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So fecal incontinence is the inability to hold your bowel or
to have control of your bowel.
And this can be one episode or daily episodes.
And it results in soiling in your underwear, and
it can be quite uncomfortable.
It usually is more commonly seen in the elderly.
About 10 to 15% of the population's affected by this disorder.
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So fecal incontinence can be multifactorial.
One of the most common reasons is starting a new medication.
And that medication can result in softening of your stool and
make it harder for you to hold.
Another common reason is constipation.
Patients who are constipated strain,
and that straining can cause some injury to those muscles over time.
You can also develop hernias in your pelvic floor from chronic straining.
And that may change the anatomy just a degree so
that you can't hold your stool as well as you normally can.
And finally, a common cause is post-obstetrical injury
to the sphincter muscles during delivery, or to the nerves that
innervate that sphincter muscle during a prolonged labor.
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So fecal incontinence is,
the times that it's related to constipation can be prevented.
But often,
we can't control the factors that result in fecal incontinence.
It's probably best, if you do start on a new medication, to find out
if there's any side effects related to loosening of the stool or
causing fecal incontinence.
But the best thing is a healthy diet, preventing constipation.
That would be items like increasing your fiber in your diet so
that you don't strain as much, increasing your water intake.
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So if someone delivers a larger child or
has difficulties with prolonged labor,
that can result in injury to your muscles or to the nerves.
If someone has long-standing constipation, that is a risk factor
for developing fecal incontinence, resulting from either a pelvic floor
hernia or from just isolated injury to that muscle group.
And then also, there has been some data suggests that obesity can be
related to development of fecal incontinence, as it does also cause
some changes in the pelvic floor and its ability to do its job well.
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So there's several different treatment options that
are available.
They range from medications that can be used to slow down or
thicken the stools to surgical options.
In between, there are some non or
less invasive type of procedures such as an injectable.
Currently those are less difficult or more difficult to obtain.
But what they do is, they inject into the muscle area and
just cause some swelling or thickening of the muscle area.
And that helps to maintain the stool inside the rectum.
The newer methods that are less invasive include sacral nerve
stimulation.
This is a electrode that's placed near the sacral nerve root,
which helps to innervate those sphincter muscles.
And that innervation, that stimulus to that innervated muscle group,
causes that pressure to go up,
and then you're able to hold your stool better.
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The surgical options that are currently available aren't used
quite as frequently, such as an overlapping sphincteroplasty.
Those are not shown to be as good in terms of a longevity for a repair.
The final option, which is relatively new,
which is really only for compassionate use,
is the implantable magnetic sphincter called the Fenix.
And that's placed right around the external sphincter and
can actually increase or augment the pressure of the anal canal,
preventing the stool from leaking out.
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So at Johns Hopkins, we offer a multidisciplinary care.
The treatment of fecal incontinence is multifactorial.
There could be all multiple reasons for this to be a problem for
an individual.
So we can have them see digestive specialists in motility issues, we
can have them see a urogynecologist, all within the same building.
And so we offer that multidisciplinary team approach
to the care of these patients,
which I think really optimizes their outcomes.
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