Opening up about a problem is never easy—especially one as personal and potentially embarrassing as fecal incontinence or chronic constipation. But once you engage with your patients about the subject, a little education can go a long way to help them along the road to wellness. After all, knowledge is power. And most patients know very little, if anything, about these conditions.
First, helping patients understand that incontinence and constipation are symptoms—not diseases or diagnoses in their own right—is extremely important. These problems can result from a wide range of underlying issues, and every patient is unique. In fact, often an individual’s problems are driven by multiple factors.
The Basics: We all know that once we eat, digestion and the principles of motility, the peristaltic action of digestive tract muscles to move the waste material through into the rectum, is automatic. Your patients rarely know what happens next – that nerves on the rectal walls sense when the rectum fills with waste and that the inner anal sphincter relaxes to allow the stool to pass. Again, this is all supposed to be automatic. When the patient has a strong enough urge to defecate (based on the sensation from the rectal wall nerves), it’s finally up to them to relax their outer sphincter to allow the stool to pass when they are ready.
Fecal Incontinence (FI) affects over 20 million Americans. Generally, this ranges from occasional leakage while passing gas to a complete loss of bowel control. It so adversely impacts quality of life, roughly 28% of these people are homebound and it is the leading cause of entry into assisted living facilities and nursing homes. It is estimated that FI is associated with 55% higher health care costs for those suffering from this.
There are two primary types of fecal incontinence – Urge Incontinence occurs in people for whom the urge to defecate comes suddenly and cannot be stopped, and Passive Incontinence, when the person is unaware they need to pass stool.
So why might your patients suffer from fecal incontinence? As their physician, there are several possible diagnoses you may determine.
It is important to assure your patient that fecal incontinence does not mean that someone is careless or lazy. Typically, it results from physical problems such as those we’ve just described above.
Many of the causes of defecation dysfunction can be addressed through physical therapy and retraining using biofeedback, while others require more invasive solutions. The good news for patients is that many fecal incontinence and related disorders can be corrected or controlled with appropriate interventions.
A simple Anorectal Manometry exam is often used to assess the ability of the rectum and anus to expand and contract, detect pressure and work together to eliminate stool. Anorectal Manometry can also be used as a biofeedback tool to help patients control their defecation urges as well as strengthen and retrain muscles to overcome many of these problems.
Oh No! . . . I Can’t Go – Explaining Muscle Control and Chronic Constipation takes a deeper dive into some of the specific problems that can cause defecation disorders and presents simplified information about these disorders that will help patients, their loved ones, and caregivers understand these problems.