with this disorder lies in psychological distress and a heavy feeling of embarrassment. Not being able to control it, faecal incontinence in fact risks to manifest all its symptoms in the middle of a conversation or during working hours. The stress and anxiety associated with this disorder are the psychological complications that inevitably derive from the awareness of not being able to fully control one's intestinal function in terms of evacuation. Not to forget, then, that many patients suffering from fecal incontinence tend to isolate themselves, avoiding as much as possible contact with people.
In addition to psychological disorders, fecal incontinence can give rise to physical problems, such as in particular:
- Maceration of the skin surrounding the anal area
- Anal skin whitening (due to the humidity of the area)
- Bedsores
- Increased risk of urinary tract infections
- Anal and / or genital itching
- Anal ulcers (infrequent)
Diagnosis
The diagnosis of fecal incontinence begins with an accurate medical history: here, the doctor will ask the patient specific questions regarding the frequency of evacuation, eating habits, the presence of possible pathologies, the use of drugs and symptoms .
The anamnesis is important to frame the patient and put a first diagnostic hypothesis on the cause of fecal incontinence. In fact, only going back to the cause it will be possible to cure the disorder at the root.
However, the anamnesis must be supported by a physical examination (digital rectal test) and possibly by a series of more detailed diagnostic analyzes:
- Digital rectal examination, essential for analyzing any sphincter defects and rectal prolapse. The doctor inserts a finger (protected by a glove and lubricated) into the anal sphincter of the patient to assess the strength of the muscles of the area and any abnormalities in the rectal site.
- Balloon expulsion test: the doctor introduces a special balloon filled with water into the rectum of the patient, who is asked to expel him. Here, the doctor evaluates the time necessary for the patient to expel the balloon: a time of more than a minute can be interpreted as an anomaly / defecation disorder.
- Anorectal manometry: useful test to evaluate the pressure exerted by the anal sphincters at rest and during the contraction.
- Proctography or cine defecografia: this test uses X-rays to estimate the amount of faecal material that the rectum can contain, while evaluating how faeces are expelled. To perform the test, a special contrast liquid is introduced into the rectum and bladder to opacify the pelvic floor organs: in this way, through a video-recording, it is possible to observe the subject's bowel movements during the expulsion of the faeces, thus allowing a global analysis of the intestinal expulsive dynamics.
- Proctosigmoidoscopy: examination that involves the insertion of an endoscope in the anal canal, in the sigma and in the rectum to visualize the intestine and possibly detect pathological signs (such as inflammation) or scar tissue.
- Electromyographic tests, useful for ascertaining or denying possible alterations to the nervous system.
- Anorectal ultrasound: examination indicated to evaluate the structural patency of anal sphincters.
The diagnostic tests just described can therefore clarify the cause of faecal incontinence and the severity of the condition.
