Stool Incontinence

Stool Incontinence

What is stool incontinence?

Stool incontinence, also known as faecal incontinence or bowel incontinence, is when you can't control your bowel movement. Bowel control depends on a coordinated effort between specific muscles and nerves:
  • Muscles: the internal and external anal sphincters, along with the puborectalis muscle, are key players in keeping the anus closed and controlling bowel movements. The internal sphincter works involuntarily (you don’t consciously control it), while the external sphincter and puborectalis muscle can be controlled voluntarily (you can tighten them when needed).
  • Nerves: the pudendal and pelvic nerves send signals to these muscles, telling them when to contract or relax. These nerves also provide signals to the brain about whether the rectum is full and if it's time to go to the bathroom.

  • Damage or weakening of any of these muscles or nerves are damaged or weakened, can lead to stool incontinence. This means you might have trouble holding in stool, feel an urgent need to go, or leak stool without realising it. Subsequently, this can lead to accidentally leaking stool from the rectum.
    The extent of stool incontinence can vary from just a small leak to completely losing control over bowel movements. Some people might feel the need to go to the toilet but can't hold it until they get there, while others might not feel the urge at all and pass stool without realising it.

    Anorectal Fissure

    Injury to the anal sphincter muscles can impair the ability to control bowel movements.

    What causes stool incontinence?

    There are several reasons why stool incontinence happens, mainly involving issues with the muscles and nerves that control bowel movements:

    Faecal impaction:

    When a person is chronically constipated, hard stool can get stuck in the rectum. This can stretch and weaken the anal muscles, making it difficult to hold in poop.

    Diarrhoea:

    Loose or watery stools can cause a sudden and urgent need to go to the bathroom, sometimes making it hard to reach a toilet in time.

    Haemorrhoids:

    A condition in which swollen veins around the anus can block the sphincter (the muscle that closes the anus) from closing properly, allowing stool to leak out.

    Muscle and nerve damage:

    Damage to the muscles around the anus and/or nerves that control the anal muscles are damaged from childbirth, chronic constipation, strokes, diabetes, or multiple sclerosis.

    Pelvic floor dysfunction:

    Weak pelvic muscles (link to service page), often due to childbirth, can lead to incontinence. Conditions like rectal prolapse (when the rectum protrudes through the anus) or rectocele (when the rectum bulges into the vagina) can also contribute to this problem.

    What are the symptoms of stool incontinence?

    Stool incontinence can show up in a few different ways. Here are the common symptoms:

    What are the symptoms of stool incontinence?

    Stool incontinence can show up in a few different ways. Here are the common symptoms:

    Uncontrolled leaks:

    You might find that you leak stool or gas without being able to stop it. This can happen when you cough, pass gas, or do physical activities.

    Unexpected stains:

    You may notice stool in your underwear after a bowel movement or see stains even when you haven't used the toilet.

    Urgent need:

    Sometimes, you might feel a strong, sudden need to go to the toilet but can't hold it long enough to get there, leading to accidents.

    Less sensation:

    You might not feel the urge to have a bowel movement or pass gas, which can result in unexpected leaks.
    These symptoms can be uncomfortable and even lead to impacted mental health where emotions such as embarrassment arise. It is important to know that you're not alone, and that there are treatments available to address stool incontinence effectively. If you're experiencing any of these issues, talk to a healthcare provider to get the help you need.

    Is stool incontinence painful?

    Stool incontinence itself is usually not painful, but it can come with discomfort or pain depending on what's causing it. Conditions like inflammatory bowel disease, rectal prolapse, or severe constipation can cause abdominal pain, cramping, or discomfort during bowel movements. Additionally, frequent cleaning and having stool on the skin can lead to irritation, itching, and soreness.
    Some individuals may experience constipation, making bowel movements infrequent and difficult.

    What are the symptoms of stool incontinence?

    Stool incontinence can show up in a few different ways. Here are the common symptoms:

    Who is at risk of stool incontinence in Singapore?

    Stool incontinence can affect various groups of people due to different risk factors. Here are the primary risk factors that can increase the likelihood of developing stool incontinence:
  • Age: people over 65 are more likely to experience stool incontinence because muscles and nerves weaken with age.
  • Gender: women are more prone to stool incontinence due to potential damage from events such as childbirth.
  • Chronic constipation: regular constipation can lead to hard stool getting stuck, which can weaken the anal muscles.
  • Nerve damage: conditions like diabetes, multiple sclerosis, and spinal cord injuries can damage the nerves that control bowel movements.
  • Underlying medical conditions: diseases like inflammatory bowel disease and irritable bowel syndrome can contribute to stool incontinence.
  • Surgery: past surgeries in the rectal area may have resulted in accidental muscle and nerve damage, leading to impaired bowel control.
  • Lifestyle Factors: lack of exercise and smoking can weaken the pelvic floor muscles and overall bowel control.
  • These risk factors increase the pressure and strain on the anus, which can cause tears in the lining, resulting in an anal fissure.
    Individuals suffering from stool incontinence may experience frequent abdominal discomfort which includes cramping or pain in the lower abdomen.

