Fecal incontinence in medicine is referred to as the term “encopresis”. This is an involuntary bowel movement with the release of feces from the anus. Patients suffering from fecal incontinence are not able to consciously control and control the bowel movement. This problem can affect anyone, regardless of age, gender and status in society. Despite the fact that encopresis is not dangerous to human life, this pathological phenomenon negatively affects its quality, affecting not only physical health, but also affecting the psycho-emotional side: patients with such pathology often become outcasts in society.
Physiological features
According to statistics, children (mostly boys) under 7 years old most often suffer from encopresis. Among adults, the problem is diagnosed in 5% of patients with a history of anus pathology. Often, encopresis occurs in women. The cause of fecal incontinence in a predominant number of cases is a difficult birth.
The ability to control the natural processes of defecation can be inhibited with age: the disease develops against the background of dystrophic processes caused by the inevitable aging of the body. For example, fecal incontinence in older people appears much more often than in men and women of mature age.
As an independent disease, encopresis is spoken only in the presence of intrauterine abnormalities in the formation of pelvic organs. If we are not talking about any congenital abnormalities, then the inability to control the urge to defecate is nothing more than a sign of disorders having a physiological or neurogenic nature. In some cases, the problem is combined with urinary incontinence.
Due to the natural mechanism of peristalsis, the intestines of a healthy person produce regular emptying. The whole process of promoting food products, which, when passing through the lower sections, accumulate in the formed feces, is carried out due to the functioning of the ANS and rectal receptors. This section of the gastrointestinal tract consists of the upper and distal spaces (from the sigmoid colon to the anus).
Defecation per se is partly an arbitrary act. The bowel movement is controlled by the “bowel movement”, which is located in the medulla oblongata. Due to the downward effect of brain impulses on the spinal part of the lumbosacral segment, the act of emptying occurs consciously. Ultimately, the external sphincter relaxes, and the abdominal muscles and diaphragm begin to contract. Normally, a person is able to independently manage bowel movements in those situations when it is inappropriate or untimely.
Why does encopres develop
According to the etiology, the causes of fecal incontinence are conditionally divided into two categories:
The first group includes disorders resulting from injuries or past pathologies. The second category includes disorders of the regulation of the brain center associated with the mechanism of formation of conditioned reflexes to excrete feces from the digestive tract.
Organic causes of fecal incontinence are most often diagnosed in adult patients. In the predominant number of cases, the disease becomes a consequence of:
- external hemorrhoids;
- chronic untreated constipation;
- lingering diarrhea;
- weakening of the muscles of the anal sphincters;
- low sensitivity of nerve receptors in the anus;
- decreased muscle elasticity in both parts of the rectum;
- disorders of the nerves of the pelvic floor.
The development of encopresis is in close causation with one of these disorders.
Anorectal pathologies
One of the most common causes of encopresis is considered hemorrhoids. With the external form of the disease, the hemorrhoid cones are localized outside, in close proximity to the entrance to the anus. Such an arrangement may interfere with the necessary closure of the anus, resulting in the involuntary release of a meager amount of loose stool or mucus.
Constipation is another problem that, without appropriate treatment, can lead to a number of complications, including encopresis. Difficulties with the act of defecation or a long absence of urges also cause involuntary excretion of feces. The most dangerous is the chronic form of constipation. With the accumulation of solid feces in large volumes, muscle tone decreases, and when you consider that feces with constipation are almost always present in the rectum, dystrophic processes develop very quickly, in just a few months. As a result, the sphincter apparatus loses its ability to contract and ceases to cope with its main purpose. And if you keep the solid masses of the muscles of the lower part still in a state, then loose stools can involuntarily drain and stand out through the anus.
A similar situation occurs with diarrhea. Due to an upset digestive system, liquid masses quickly accumulate in the intestines and considerable efforts are required to retain them. It’s no secret that even a healthy person with diarrhea can sometimes find it difficult to get to the restroom, therefore, in the presence of unfavorable physiological factors, the patient may suddenly have an emptying act.
