Chair incontinence - what to do?

The causes of fecal incontinence are many: wrong diet, constipation, muscle weakness in old age or chronic diseases can be the trigger for a fecal incontinence. Therapeutically, for example, a change in diet and strengthening of the pelvic floor can help against fecal incontinence. The following article will tell you how to identify faecal incontinence, what are the causes, and what relief is when you are stool incontinent.

What is faecal incontinence?

Fecal incontinence describes the inability to retain the stool and digestive gases in the rectum until random stool settling. Up to three percent of the German population are affected.

When do you talk about fecal incontinence?

Generally, one speaks of fecal incontinence when intestinal gases or intestinal contents escape involuntarily from the rectum regularly and can not be held back until the toilet is used.

Fecal incontinence is to be distinguished from Einkoten (Enkopresis). Einkoten describes - sometimes even arbitrarily - discontinuation of defecation of normal consistency in places that are not intended in the sociocultural environment of the person concerned.

This is how the diagnosis goes

To diagnose faecal incontinence, a doctor's visit is necessary. For the diagnosis of faeces incontinence, the most important symptoms for the physician are the symptoms which the patient describes in a medical interview.

Also helpful in diagnostics is a physical examination with rectal-digital examination, in which the tension of the sphincter muscle is measured. The muscle tension of the sphincter muscle can additionally be measured with the aid of apparatus measuring instruments, for example in the form of continence tests. A healthy person can normally hold about 800 ml of liquid here.

Depending on the case, imaging studies such as MRI of the rectum can also be helpful.

How does defecation work normally?

If a chair enters the rectum, it activates stretch receptors. As a result, the inner sphincter automatically relaxes. Meanwhile, the muscle tension of the outer sphincter increases, which we can control at random. Feeling of the urge causes stool urgency. The chair is deflated only when the external sphincter and pelvic floor relax.

Symptoms and classification of fecal incontinence

Fecal incontinence is medically classified into three degrees of severity based on the severity of its symptoms:

  • Grade 1: Uncontrolled discharge of intestinal gases
  • Grade 2: Uncontrolled departure from a liquid chair
  • Grade 3: Uncontrolled departure from firm chair

There are also two special forms of faecal incontinence:

  • Chair smearing describes the departure of the smallest amounts of stool.
  • Urge syndrome, urge incontinence, is defined as the need to go to the toilet immediately as soon as there is an urgency to urinate because the stool can no longer be held back by those affected after entering the rectum.

Typical causes of fecal incontinence

There are many different causes of fecal incontinence:

  • In old age, a common cause of fecal incontinence is chronic constipation combined with a diminishing ability to control the pelvic floor and sphincter at will. Frequently, in these cases of pelvic floor weakness, urinary incontinence occurs simultaneously.
  • Natural birth or surgery can cause muscular sphincter injuries, which can cause fecal incontinence.
  • Ulcers in the rectum, such as colon cancer, can damage the muscles and nerves in the rectum and thus promote fecal incontinence.
  • Chronic inflammatory bowel disease such as Crohn's disease or ulcerative colitis can cause fecal incontinence. This may be due to limited voluntary control of the sphincter caused by chronic inflammation of the rectum. Increases the risk of incontinence by the tendency to severe diarrhea and inflammatory fistulas between the intestine and skin.
  • In neurological disorders of the nerves, such as paraplegia or post-stroke, voluntary contraction of the pelvic floor muscles may be restricted, which may result in fecal incontinence.
  • After consumption of alcohol, the general muscle tension in the body and thus also that of the sphincter and pelvic floor decreases. Therefore, stool can be withheld worse in the alcoholized state.
  • In children, malformations of the musculature or nervous system may be present at birth, which can often be symptomatically associated with fecal incontinence. These include, for example, malformations of the intestine (atresia), muscle diseases and forms of spina bifida (meningomyeloceles).

What to do with faecal incontinence

The topic of "incontinence" in general is distressing and shameful for those affected and relatives. It is all the more important to get professional help. This of course also applies in the case of fecal incontinence.

General measures such as chair regulation, in collaboration with family doctor and physiotherapist through muscle exercises and targeted nutrition, may be the first step in the treatment. In addition, nursing measures and medical aids such as insoles and diapers are an important support in everyday life with fecal incontinence.

Remedy for faecal incontinence

There are many medical products for adults that help to lead a largely normal everyday life despite fecal incontinence. These include, for example, insoles, anal tampons and diapers for adults, which can be bought for example in drugstores.

Which therapy helps?

Pelvic floor exercises and pelvic floor exercises help to strengthen the outer sphincter with targeted exercises. These exercises promote the voluntary tension of the pelvic floor muscles. Just as helpful as pelvic floor exercises can be biofeedback training as another option for treatment.

If faecal incontinence occurs especially in thin stools, medications such as loperamide can help by slowing the bowel movement. In constipation, on the other hand, faecal incontinence can be treated with medication that aids bowel movement (laxatives).

Treatment by surgical procedures

As a last resort of therapy, there are also surgical procedures. For example, muscle tears of the inner and outer sphincter muscles can be sutured to restore muscle function.

If it is not the musculature but the nervous system of the rectum that causes the fecal incontinence, a pacemaker, for example, can be implanted. This stimulates the nerves of the sphincter and activates the muscle in this way.

Diet: What to eat in fecal incontinence?

In general, in case of faecal incontinence, flatulent foods should be avoided. Dietary advice may also be helpful in the case of faecal incontinence to give individual tips. For example, constipation or a tendency to diarrhea can be specifically prevented.

People who are prone to diarrhea or urge incontinence, for example, should rather abstain from dietary fiber or at least consume it with sufficient fluid. In contrast, it is recommended in case of constipation, eat targeted fiber to thereby stimulate the intestinal movements.

Which doctor treats a fecal incontinence?

In general, it is recommended that you first go to the treating GP with symptoms of fecal incontinence. There already can be made first investigations and therapy recommendations are given. These include, for example, a change in diet, medication for chair regulation or referral to a physiotherapist.

If these measures fail to provide sufficient relief for the treatment, fecal incontinence is typically treated by a proctologist.

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