INCONTINENCE OF FECES

INCONTINENCE OF FECES: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is the stool volume small or large? A small volume of stool should suggest anal fissure; hemorrhoids, diarrhea, or postoperative incontinence from a fistulectomy; or other types of surgery in the perirectal area.
2. Is the incontinence intermittent? Intermittent incontinence suggests epilepsy or organic brain syndrome.
3. Are there hyperactive reflexes in the lower extremities? Presence of hyperactive reflexes in the lower extremities should suggest a spinal cord tumor or trauma to the spinal cord, multiple sclerosis, a parasagittal meningioma, transverse myelitis, and syringomyelia.
4. Are there hypoactive reflexes in the lower extremities? The presence of hypoactive reflexes in the lower extremities should suggest tabes dorsalis, a cauda equina tumor, spinal stenosis, and other conditions of the lumbar spine and lumbosacral area.

DIAGNOSTIC WORKUP

Routine studies include a CBC, sedimentation rate, chemistry panel, and VDRL test. A sigmoidoscopy and barium enema are needed to exclude malignancy. The anorectal area should be carefully inspected for lesions and the sphincter competence determined by a digital exam. If these findings are normal, it would be wise to consult a neurologist. If one is not available, further workup may be done.

If there are hyperactive reflexes with cranial nerve signs, a CT scan or MRI of the brain should be done. If there are hyperactive reflexes of all four extremities with no cranial nerve signs, MRI of the cervical spine should be done. With hyperactive reflexes of the lower extremities only, MRI of the thoracic cord should be done. If there are hypoactive reflexes in the lower extremities, MRI or CT scan of the lumbar spine should be done. If increased intracranial pressure has been excluded, a spinal tap may be done to help diagnose multiple sclerosis or tabes dorsalis. Anorectal manometry and defecography may be used to detect anal and rectal muscle dysfunction.

If the general physical examination and neurologic examination are negative, psychogenic causes should be considered, and cystometric studies might be helpful. The patient should be referred to a psychiatrist.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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