“For a long time now, I have had gas leakage that happens very easily. I barely have to move and I lose gas without any control. This is very embarrassing as it is quite audible.
Lately, however, I have been losing stool control even though the stools are well formed. I think that I am passing gas but in fact stools come out with it.
I now have to wear a pad all the time for this problem. In fact, I am not even aware and I have stools in my pad when I go to the bathroom. Sometimes this is a smear, some other times there are stool pebbles.
I work closely with people and this is affecting me as I feel that I am constantly smelling of stools.
This loss of stools has really got me very upset , much more than the gas leakage. I am in my mid 50’s and consider myself to be very healthy and in fact, young. I am in shape and not even obese, however, I cannot go to the gym as I am always concerned that exertion may force the stools to come out even more.
Even though the gas problem started a little after the birth of my children, this stool leakage is recent.
I have done every possible kegel exercise but there is no difference…”
Dr Parks, considered the father of fecal incontinence management, in his President’s Address to the Royal Society of Medicine, in 1974 said:
“The plight of a patient with fecal incontinence is a very unhappy one indeed. There is obvious association with uncleanliness and a feeling of being a social outcast. Such a person will not meet people, not leave the house, or be able to do any shopping. If the problem is known to the family, the patient may well be rejected as a result, especially in old age.
It is indeed a very grave social problem especially in the elderly and anything that would improve it is highly desirable.”
Things have changed a lot since 1974. We now have different diagnostic tests and also treatments available for this condition. Women do not have to live with this dreadful condition.
What is fecal incontinence or accidental bowel leakage? Fecal incontinence is the involuntary loss of liquid or solid stools that is a social or hygienic problem.
How common is this condition?
The prevalence of accidental bowel leakage in community dwelling women over age 60 varies from 12 to 33% with increasing prevalence with advancing age. The prevalence reaches nearly 50% in women who are residents of nursing homes and are physically debilitated. In the few studies that have evaluated the prevalence of combined urinary and fecal incontinence in women, rates of 35 to 50% have been reported. In fact, accidental bowel leakage occurs 8 times more often in women than in men.
What are the unique anatomic characteristics of the anal canal and the rectal sphincter muscles?
The anal canal is the terminal part of the large bowel and it opens up to the outside at the anus. It has a very rich plexus of nerves which can distinguish between gas, liquid and solid stools and allows the passage of one without the other!
The muscles of the anal canal are also unique in that the downwards muscle movement of the rest of the bowel called peristalsis where the stools are being moved downwards is opposed by the anal sphincter which stays tightly closed and prevents the stools from coming out.
How do you manage patients with this condition at AUGM?
It is important to get a thorough history, perform a specific rectovaginal examination, look for prolapse, assess for constipation and stool frequency by means of the stool diaries and do certain specific tests.
Once this is done, the treatment options start from basis management of constipation, to bulking agents to bowel motility modifiers to specific procedures.
Interstim is a neurostimulation procedure that works well for this condition. In the past all we had was the Park’s operation which was the sphincter repair surgery.
In summary, a proper workup allows us to identify the correct treatment for this condition. Most patients with either one or a combination of treatment options will notice satisfactory improvement in their symptoms. Women do not have to continue to suffer from this condition. Our field continues to advance and newer treatment options such as a rectal sling are being investigated.