Muscle weakness of the anal sphincter
Damage to the muscles of one of the elements of the sphincter apparatus may deprive a person of the ability to control their bowel movements. To a greater extent, everything depends on the severity of the injury: the ability to keep the anal opening closed and prevent leakage of liquid feces can be lost completely or partially. Therefore, the causes of fecal incontinence and the treatment of this pathology are in a direct relationship.
Sphincter muscle damage often occurs during childbirth. The risk of such a complication is especially great with cutting the perineum and its ineffective treatment. The cause of fecal incontinence in women in most cases is an unsuccessful episiotomy or the use of obstetric forceps to remove the fetus from the mother’s womb.
Malfunctioning nerve receptors
In the submucous membrane of the rectum, in addition to blood and lymph vessels, nerve endings and plexuses are present. As soon as the amount of feces necessary for defecation is achieved, the receptors send a signal to the brain. Thus, a person consciously controls the work of anal sphincters.
Until the intestines are empty, the nerve endings will not cease to supply the appropriate impulses to the brain. This, in turn, causes the sphincters to contract almost all the time. Muscles can relax only during the act of excreting feces from the digestive tract. With dysfunction of the submucous nerve plexus, a person does not feel the urge to defecate, and therefore is not able to hold feces or visit the toilet on time. Such a violation is most often observed in stroke patients with diabetes mellitus, multiple sclerosis.
Rectal Muscular Inelasticity
In every healthy person, the lower intestine is able to stretch in order to hold large volumes of stool until the next emptying. For this, the gut must have high elasticity. However, past inflammatory-anorectal diseases, intestinal surgery or radiation therapy lead to the formation of hard scars on the walls of the rectum. The formed scar tissue does not possess such a property, and therefore the intestinal walls lose their natural elasticity.
Disorders within the pelvic floor
These include:
- prolapse or protrusion of the walls of the rectum beyond the anus;
- low muscle tone involved in bowel movements;
- prolapse and prolapse of the pelvic floor.
All these problems indicate poor bowel function, therefore, they can cause fecal incontinence in men and women.
Psychosomatic and neurogenic causes
Here we are talking about dysregulation of the brain centers responsible for triggering conditioned reflexes. Triggers for the development of the disease caused by these causes are associated with a rectoanal inhibitory reflex, which:
- It is not developed at all or is implemented late;
- lost against unfavorable factors (CNS lesions).
The first mechanism for the development of pathology is neurogenic and always congenital, the second is acquired, and the third arises due to mental disorders, in the list of which:
- mental retardation;
- schizophrenia;
- deep depression;
- manic obsessive states;
- neurosis;
- personality disorders;
- severe emotional upheaval.
In the presence of any of the above problems, the neuromuscular transmission chain is damaged, so a conscious and controlled act of defecation becomes impossible. In such patients, fecal and urine incontinence may occur simultaneously.
Encopresis stages
Fecal incontinence in women, men and children in medical practice is usually divided into three degrees. Depending on the stage of the pathology, the most effective treatment option is determined:
- I degree - inability to retain gases, a slight smearing of feces is possible.
- II degree - the inability to control the act of emptying with loose stool.
- III degree - complete incontinence of solid feces.
In addition, the treatment of encopresis will depend on:
- Does the patient experience preliminary urges before defecation;
- whether stool periodically occurs without emptying signals;
- whether fecal incontinence occurs against the background of physical labor, coughing, sneezing.
Diagnosis of the disease
The simplest task for a proctologist is to establish a diagnosis of fecal incontinence. In women, finding the cause, which in the predominant number of cases lies in the consequences of a difficult birth, is simple. A much more difficult task is to determine what triggered the pathology in men and children. Of particular importance is:
- the duration of the disease;
- the frequency of episodes of involuntary excrement;
- the nature of excreted feces;
- ability to control gas discharge.
To confirm the disease and detect its causes, the patient is sent for the following diagnostic procedures:
- Anorectal manometry. The study consists in determining the sensitivity of the nerve endings of the rectum, assessing the state of muscles of the anal sphincters.
- Proctography. This is a type of x-ray procedure that is performed to determine the volume and placement of feces in the rectum. Based on the results of proctography, conclusions can be drawn about the functionality of the intestine.
- Magnetic resonance imaging. The most informative research method, which allows you to get a three-dimensional image of organs and soft tissues of the pelvis, without x-ray radiation.
