Rectal incontinence is a humiliating condition that is much more common in women than in men, especially as we age. Some women are confined to their homes, or even placed in nursing homes primarily because of their loss of control over their bowel function. The fear of public humiliation, and the unpredictable nature of the problem impacts every aspect of life. An accident at work, or in the car, or (horror of horrors) during sex, is just too terrible to even think about.
Childbirth can weaken the muscles surrounding the rectum, allowing gas to escape, and staining or smearing of stool on the clothing occurs. Urgency develops in which an impending bowel movement cannot be delayed long enough to reach a restroom. As the condition progresses, liquid stool cannot be controlled and finally even solid stool cannot be contained. While pads or diapers can be used for urinary incontinence, they are not satisfactory for fecal incontinence because of the odor. Any condition causing loose watery stool compounds the problem, conditions such as irritable bowel, reactions to certain foods or medications, or viral illness.
Evaluation for rectal incontinence includes a review of your medications and diet, your family history of colon related disease, and an examination paying close attention to the condition of your muscles, reflexes and nerve supply, examination for blood in the stool, and possibly a colonoscopy to evaluate for inflammatory bowel disease.
We will also evaluate you for irritable bowel syndrome which is a common and treatable condition causing unpredictable and at times explosive diarrhea, cramping, and pain. Numerous medications and treatments are available for IBS including prescription medications, over the counter bulking agents such as Metamucil or Fibercon, and probiotics.
Effective management of hemorrhoids also improves continence as the swollen tissue of a hemorrhoid is not as strong for holding back fecal contents as a healthy rectal lining. If over the counter remedies are not sufficient for controlling your hemorrhoids, we can prescribe stronger prescription treatments or banding for your hemorrhoids.
Stool bulking medications like Fibercon or Metamucil, while often used as laxatives, help relieve rectal incontinence by producing a solid stool that is more easily controlled. Over the counter medications like Imodium may be helpful in preventing the rapid movement of food through the intestines leading to loose stool, but might also cause constipation if used to excess. Taking Imodium with the first loose stool prevents a second one, and if the occurrence of diarrhea is daily and predictable, daily Imodium can be helpful.
Management of rectal incontinence usually involves dietary changes including the addition of dietary bulking agents such as whole grain, and the avoidance of pectin found in some fresh fruits. Some artificial sweeteners cause loose stool and should be avoided. High fiber cereals and breads can improve colon motility and prevent the loose stools that are so hard to control.
There are many ways to dress up whole grain oatmeal for those of us who find relief in eating oatmeal every day. It can be cooked with skim milk instead of water for a richer taste, and added brown sugar, raisins, cinnamon, vanilla, almond extract, chunks of apple, or other spices can give you the variety you need. It cooks up in the microwave in under two minutes.
Other sources of whole grain fiber are cereals such as raisin bran and shredded wheat, and fiber bars such as Fiber One and Nature Valley. Vegetables such as fresh spinach, lettuce, celery, and carrots have a lot of fiber. Fruits like apples, grapes and oranges have a lot of fiber.
For those who cannot find relief from dietary measures, surgical procedures are available to reinforce the rectal muscle and improve continence. We can refer you to a center of excellence for this surgery.
No one should be confined to their home waiting for their bowels to move, and no one should be humiliated in public by an odor or an accident. If you have a problem controlling your bowels, seek help now, and get the relief you deserve.