Fecal incontinence is also known as bowel incontinence, accidental bowel leakage, or having loose bowels. Almost everyone will experience an “accident” in having stool leak while passing gas, a bout with diarrhea, or being forced to hold in a bowel movement because of lack of bathroom facilities nearby. However, chronic or ongoing bowel leakage is cause to seek help.
Don’t feel embarrassed. There are many reasons why you can find yourself having this issue.
The body is a marvelous system of cells, nerves and muscles that function without having to think about it. Cell regeneration, digestion, and waste elimination all take place as a result of sophisticated, automated processes.
Bowel leakage happens as a result of a breakdown in communication within the complicated nerve and muscle system of the anus and rectum. If the nerves or muscles have been damaged, this will cause problems. The causes can be:
- Childbirth through vaginal delivery
- Anal or rectal surgery
- Muscle or nerve damage, stroke, spinal injury
- Diseases such as diabetes, Alzheimer’s, dementia, Crohn’s disease, ulcerative colitis
- Chronic diarrhea
West County Colon Rectal Care specializes in treating all forms of bowel incontinence, mild and severe. Dr. Robert West is a highly trained board certified proctologist who specializes in diseases of the colon, rectum and anus. Along with our highly trained staff, that is all we do. We understand the sensitive nature of health issues affecting the colon, rectum and anus. At West County Colon Rectal Care, you can be assured that you will receive expert care.
Fecal incontinence, if not treated, will affect your quality of life, self-esteem and well-being.
We have found the following tests to be the most helpful in determining the best treatment options to treat your fecal incontinence.
On the initial appointment, it’s important to understand what symptoms and causes may be involved with the fecal incontinence. Answers to the following questions will help:
- How often are you experiencing problems?
- Are you experiencing abdominal pain or rectal pain?
- What are your symptoms?
- How long have you had these symptoms?
- What is the most distressing symptom?
- What medications are you taking (over the counter and prescriptions)?
- What is your lifestyle (diet, sedentary or active)?
- What other health issues, if any, do you have?
- A rectal exam will help visually check for any issues that can be seen immediately. This would include the presence of hemorrhoids, fissures, or evidence of previous surgeries.
An anorectal manometry test is the most well established and widely used tool for evaluating patients with constipation or fecal incontinence. After a physical exam of the anal region, this test is given to measure how weak or strong the anal sphincter muscles are. In addition, the test measures the neural reflexes that are needed for normal bowl movements.
What is Involved with the Anorectal Manometry Test?
The procedure is done in the office and takes about 30 minutes. You will be asked to change into a hospital gown. The person administering the test will ask some brief health history questions. They will explain the procedure as described here and will ask if you have any questions.
You will be asked to lie on your right or left side. The test uses a small, flexible catheter, about the size of a thermometer, with a balloon on the end. This is inserted into the rectum. The catheter is connected to a machine that measures the pressure of the sphincter muscles. The balloon may be inflated during the test to assess the normal reflex pathways.
The machine will be measuring the anal sphincter muscle pressures. You may be asked to squeeze, relax or push at various times during the test.
Squeezing will involve tightening the sphincter muscles in order to prevent anything from coming out. Relaxing is just that, not controlling the muscle.
Pushing would mean to bear down or push as if trying to have a bowel movement. In addition to the anorectal manometry test are two other tests that may be performed: an anal sphincter electromyography (EMG) and a balloon expulsion test.
Anal Sphincter EMG
An anal sphincter electromyography (EMG) evaluates the nerve supply to the anal muscle. This electrical activity is recorded by placing a small electrode into the anal canal.
As in the anal manometry test, the patient is asked at various times to relax, squeeze or push. During the squeezing and pushing, the anal sphincter EMG confirms whether the muscles are contracting properly.
This sounds like the opposite should happen, but ideally, muscles should relax upon pushing. The tracing of the electronic activity will increase when the sphincter and pelvic floor muscles contract, which is not ideal.
Low anal squeeze pressures on an anal manometry test with normal EMG activity may indicate a torn sphincter muscle. This muscle can be repaired.
This is a simple procedure to determine pelvic floor function. A balloon is inserted into the rectum. The balloon is filled with air. The patient is asked a series of questions about when they can feel the balloon. It is a procedure that measures rectal compliance, or sensitivity and stretch of the rectum. Rectal compliance is also increased in patients with chronic constipation.
If you are allergic to latex, it’s important to inform the technician prior to the test so that a latex free balloon may be used.
Colonoscopy has mostly been thought of as screening for colon cancer. However, a colonoscopy is very helpful in diagnosing causes of fecal incontinence.
A colonoscopy is an examination that uses an endoscope to view the entire large bowel or colon. The doctor can view obstructions, polyps, bleeding, ulcers, tumors or other causes of inflammation.
A colonoscopy will be recommended if there is unexplained rectal bleeding, blood in the stool, sudden weight loss, sudden constipation, sudden fecal incontinence, or a suspected blockage.
Why Are These Tests Important?
Anal Manometry, anal sphincter EMG and the balloon test all help a doctor to treat patients with severe constipation or fecal incontinence. The anal sphincter muscles are very important, specialized muscles that regulate the proper passage of bowel movements.
If the muscles are weak, or if the muscles don’t contract in a timely fashion, stool will leak, which translates to incontinence. A poor sensation in the rectum can also contribute to fecal incontinence. These tests can help a doctor determine what kind of treatments are necessary.
If muscles don’t relax properly when bearing down or pushing to have a bowel movement, this can cause an obstruction and constipation. While there are many causes for fecal incontinence, an anal manometry test can help doctors and patients identify the problem and offer effective treatments.
Measuring how the muscles respond will determine what action the doctor and patient can take to improve and correct these issues
We look forward to helping you feel confident and healthy again.
Call us: (314) 720-0050