Fecal incontinence
Fecal incontinence: Excerpt from Handbook of Signs & Symptoms (Third Edition)
Fecal incontinence, the involuntary passage of feces, follows a loss or an impairment of external anal sphincter control. It can result from many GI, neurologic, and psychological disorders; the effects of drugs; or surgery. In some patients, it may even be a purposeful manipulative behavior.
Fecal incontinence may be temporary or permanent; its onset may be gradual, as in dementia, or sudden, as in spinal cord trauma. Although usually not a sign of severe illness, it can greatly affect the patient’s physical and psychological well-being.
History and physical examination
Ask the patient with fecal incontinence about its onset, duration, and severity and about any discernible pattern — for example, does it occur at night or only with episodes of diarrhea? Note the frequency, consistency, and volume of stools passed within the past 24 hours and obtain a stool sample. Focus your history taking on GI, neurologic, and psychological disorders.
Let the history guide your physical examination. If you suspect a brain or spinal cord lesion, perform a complete neurologic examination. (See
Neurologic control of defecation.) If a GI disturbance seems likely, inspect the abdomen for distention, auscultate for bowel sounds, and percuss and palpate for a mass. Inspect the anal area for signs of excoriation or infection. If not contraindicated, check for fecal impaction, which may be associated with incontinence.
Medical causes
Dementia
Any chronic degenerative brain disease can produce fecal as well as urinary incontinence. Associated signs and symptoms include impaired judgment and abstract thinking, amnesia, emotional lability, hyperactive deep tendon reflexes, aphasia or dysarthria and, possibly, diffuse choreoathetoid movements.
Head trauma
Disruption of the neurologic pathways that control defecation can cause fecal incontinence. Additional findings depend on the location and severity of the injury and may include a decreased level of consciousness, seizures, vomiting, and a wide range of motor and sensory impairments.
Inflammatory bowel disease
Nocturnal fecal incontinence occurs occasionally with diarrhea. Related findings include abdominal pain, anorexia, weight loss, blood in the stools, and hyperactive bowel sounds.
Rectovaginal fistula
Fecal incontinence occurs in tandem with uninhibited passage of flatus.
Spinal cord lesions
Any lesion that causes compression or transsection of sensorimotor spinal tracts can lead to fecal incontinence. Incontinence may be permanent, especially with severe lesions of the sacral segments. Other signs and symptoms reflect motor and sensory disturbances below the level of the lesion, such as urinary incontinence, weakness or paralysis, paresthesia, analgesia, and thermanesthesia.
Other causes
Drugs
Chronic laxative abuse may cause insensitivity to a fecal mass or loss of the colonic defecation reflex
Surgery
Pelvic, prostate, or rectal surgery occasionally produces temporary fecal incontinence. Colostomy or ileostomy causes permanent or temporary fecal incontinence
Special considerations
Maintain proper hygienic care, including control of foul odors. Provide meticulous skin care, and instruct the patient to do the same if he’s able. Also, provide emotional support for the patient because he may feel deep embarrassment. For the patient with intermittent or temporary incontinence, encourage Kegel exercises to strengthen abdominal and perirectal muscles. For the neurologically capable patient with chronic incontinence, provide bowel retraining.
Pediatric pointers
Fecal incontinence is normal in infants and may occur temporarily in young children who experience stress-related psychological regression or a physical illness associated with diarrhea. Pediatric fecal incontinence can also result from myelomeningocele.
Geriatric pointers
Fecal incontinence is an important factor when long-term care is considered for an elderly patient. Leakage of liquid fecal material is especially common in males. Age-related changes affecting smooth-muscle cells of the colon
may change GI motility and lead to fecal incontinence. Before age is determined to be the cause, however, any pathology must be ruled out.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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