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What is it about ?
The involuntary loss of stool (faecal incontinence) is found in a whole series of diseases:
- Acute infectious diarrhea ;
- Dry, hard stool ‘plug’ in the intestine;
- Overuse of laxatives;
- Lesions of the circular muscle of the anus (anal sphincter) (after surgery, childbirth or pelvic fracture);
- Descent of the rectum inside itself (rectal invagination or internal rectal prolapse);
- Descent of the rectum through the anus (rectal prolapse);
- Tumors in the rectum or anus;
- Inflammatory colon disease ;
- Congenital anomalies;
- Neurological diseases (for example dementia, multiple sclerosis (MS), cerebral infarction, paralysis).
In whom and how often does it occur?
Fecal incontinence is more common in older people, but a significant percentage of those affected are of working age. About 2 to 3 in 100 people have fecal incontinence.
It is estimated that involuntary loss of stool occurs at least once a week in 5% of people aged 50 and over, in more than 10% of people aged 70 or over, and in more than 20% of the elderly. 80 years of age or older.
The most affected group are older women. They are a more vulnerable group than men, because of the structure of their pelvic floor and because they suffer more from constipation.
How to recognize it?
Unintentional loss of stool can occur after feeling an urgent need for not getting to the toilet on time. It can also be triggered by increased pressure in the stomach, for example by sneezing, coughing or laughing. There are also forms of incontinence which mix the two types of mechanism (mixed forms).
How is the diagnosis made?
The doctor starts by asking you what medications you are taking (for example, laxatives), asks you about the nature of the stool loss (frequency, hard or soft consistency), and asks if there are any urine loss at the same time, if you have a disease of the nervous system and have had surgery on the stomach.
The doctor will then carefully inspect the anus and the last part of the large intestine. To do this, he smells with his finger (digital rectal examination) and looks directly through a tube into the intestine (scopy).
By inspecting the anus, the doctor may ask you to push as if you are having a bowel movement. In this way, he can assess the functioning of the muscles of the pelvic floor and check whether, under high pressure, part of the anus or the last part of the large intestine comes out (prolapse).
The doctor will also check for a tumor in the colon or anus.
What can you do ?
Avoid the constipation and diarrhea. Sometimes it is enough to adapt the diet. If you tend to be constipated, it is important to eat enough fiber.
Sometimes the doctor may also suggest a physical therapy program to learn how to control the anus and pelvic floor muscles. It is important to do the exercises well.
What can the doctor do?
Treatment depends on the cause.
If the symptoms are mild, an attempt is made to remedy them with medication. If the fecal incontinence is due to a particular drug, another drug must be found to replace it.
The constipation and / or the diarrhea can be treated with appropriate drugs.
In the event of involuntary loss of stool associated with prolapse or intussusception, the doctor will refer you to a specialist.
In the event of severe faecal incontinence (daily soiled underwear), the doctor should refer you to a specialist, unless the cause cannot be treated (for example in case of dementia advanced or neurological disease).
If conservative treatment does not help, the specialist may suggest an operation, for example repair of a tear in the anal sphincter or intervention on the muscles of the perineum.
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