Fecal incontinence in medicine is referred to as encopresis. We are talking about involuntary emptying of the intestines with the release of feces from the anus. Patients suffering from fecal incontinence are not able to consciously manage and control the process of defecation. This problem can affect anyone, regardless of age, gender and status in society. Despite the fact that encopresis is not dangerous for human life, this pathological phenomenon negatively affects its quality, affecting not only physical he alth, but also affecting the psycho-emotional side: patients with this pathology often become outcasts in society.
Physiological characteristics
According to statistics, children (mostly boys) under the age of 7 suffer from encopresis most often. 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 the predominant number of cases is difficult childbirth.
The ability to control naturaldefecation processes can be inhibited with age: the disease develops against the background of degenerative processes caused by the inevitable aging of the body. For example, fecal incontinence in the elderly 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 anomalies in the formation of the 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 that have a physiological or neurogenic nature. In some cases, the problem is combined with urinary incontinence.
Due to the work of the natural mechanism of peristalsis, the intestines of a he althy person produce regular emptying. The whole process of promoting food products, which, when passing through the lower sections, accumulate in the formed fecal masses, 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 itself is a somewhat arbitrary act. The control of bowel movements is carried out by the "defecation center", which is located in the medulla oblongata. Due to the downward effect of brain impulses on the spinal 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 independentlymanage bowel movements when they are inappropriate or inopportune.
Why encopresis develops
According to the etiology, the causes of fecal incontinence are conventionally divided into two categories:
- organic;
- psychogenic.
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 the release of 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;
- protracted diarrhea;
- weakening of the muscles of the anal sphincters;
- low sensitivity of nerve receptors in the anus;
- reduced muscle elasticity in both parts of the rectum;
- Pelvic floor nerve disorders.
The development of encopresis is in close causal relationship with one of these disorders.
Anorectal pathologies
One of the most common causes of encopresis is hemorrhoids. With the external form of the disease, hemorrhoidal bumps are localized outside, in close proximity to the entrance to the anus. This arrangement can interfere with the proper closure of the anus, resulting in the involuntary release of a meager amount of loose stool or mucus.
Constipation is anothera problem that, if left untreated, can lead to a number of complications, including encopresis. Difficulties in the act of defecation or prolonged absence of urges also cause involuntary release of feces. The most dangerous is the chronic form of constipation. With the accumulation of solid feces in large volumes, muscle tone decreases, and given that fecal masses are almost constantly present in the rectum during constipation, 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 section still in a state, then loose stools can involuntarily drain and stand out through the anus.
A similar situation occurs with diarrhea. Due to the disorder of the digestive system, liquid masses quickly accumulate in the intestines and considerable effort is required to retain them. It's no secret that even a he althy person with diarrhea sometimes finds it difficult to get to the restroom, so if there are adverse physiological factors, the patient may suddenly have an act of emptying.
Weakness of anal sphincter muscles
Damage to the muscles of one of the elements of the sphincter apparatus can deprive a person of the ability to control their bowel movements. To a greater extent, it all depends on the severity of the injury: the ability to keep the anus closed and prevent liquid feces from flowing out may be lostfully or partially. Therefore, the causes of fecal incontinence and the treatment of this pathology are in direct relationship.
Sphincter muscle injury often occurs during childbirth. The risk of such a complication is especially high in case of perineal dissection and its ineffective treatment. Fecal incontinence in women is most commonly caused by an unsuccessful episiotomy or the use of obstetrical forceps to remove the fetus from the mother's womb.
Incorrect functioning of nerve receptors
In the submucosa of the rectum, in addition to blood and lymphatic vessels, there are nerve endings and plexuses. As soon as the volume of feces necessary for defecation is reached, the receptors send a signal to the brain. Thus, a person meaningfully controls the work of the anal sphincters.
Until the intestines are empty, the nerve endings will not stop sending 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 submucosal 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 patients who have had a stroke, suffering from diabetes, multiple sclerosis.