- Transrectal ultrasound. Screening involves the introduction of a special sensor into the anus, which sends ultrasonic waves to organs and tissues.
- Sigmoidoscopy. This method is used to investigate the state of the upper and lower parts of the rectum. A proctoscope is inserted into the anus of the patient - a flexible thin hose with a camera.
- Electroneuromyography. The study is carried out to determine the electrical activity of the muscles.
Conservative treatment
Fecal incontinence in adults and children requires systemic therapy. When encopresis is most often resorted to surgery, however, this method is the most radical. When an encopresis of the first degree, complex conservative therapy is most often prescribed, which is a course of therapeutic and preventive measures aimed at strengthening the sphincter muscles and reducing the severity of the disease. These include:
- diet food;
- bowel movement;
- muscle training;
- the use of drugs;
- electrical stimulation.
Diet for patients with fecal incontinence
What to do first? Of course, rethink nutrition. There is no universal diet for all individuals with encopresis. It often happens that a product that is recommended for use by one patient in another, on the contrary, increases incontinence.
Typically, a diet consists of foods containing dietary fiber and vegetable proteins. Thanks to these ingredients, feces become softer, do not interfere with normal intestinal peristalsis. The daily norm of plant fibers should be at least 20 g. To supplement their number, take dietary supplements with fiber. Among the foods rich in it, it is worth noting:
- legumes (soy, peas, lentils, beans);
- bran;
- peeled potatoes;
- brown rice;
- whole wheat pasta;
- cereals;
- flax-seed;
- nuts
- dried fruits;
- carrot;
- pumpkin;
- fruits.
It is strongly not recommended to use dairy products, caffeinated drinks, semi-finished products and sausages. Banned sweets and pastries, fatty and spicy dishes. Apples, peaches and pears are fruits that should not be eaten by women or men with fecal incontinence. Reason: these fruits have a laxative effect on the body.
In addition, sufficient intake of fluids throughout the day is of considerable importance, especially with frequent diarrhea. In order to prevent the deficiency of nutrients and trace elements, vitamin-mineral complexes are prescribed to the patient.
Establishing a bowel movement
For successful treatment of encopresis, intestinal training is crucial. In order for the bowel movement to stabilize, it is necessary to develop the habit of visiting the toilet at a particular time of the day. For example, in the morning, after eating, or before bedtime. Proctologists pay special attention to this condition for the treatment of fecal incontinence, because it is the correct mode of intestinal behavior that will reduce the frequency of unpleasant episodes. The process of "training" is quite lengthy, it can take from two weeks to several months.
Pelvic muscle strengthening
Strong pelvic floor muscles are another prerequisite for good bowel function. The essence of the training is to regularly perform exercises that contribute to the reduction and relaxation of the pelvic muscles. You need to do during the day for several minutes. It may take 3-4 months to achieve good results. Such treatment for fecal incontinence is often recommended for women after a difficult birth.
Drug exposure
Again, there is no single and suitable medicine for eliminating the problem. In a predominant number of cases, doctors advise taking laxatives based on herbal ingredients. In addition, due to the regular use of such funds, it is much easier for patients to come to the correct bowel movement.
Electrical stimulation
This method of treating fecal incontinence involves embedding an electrical stimulator under the epidermis. Its elements will be located on the nerve endings of the rectum and anus. The electrical impulses that the stimulator will send are transmitted to the nerve receptors, due to which the defecation process becomes controlled.
Operation
With the low efficiency of the described methods, an indication for surgical treatment arises. Taking into account the causes of fecal incontinence in people, the specialist selects the most optimal option for intervention:
- Sphincteroplasty. If the encopresis was caused by rupture of the sphincter muscles during childbirth or by household trauma to the external anal sphincter, this type of operation is more preferable. Its principle is to connect damaged tissues, which returns the valve to its previous functionality. After sphincteroplasty, a person will again be able to control the release of gases, solid and liquid feces.
- Muscle transposition. This kind of intervention is resorted to in case of failure of sphincteroplasty. During the operation, the lower part of the gluteal muscles is separated from the coccyx and a new anal opening is formed. So that the transplanted muscles can contract, electrodes are built into them.
