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Incontinence > Tips for treatment and care > Diagnosis and therapy of fecal incontinence

Diagnosis and therapy of fecal incontinence

Even fecal incontinence is a big taboo, and persons affected often hide their problems even from physicians.

Fecal incontinence is a big taboo subject in society.

During a detailed anamnesis the physician should specifically inquire about previously existing diseases, operations, injuries, births, beginning of symptoms, defecation frequency, character of the feces, circumstances of involuntary defecation and previous therapies.

A patient diary facilitates diagnostic recording and monitoring of a therapy and provides a more objective overview of the symptoms.

During a clinical examination of the anal region the physician should pay attention to the following:

  • Irritations
  • Inflammatory or ulcerous changes in the perineal skin
  • Fissures
  • Scars
  • Abnormalities
  • Fistula etc.

The anocutaneous reflex is examined through the digirectal examination to test the closing pressure of the sphincter. Additionally further examinations can be conducted additionally:

  • Anorectal manometry (measures the function of the sphincter system and checks the therapeutic result).
  • Anorectal endosonography (identifies the structural damage and the degenerating illness of the sphincter musculature).
  • Procto- and rectosigmoidoscopy (benign or malignant stenosing disease as well as inflammations of the mucous membrane are diagnosed as possible triggers).

Defecography is used to examine defecation in an X-ray test. This procedure is however not used regularly. The physician can measure the sphincter function by means of pelvis floor electromyography.

Treatment of fecal incontinence

If conservative treatment is unsuccessful, an operation is indicated.

Patients with fecal incontinence should – if possible – always be treated curatively. Therapy of the underlying diseases includes conservative as well as surgical procedures.

At the beginning of therapy the patient is usually treated conservatively. During physical therapy the patient consciously experiences body functions which have taken place autonomously up to now and learns to control defecation correctively. The pelvic floor musculature with the sphincter musculature inside it is selectively built up. These pelvic floor exercises can be supplemented by biofeedback therapy and electrostimulation of the sphincter.

Fecal incontinence can be additionally treated medicinally with active agents such as loperamide. They decrease bowel passage time, increase solidity of the feces and in this manner lower defecation frequency.

An operation is usually indicated when conservative therapy failed. If the external musculature is damaged, it can be surgically reconstructed using different procedures (e.g. suture, post anal repair). If the external musculature is totally destroyed, the sphincter must be surgically replaced by for example:

  • Anterior levatorplasty
  • Stimulated gracilisplasty
  • Artificial sphincter

Absorbent pads and briefs should be provided and corresponding care measures should be conducted for patients affected who cannot be treated by causal therapy. Creams and ointments alleviate irritation of skin triggered by aggressive feces. Anal tampons enable the person affected to remain continent over several hours. They close the anal canal so that no odors or feces can leak.