Fecal incontinence (aka bowel/anal incontinence, accidental bowel leakage) is a lack of control over defecation, causing involuntary loss of bowel contents, including flatus (gas), liquid stool elements and mucus, or solid feces
Cause
Constipation
Diarrhea
Immediate/delayed damage from childbirth
Complications from prior anorectal surgery, especially involving the anal sphincters or hemorrhoidal vascular cushions
Altered bowel habits, e.g. caused by IBS, Crohn's disease, ulcerative colitis, food intolerance, or constipation w/ overflow incontinence
Pathophysiology
Continence is maintained by several interrelated factors, and there is usually 1+ deficiency of thes emechanisms for incontinence to develop
Tx
Diet
Drug
Surgery
Complications
Local reactions of the perianal skin and urinary tract, including:
Maceration, softening and whitening of skin due to continuous moisture
UTI's
Decubitus ulcers (pressure sores)
Financial expense, due to cost of drugs, incontinence products, and loss of productivity, both to the Pt, employer, insurance, and society generally
Decreases quality of life, including stigmatization, needing to organize life around easy access to bathroom and avoidance of enjoyable activities
Psychological, self-esteem related, including shame, humiliation, depression, attempting to self-manage the Sx in secrecy from others
Epidemiology
Affects 2% of adults
One of the most psychologically and socially debilitating conditions in an otherwise healthy Pt
Practitioners are often unaware of the impact of fecal incontinence
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