Incontinence in Women
Researchers have concluded that more than one out of ten adult women in the general population has fecal incontinence. Almost one in fifteen of these women has moderate to severe symptoms.1 It is estimated that the prevalence of fecal incontinence in the community ranges from 6 percent in women younger than 40 to 15 percent in women over the age of 40.1
The natural stress and pressure that occur during childbirth can lead to pelvic floor damage and fecal incontinence. This injury is not always preventable. In fact, fecal incontinence may not present itself until decades later, when normal aging causes loss of muscle tone. The weakened muscles may lose the ability to compensate for the earlier injury and incontinence results.
If you are experiencing bowel incontinence, you should mention it to your primary care provider. When you first meet with a health care provider, you should be prepared to supply a detailed history of your medical problems, medications, surgeries, childbirth history and stool leakage. Keeping a bowel chart and symptom diary prior to your appointment may be helpful. You should also be prepared for physical diagnostic procedures, including blood testing.
Sometimes even small lifestyle changes like dietary modifications or eliminating certain medications can be helpful in regaining bowel control. Increasing fiber or taking medication may provide relief by changing the consistency of the stool, since firm stool is easier to control than loose or liquid stool. The first steps to controlling incontinence are to normalize stool consistency with increased fiber intake or other bulking measures and to strengthen the sphincter muscles with pelvic floor exercises. Often, treatment includes both medical and behavioral therapy.
Lifestyle Modifications—If your fecal incontinence is associated with constipation, then good fluid intake, regular exercise and regular bowel habits can be helpful. The key elements are to work with fiber and fluid intake to establish stool that is soft but formed, as well as responding promptly to the urge to defecate.
Medications—Your provider will review your prescribed and over-the-counter medication to determine if any of them are causing or contributing to constipation or diarrhea. None of these should stop being taken, however, without the recommendation of a health care provider.
Exercise—Pelvic floor muscle exercises (Kegel exercises), when performed regularly and correctly, can greatly improve anal sphincter muscle tone and function. This often leads to increased bowel control and a reduction or elimination of fecal incontinence episodes within a few weeks.
Biofeedback—Biofeedback is a non-invasive technique that converts anal sphincter muscle contractions to a visual display on a computer screen to help a patient become more aware of their anal sphincter muscles. This technique can be used to teach or supplement pelvic muscle exercises.
People who continue to experience bowel incontinence despite other treatments may require surgery to regain control. Surgery may especially be needed for those who have experienced anal muscle injuries. Surgical options depend on the cause of the incontinence, the severity of the problem, the health and age of the patient and the clinical judgment of the surgeon.
Historically used surgical options include:
Sphincteroplasty—Rectal sphincter repair was the first treatment developed to treat fecal incontinence. It corrects a defect and involves re-attaching the rectal muscles to tighten and strengthen the sphincter.
Artificial Anal Sphincter—This synthetic sphincter is a small implant that imitates the natural function of the anal sphincter muscle and is manually controlled by the patient with a bulb pump placed discretely in the body.
Sacral Nerve Stimulation (InterStim®)
1 Bharucha AE, Zinsmeister AR, Locke GR, Seide BM, McKeon K, Schleck CD, Melton LJ. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN. Gastroenterology. 2005; 129(1):42-9.