Inelastic rectal musculature
In every he althy person, the lower intestine is able to stretch in order toto hold large volumes of stool until the next emptying. To do this, the intestine must have high elasticity. However, previous inflammatory anorectal diseases, intestinal surgery or radiation therapy lead to the formation of hard scars on the walls of the rectum. The resulting scar tissue does not have this property, and therefore the intestinal walls lose their natural elasticity.
Pelvic floor disorders
These include:
- protrusion or protrusion of the walls of the rectum beyond the anus;
- low muscle tone involved in the act of defecation;
- omission and prolapse of the pelvic floor.
All of these problems are indicative of poor bowel function and can therefore cause fecal incontinence in both men and women.
Psychosomatic and neurogenic causes
Here we are talking about violations of the regulation of the brain centers responsible for triggering conditioned reflexes. The triggers for the development of the disease caused by these causes are associated with the rectoanal inhibitory reflex, which:
- not produced at all or implemented late;
- lost due to adverse factors (CNS lesions).
The first mechanism for the development of pathology is neurogenic in nature and is always congenital, the second is acquired, and the third occurs due to mental disorders, in the list of which:
- mental retardation;
- schizophrenia;
- deep depression;
- manic obsessions;
- neuroses;
- personality disorders;
- the strongest emotional upheavals.
In the presence of any of the above problems, the neuromuscular transmission chain is damaged, so the conscious and controlled act of defecation becomes impossible. These patients may experience both fecal and urinary incontinence.
Stages of encopresis
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 hold gases, possibly slight smearing of feces.
- II degree - the inability to control the act of emptying with loose stools.
- III degree - complete incontinence of solid feces.
In addition, treatment for encopresis will depend on:
- Does the patient feel pre-urging before defecation;
- does intermittent stool flow occur without voiding signals;
- does fecal incontinence occur due to physical labor, coughing, sneezing.
Diagnosis of disease
The easiest task for a proctologist is to make a diagnosis of fecal incontinence. In women, finding the cause, which in the majority of cases lies in the consequences of difficult childbirth, is as easy as shelling pears. A much more difficult task is to determine what provoked the pathology in men and babies. Of particular importance is:
- duration of disease;
- frequency of episodes of involuntary fecal excretion;
- character of excreted feces;
- ability to control gas.
To confirm the disease and discover its causes, the patient is referred for the following diagnostic procedures:
- Anorectal manometry. The study consists in determining the sensitivity of the nerve endings of the rectum, assessing the condition of the muscles of the anal sphincters.
- Proctography. This is a type of x-ray procedure that is performed to determine the volume and placement of stool 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 that allows you to get a three-dimensional image of the organs and soft tissues of the small pelvis, without x-rays.
- 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 condition of the upper and lower parts of the rectum. A sigmoidoscope is inserted into the patient's anus - 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. The most common treatment for encopresis is surgery.however, this method is the most radical. With first-degree encopresis, 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;
- stool routine;
- muscle training;
- drug use;
- electrical stimulation.
Diet for patients with fecal incontinence
What to do first? Of course, reconsider nutrition. There is no universal diet for all people with encopresis. It often happens that a product that is recommended for use by one patient, on the contrary, increases incontinence in another.
Usually, the diet consists of foods containing dietary fiber and vegetable proteins. Thanks to these ingredients, the feces become softer, do not interfere with normal intestinal peristalsis. The daily norm of plant fibers should be at least 20 g. To replenish their amount, dietary fiber supplements are taken. Among the foods rich in it, it is worth noting:
- legumes (soybeans, peas, lentils, beans);
- bran;
- potato with skin;
- brown rice;
- whole wheat pasta;
- oatmeal;
- flaxseed;
- nuts;
- dried fruits;
- carrot;
- pumpkin;
- fruits.
It is strictly not recommended to consume dairy products, caffeinated drinks, convenience foods and sausages. Banned sweets and pastries, fatty and spicy dishes. Apples, peaches, and pears are fruits that women or men with fecal incontinence should not eat. Reason: These fruits have a laxative effect on the body.
In addition, sufficient fluid intake throughout the day is of no small importance, especially if diarrhea is frequent. In order to prevent deficiency of nutrients and trace elements, the patient is prescribed vitamin-mineral complexes.
