fecal incontinence; anal incontinence; bowel incontinence; includes: encopresis
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Introduction
Involuntary passage of gas or feces.
Etiology
- inability to get to toilet
- constipation
- laxative use
- fecal impactation
- rectal sphincter injury
- obstetrical injury (peripartum injury)
- reduced anal sphincter & puborectalis contraction
- sensation is normal[13]
- obstetrical injury (peripartum injury)
- pudendal nerve damage
- pudendal nerve entrapment
- reduced anal sensation
- weakness of external anal sphincter
- puborectalis strength normal
- spinal cord compression/cauda equina syndrome
- weakness of puborectalis
- external anal sphincter strength normal
- pudendal nerve entrapment
- diarrhea
- altered mental status
- seizures[5]
* even if patient's loss of ability to perform activities of daily living (ADL) (i.e. inability to get to the toilet) occurred after a hospitalization, inability to perform ADL rather than the hospitalization is the most likely contributing factor to fecal incontinence[12]
Epidemiology
- 2% of population;
- increased prevalence in elderly & women
- 5-6% of community-living elderly[12]
- prevalence of 16% in elderly > 70 years of age[1]
- 10-64% of nursing home residents[12]
- 80% of women with fecal incontinence are postmenopausal
- only 1/3 of patients consult physician
- more common in women with urinary incontinence
- encopresis in children who have been toilet trained
Pathology
- loss of normal function controlling fecal continence
- dysfunction of smooth & voluntary muscles
- decreased rectal compliance[12]
- lack of reflex coordination
- diminished anorectal sensation[12]
- dysfunction of smooth & voluntary muscles
Laboratory
Diagnostic procedures
- electroencephalography (EEG) to assess absence seizures in elderly cognitive & functional change associated with new-onset fecal & urinary incontinence[2]
Radiology
- abdominal radiograph for colonic distention by excessive feces[5]
Management
- bowel management
- high-fiber diet
- bulking agents
- planned evacuations
- biofeedback
- pharmaceutical agents
- loperamide
- enemas daily or every other day
- avoid offending agents
- treatment of fecal impactation
- smoking cessation
- weight reduction if obese
- exercise
- surgery
- injection of dextranomer in stabilized hyaluronic acid (NASHA Dx) into the submucosa of the anal canal as a bulking agent[6]
- consider after conservative measures have failed[6]
- inflatable vaginal device (Eclipse System) FDA-approved for women with fecal incontinence[7]
- prevention (see prevention of fecal & urinary incontinence)
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2015, 2018, 2021.
- ↑ 2.0 2.1 Journal Watch 22(24):185, 2002 Meschia M, Pifarotti P, Gattei U, Crosignani PG. Injection therapy for the treatment of stress urinary incontinence in women. Gynecol Obstet Invest. 2002;54(2):67-72. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12566746
- ↑ Shamliyan TA et al, Systematic review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med 2008, 148:459 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18268288
- ↑ Landefeld CS et al National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008 Mar 18;148(6):449-58. Epub 2008 Feb 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18268289
- ↑ 5.0 5.1 5.2 5.3 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 6.0 6.1 6.2 6.3 6.4 Wald A. New treatments for fecal incontinence: Update for the gastroenterologist. Clin Gastroenterol Hepatol 2014 Feb 19 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24534548 <Internet> http://www.cghjournal.org/article/S1542-3565%2814%2900234-1/abstract
- ↑ 7.0 7.1 FDA News Release. February 12, 2015 FDA permits marketing of fecal incontinence device for women http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm434130.htm
- ↑ Costilla VC, Foxx-Orenstein AE, Mayer AP, Crowell MD. Office-based management of fecal incontinence. Gastroenterol Hepatol (N Y). 2013 Jul;9(7):423-33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23935551
- ↑ Agency for Healthcare Research and Quality (AHRQ) Research Review. March 21, 2016 Treatments for Fecal Incontinence https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2201
- ↑ Saga S, Vinsnes AG, Morkved S, Norton C, Seim A. Prevalence and correlates of fecal incontinence among nursing home residents: a population-based cross-sectional study. BMC Geriatr. 2013 Aug 30;13:87. doi:http://dx.doi.org/ 10.1186/1471-2318-13-87. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24119057 Free PMC Article
- ↑ Yu SW, Rao SS. Anorectal physiology and pathophysiology in the elderly. Clin Geriatr Med. 2014 Feb;30(1):95-106. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24267605 Free PMC Article
- ↑ 12.0 12.1 12.2 12.3 12.4 12.5 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 13.0 13.1 NEJM Knowledge+ Gastroenterology
- ↑ PubMed Health: Encopresis http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002537/
- ↑ Symptoms & Causes of Fecal Incontinence https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/symptoms-causes