What is faecal incontinence and how to treat it
Faecal incontinence, or continence disorder, refers to the condition in which the patient does not feel the sensation of having to defecate and therefore unconsciously loses their faeces or gas
Not only that: it also implies a more important problem with implications for the disorder itself and anorectal function, but also for the social and personal sphere.
Sometimes this is a real social discomfort that affects the person’s quality of life.
How faecal incontinence manifests itself
There are several manifestations related to continence disorder.
These can range from simple soiling, i.e., small faecal leaks that soil one’s underwear, due to not being able to clean oneself properly, to urgency incontinence, i.e., having to run to the bathroom when one feels the urge to evacuate.
What are the causes of faecal incontinence
These disorders may depend on the quality of our stools.
It is clear that less formed stools are more likely to lead to incontinence episodes.
It is important to emphasise that we are talking about a spectrum of conditions and that faecal incontinence is not just about the person losing stools without realising it: for there to be continence disorders, there must be anatomical and functional alterations in the structures deputed to it.
Other difficulties related to continence, in fact, can be traced back to anatomical alterations concerning
the structure, i.e. alteration of the muscles, pelvic floor, anus or rectum;
function, where the muscles are intact, but are unable to function properly (e.g. spinal trauma).
Who suffers from faecal incontinence
Very often, people who suffer from these faecal incontinence variables (e.g. soiling, urgency incontinence) do not declare this disorder precisely because they are ashamed of it or for other reasons related to modesty and sociality.
It is therefore important to raise awareness, to inform, to clear customs of the problem, knowing that there are doctors and other specialists who deal with it and who can study it, help and make these people feel better.
We are talking about an improvement in quality of life, which is the big difference in the surgical field when treating functional pathologies like this.
Faecal incontinence is much more frequent in women than in men and this is due to particular anatomical problems related to the pelvic floor (e.g. pregnancies), in a 4:1 ratio.
A laxity of the pelvic floor ligaments can also lead to this disorder.
In normal anatomical situations, without anatomical defects, the most affected age groups are 50 years and older, for both men and women.
It is obvious that in the presence of anatomical lesions, especially in women, pictures of faecal incontinence can also occur at an age below 50, and this is because they are linked to birth trauma, with a tumultuous expulsive phase, where obstetric lacerations are created at the level of the perineal body, which can lead to continence disorders over time.
In the vast majority of cases, these are pelvic floor dysfunctions that can be caused by rectal prolapse, i.e. the descent of the rectum, which does not necessarily come out of the anus, but can also be internal, as if it were a telescopic telescope, leading to an alteration in the function of the muscles deputed to anal continence and also to a change in anorectal sensitivity, whereby the presence of faecal material is not recognised.
Because of this condition, many people may begin to suffer from episodes of incontinence or episodes of defecatory urgency.
When to see a specialist
Suffering from incontinence does not mean that, necessarily, every day, episodes occur: 2 episodes per week are sufficient.
Ironically, everyday incontinence is safer and more manageable than occasional incontinence.
So when is it time to go to the specialist?
There is no standard number of times, but it is subjective: one sees the specialist when the number and frequency of episodes alter one’s quality of life.
Diagnosis
The first thing to know is that there are specialists who also deal with this problem; specialists who are able to pinpoint it and direct the patient towards the most appropriate diagnostic tests.
These depend on the underlying problem and include:
- endoanal ultrasound to assess the sphincter system;
- dynamic magnetic resonance imaging to assess the movement and function of the pelvic organs: rectum, anus, bladder, uterus/vagina in women
- anorectal manometry to assess pressures in the anus/rectum and the functionality of the muscles;
- colonoscopy, in indicated cases.
Once the diagnosis has been made, it is possible to direct the patient towards a purely rehabilitative therapy or, if conservative treatment fails, towards surgical treatment.
Surgical treatment for faecal incontinence
Surgical treatment, which always involves short hospital stays, is always minimally invasive and can take place
- in laparoscopy, through the abdomen
- in robotic surgery
- through the anus, transanal or transrectal.
Sometimes it is also possible to reconstruct the sphincter apparatus.
In this regard, it is possible to apply devices that simulate an artificial sphincter in order to improve the tone and contraction of the sphincter muscles.
In selected cases, we use sacral neuromodulation, which consists of applying a device, similar to a pacemaker, that stimulates the sacral roots in such a way as to increase the contraction of the sphincter apparatus.
In the case of rectal prolapse, on the other hand, it is possible to resort to rectopexy, by laparoscopic or robotic means, or through transanal prolapsectomy that removes the prolapse.
The results are extremely good, on the assumption that first of all it must not make the situation worse and then it must try to improve it, as far as possible.
The post-surgery
As far as post-surgery is concerned, there are no particular indications, except to observe a correct dietary hygiene of life: no to weight gain, yes to a balanced diet.
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