    How is stool incontinence diagnosed?

    Diagnosing stool incontinence involves a few key steps, starting with understanding your medical history and performing a physical examination, followed by specific tests to pinpoint the cause;

    Medical History and Physical Exam

  • Questions: your doctor will ask about your symptoms and medical history to determine underlying factors that are causing stool incontinence.
  • Physical Exam: includes a visual inspection of the anus and a digital rectal exam to check muscle strength and look for abnormalities.
  • Key Medical Tests

  • Anorectal manometry: Measures the strength and coordination of anal sphincter muscles using a flexible tube with a balloon.
  • Balloon expulsion test: assess how well you can expel a small, water-filled balloon from your rectum.
  • Anorectal ultrasonography: uses a wand-like instrument to create images of the sphincter muscles.
  • Proctography: X-ray or MRI images taken during bowel movements to evaluate rectal capacity and expulsion ability.
  • Colonoscopy: used to examine the entire colon with a flexible tube and camera.
  • MRI: Provides detailed images of sphincter muscles and their function during defecation.
  • Pudendal nerve test: measures the function of the nerve controlling the anal sphincter.
  • EMG: checks for nerve damage affecting sphincter muscles.
  • Blood/Stool Tests: identify infections that could cause frequent diarrhoea.
  • These steps aid your healthcare provider in understanding the cause of stool incontinence and planning the best treatment for you.

    What are the treatment options for stool incontinence in Singapore?

    CRCS Clinic offers a range of effective treatments to manage stool incontinence. The treatment prescribed will upon the cause of your stool incontinence issue;

    Medications:

    Such as anti-diarrheal or laxatives will be prescribed to treat diarrhoea and constipation for mild cases of stool incontinence. You will then be monitored to assess if stool incontinence is resolved before deploying more invasive treatments.

    Physical therapy:

    if stool incontinence is a result of issues such as pelvic floor disorders, you will be assigned a physical therapist to strengthen affected areas first.

    Bowel therapy:

    You will be guided to consciously set specific times in the day for bowel movement. This is to help you regain control and prevent accidental leakages.
    Surgical intervention may be necessary to correct underlying issues such as rectal prolapse or sphincter damage caused by childbirth. In such cases your options may include;

    Robotic Colorectal Surgery:

    A high-tech surgery using robotic arms controlled by a surgeon to perform operations on the colon and rectum. This method can repair damage with better accuracy, reducing recovery time and improving bowel function.

    Laparoscopic Colorectal Surgery:

    A minimally invasive surgery using small incisions and a camera to guide the surgery. It causes less pain and has a faster recovery time, which can quickly improve bowel function and control.

    Transanal Endoscopic Microsurgery (TEMS/TEO) & Minimally Invasive Surgery (TAMIS):

    Specialised surgeries done through the anus to remove tumours or repair damage. These techniques allow for effective removal or repair with minimal damage to surrounding tissues, improving bowel control and reducing symptoms.

    Stoma:

    A surgical procedure that creates an opening (stoma) in the abdomen to divert stool into a bag. For severe cases, this can provide a permanent solution, bypassing damaged parts of the digestive system to prevent incontinence completely.
    Each of these treatments targets different causes and aspects of stool incontinence, aiming to improve bowel control and overall quality of life. Contact us today (link to contact page) to schedule a consultation and find the right treatment for your needs. Taking action now can lead to a more comfortable and manageable daily life.

    Frequently Asked Questions

    Some cases of stool incontinence can be effectively treated and even resolved with the right approach. However, for others, it might require ongoing management to keep symptoms under control. The success of treatment largely depends on the cause of the incontinence and the treatment methods used.

    Dietary adjustments to include more fibre, regular exercise, and avoiding foods that irritate the bowel can help manage symptoms. Maintaining a healthy weight and practising pelvic floor exercises are also beneficial in improving bowel control.

    If you frequently experience stool incontinence or it severely affects your daily life, it's important to seek medical help. Early treatment can lead to better outcomes and prevent the condition from getting worse. Don't hesitate to talk to a healthcare provider if incontinence is impacting your quality of life.

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    Colorectal Care Specialists (CRCS)

    3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, SG 228510

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