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Fecal Incontinence and Chronic Constipation

Incontinence is the impaired ability to control gas or stool

Constipation is a condition in which you have fewer than three bowel movements a week, or hard, dry and small bowel movements that are painful or difficult to pass.

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WHAT IS CONSTIPATION?

Constipation is the passage of too few bowel movements per week. People have very individual ideas about what constipation is and what constitutes “normal” bowel
function. While it may be normal for one person to have a bowel movement three times a day, the next person may have one three times a week. Constipation may mean hard, dry stools that are difficult to pass, even if you go everyday. Chances are you know what is regular for you, and therefore what is irregular for you.

WHAT CAUSES CONSTIPATION?

In trying to understand why you sometimes experience constipation, remember that your body’s needs are unique. From time to time these needs change, sometimes as a result of diet and exercise. In turn, your body responds with certain symptoms, including constipation.

Common causes of occasional constipation include:
– Poor eating habits (for example, too much junk food, too much caffeine, irregular eating times)
– Diet lacking in fiber and/or liquids
– Lack of exercise
– Some medications
– Stress
– Pregnancy
– Travel

More serious causes, such as surgery or disease, are rarely responsible for the mild constipation most people occasionally experience. However, if you are constipated frequently and non-prescription medications do not improve your condition, be sure to tell your doctor.

WHAT CAN I DO ABOUT CONSTIPATION?

Help yourself maintain regularity by adding some of these simple steps to your daily routine:
– Gradually add high-fiber foods to your diet including: fruit, dried fruits, unpeeled raw vegetables, bran cerals and whole-grain breads.
– Drink 8 to 10 glasses of juice or water each day
– Follow a regular exercise program. Walking is good for the heart and body, and abdominal exercises help improve intestinal muscle tone. Ask your doctor about a program that would be right for you.
– Respond to the urge to have a bowel
movement. When you feel the urge, relax and let your body take the time it needs. If you ignore the urge, you could prolong the
problem.
– If one is recommended by your doctor, take a high-fiber supplement to help you stay
regular.
– Use laxatives only as your doctor
recommends.

WHAT IS INCONTINENCE?
Incontinence of stool means the inability to control the passage of stool or gas. Some people have mild trouble holding gas; while others have severe trouble holding stool. Incontinence is a miserable problem that many people have trouble talking about. People are frequently embarrassed and afraid there is no help. However, treatment is available.

HOW COMMON IS THIS PROBLEM?
One study showed that over 2% of the population suffers from incontinence. More than 30% of nursing home patients are incontienent. It affects women more than men, and it becomes more common as people age and their sphincter muscles lose tone.

WHAT CAUSES INCONTINENCE?
Normal control of the passage of stool depends on many factors. A problem in any of the following areas can contribute to lack of control. One factor is the time it takes for stool to pass through the bowel. If stool moves throught the bowel too quickly, a person may not have warning and may have an accident. This happens most commonly to people with irritable bowel syndrome or inflammation of the bowel. The consistency of the stool is difficult for anyone to control. Anything that causes diarrhea, such as infection, inflammation, and food intolerance can lead to incontinence.

Normally, the rectum will stretch to hold stool or gas entering it, giving the person time to make it to the bathroom. If the rectum is full of stool or an abnormal growth, it may not expand further to hold additional stool. If this happens, loose stool may leak out. To prevent leakage one must be able to tell that stool or gas is present in the rectum. People with neurological problems, such as a stroke, may have abnormal sensation in the rectum. They will not be able to sense that gas or stool has entered the rectum and therfore have no warning to go to the bathroom.

The sphincter muscle, a circle of muscle around the anus, keeps the anus closed. It needs to funtion properly in several ways for adequate control. It needs to hold the anus closed at rest and squeeze to tighten the anus when stool or gas enter the rectum. As people age, the muscle gradually loses strength. The sphincter muscle can also be injured during childbirth or during rectal surgery. If injury is recognized and repaired, the muscle usually heals properly. If it does not, there may be a gap in the circle of the muscle so it is unable to close correctly. For some people this gap is small and only becomes a problem when the muscle weakens with age. Two nerves stimulate the sphincter muscle. If the nerves are injured, the sphincter muscle may become weak. The nerves may be injured through stretching during pregnancy or childbirth or from excessive straining to move one’s bowels. Rectal prolapse, tissue that repeatedly comes out through the anus, can also stretch or injure the nerve. In these situations, the muscle is intact but does not work properly, resulting in incontinence.

For more information about fecal incontinence, chronic constipation and related gastrointestinal problems, contact:

The Bowel Control Awareness Campaign is a service of the
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
www.bowelcontrol.nih.gov/

American Society of Colon and Rectal Surgeons
www.fascrs.org

International Foundation for Functional Gastrointestinal Disorders
www.iffgd.org

National Association for Continence
www.nafc.org

The Simon Foundation for Continence
www.simonfoundation.org

American College of Gastroenterology
www.gi.org

National Institute of Diabetes & Digestive & Kidney Diseases
http://www.niddk.nih.gov/

National Association for Continence
www.nafc.org

American College of Gastroenterology
www.gi.org

National Institute of Diabetes & Digestive & Kidney Diseases
http://www.niddk.nih.gov

American Academy of Family Physicians
P.O. Box 11210
Shawnee Mission, KS 66207–1210
Phone: 1–800–274–2237 or 913–906–6000
Fax: 913–906–6075
Email: fp@aafp.org
Internet: www.aafp.org

American Neurogastroenterology and Motility Society
45685 Harmony Lane
Belleville, MI 48111
Phone: 734–699–1130
Fax: 734–699–1136
Email: admin@motilitysociety.org
Internet: www.motilitysociety.org

International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217–8076
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org

HOW CAN ANORECTAL MANOMETRY WITH THE MCOMPASS HELP?
Anorectal Manometry is a test performed to evaluate patients with fecal incontinence. A catheter is placed into the anus to record pressures as patients tighten and relax the sphincter muscle. Anorectal manometry measures the pressures of the anal sphincter muslces, the sensation the rectum and the neural reflexes that are needed for normal bowel movements.

HOW IS THE TEST PERFORMED?
You will be asked to undress from the waist down and to put on a gown with the
opening in the back. A trained technologist will explain everything that will happen. The technologist will ask you to lie on an
examination table, turn onto your left side, and bend your knees. A small catheter with a small balloon at the end will be inserted into your rectum. The balloon will be inflated and measurements will be taken while you squeeze and relax your muscles. This test is performed in the GI Physiology Laboratory in the Medical Procedures Unit.

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