- Colostomy. This method of surgical treatment is chosen for pelvic floor injuries, congenital malformations and oncological diseases affecting the lower intestine and sphincter apparatus. During the operation, part of the colon is brought out, making a corresponding hole in the anterior abdominal wall. After the intervention, patients are forced to use colostomy containers - excrement reservoirs. Such treatment for fecal incontinence is carried out in extremely difficult cases.
- Implantation of an artificial sphincter. , . , . , , , .
Disease in children
In a healthy child, the ability to control bowel movements can take up to 4-5 years. A characteristic symptom of fecal incontinence in children is a constant or periodic stain of underwear with feces. Doctors do not make the diagnosis "encopresis" for children under 5 years of age. If, after some time after the child was able to control the acts of defecation, a relapse occurred, they speak of secondary fecal incontinence.
In children, the main cause of the development of encopresis is chronic constipation. At the same time, other factors can provoke fecal incontinence in children:
- Psycho-emotional stress. The body of the kids reacts sharply to any experiences. Problems in the family, fear of parents or teachers, accident, fear - all this depresses the immature psyche of the child and can lead to the development of encopresis.
- Ignoring toilet calls. With the systematic suppression of natural need, the rectum is filled with excrement, the pressure on the sphincter increases and the muscles cease to cope with it. Prolonged stool retardation causes a bowel sprain and loss of receptor sensitivity, which subsequently only exacerbates the problem.
- Neurological disorders, including spinal cord lesions, cerebral palsy, congenital amyotonia, epilepsy.
- Anomalies in the development of the rectal walls (Hirschsprung syndrome).
Regardless of the cause of fecal incontinence, in children, unconscious excretion of feces is most often observed in the afternoon. Night encopresis is much less common. They begin treatment as soon as the doctor diagnoses fecal incontinence. After establishing the cause, they begin therapy, which is carried out sequentially in several stages:
- Begin by cleansing the intestines. In the morning and evening for one to two months, the baby is given cleansing enemas that will allow not only to evacuate stagnant feces, but also to develop a reflex for regular bowel movements.
- The next stage is closely related to the previous one and consists in accustoming to timely bowel movement. The excretion of feces at the same time of the day minimizes the risk of uncontrolled bowel movements. It is especially important for a young child to create a favorable environment that will help form positive associations with going to the toilet.
- Diet correction The child must be fed easily digestible food. It is advisable to include fiber and laxative foods in the diet: kefir, herbs, prunes, fresh bread, cabbage, carrots. You can supplement the menu with decoctions of buckthorn and senna.
Basic procedures for babies
Training the sphincter apparatus is one of the unchanging conditions for strengthening the muscles of the rectum:
- A thin rubber tube (3-4 cm) is inserted into the anus.
- At the same time, the child should compress and relax the anal sphincter alternately, push and hold the training object.
The technique is suitable for the treatment of fecal incontinence in older children.
In parallel with training sessions, the child is prescribed a course of electrical stimulation of the muscle apparatus, which consists of 8-10 procedures. The currents used during the session help restore the relationship between the sphincter apparatus and the nerve endings of the rectum. The procedure is not performed at home.
Medication for encopresis involves the injection of Prozerin. A solution of this drug in 0.05% concentration contributes to the speedy restoration of neuromuscular conduction. The course of treatment with Proserinum lasts about two weeks.
In conclusion
Social isolation, which this problem often leads to, causes apathy and depression in patients. But you can’t despair! With a responsible attitude to one's own health, encopresis can be cured. The main thing is not to delay and consult a doctor at the first alarming symptoms. Despite the delicacy of the existing problem and the feeling of shame, visiting a doctor is the first step on the road to recovery.
A child with fecal incontinence requires a particularly reverent attitude. Parents should explain to him that his guilt is not happening. The child needs to be introduced to the physiological characteristics of the human body and try to explain in simple terms how this problem appeared. Difficulties are not constant; time is needed for everything. In no case can you blame the baby, scold him or threaten punishment for each "embarrassment". If the child gets rid of emotional experiences, tunes in to a positive solution to the problem, the result will not be long in coming.