Establishing a bowel movement
In order to successfully treat encopresis, bowel training is essential. In order for the bowel movement to stabilize, it is necessary to develop the habit of going to the toilet at a specific time of day. For example, in the morning, after meals or before bed. Proctologists pay special attention to this condition for the treatment of fecal incontinence, because it is the correct mode of bowel behavior that will reduce the frequency of unpleasant episodes. The process of "learning" itself is quite lengthy, it can take from two weeks to several months.
Strengthening the pelvic muscles
Strong pelvic floor muscles are another prerequisite for good bowel function. The essence of the training comes down to the regular performance of exercises that contribute to the contraction and relaxation of the pelvic muscles. You need to do a few minutes during the day. It may take 3-4 months to achieve good results. Suchtreatment for fecal incontinence is often recommended for women after a difficult birth.
Medication effects
Again, there is no single and suitable medicine for all problems. In most cases, doctors advise taking laxatives based on herbal ingredients. In addition, due to the regular use of such remedies, it is much easier for patients to come to the correct defecation regimen.
Electrical stimulation
This method of treating fecal incontinence involves the insertion of an electrical stimulator under the epidermis. Its elements will be placed on the nerve endings of the rectum and anus. The electrical impulses that the stimulator will send are transmitted to nerve receptors, due to which the defecation process becomes controlled.
Operation
With the low efficiency of the described methods, there is an indication for surgical treatment. Taking into account the cause of fecal incontinence in people, the specialist selects the most optimal intervention option:
- Sphincteroplasty. If encopresis was caused by rupture of the sphincter muscles during childbirth or 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 anus is formed. Electrodes are inserted into the transplanted muscles to allow them to contract.
- Colostomy. This method of surgical treatment is chosen for pelvic floor injuries, congenital anomalies and oncological diseases affecting the lower intestine and sphincter apparatus. During the operation, part of the large intestine is brought out by making a corresponding hole in the anterior abdominal wall. After the intervention, patients are forced to use colostomy bags - reservoirs for collecting excrement. Such treatment of fecal incontinence is carried out in exceptionally difficult cases.
- Implantation of an artificial sphincter. This is one of the newest methods of surgical treatment of encopresis, which consists in placing a special inflatable cuff around the anus. At the same time, a small pump is installed under the skin, which is activated by the person himself. When the patient feels the need to go to the toilet, he deflates the cuff, and after the act of defecation inflates again, which completely eliminates the possibility of passing feces through the anus.
Disease in children
In a he althy child, the ability to control bowel movements may take up to 4-5 years. A characteristic symptom of fecal incontinence in children is the constant or periodic soiling of underwear with feces. Doctors do not diagnose "encopresis" for babies under 5 years of age. If some time after the child managed to control the acts of defecation, there was a relapse, they speak of secondary fecal incontinence.
In babies, the main cause of encopresis is chronic constipation. At the same time, other factors can also provoke fecal incontinence in children:
- Psycho-emotional stress. The body of babies reacts sharply to any experiences. Problems in the family, fear of parents or teachers, an accident, fear - all this depresses the immature psyche of the child and can lead to the development of encopresis.
- Ignoring the urge to go to the toilet. With the systematic suppression of natural needs, the rectum overflows with excrement, the pressure on the sphincter increases and the muscles cease to cope with it. Prolonged retention of feces causes stretching of the intestine and loss of sensitivity of the receptors, which subsequently only exacerbates the problem.
- Neurological disorders, including spinal cord injury, cerebral palsy, amyotonia congenita, epilepsy.
- Anomalies in the development of the rectal walls (Hirschsprung syndrome).
Regardless of the cause of fecal incontinence, in children, unconscious fecal excretion most often occurs during the day. Nocturnal encopresis is much less common. Treatment is started as soon as the doctor makes a diagnosis of fecal incontinence. After establishing the cause, they begin therapy, which is carried out sequentially in several stages:
- Start with bowel cleansing. In the morning and in the evening for one to two months, the baby is given cleansing enemas, which will allow not only to evacuate stagnant feces, but also to develop a reflex for regular defecation.
- The next stage is closely related to the previous one and consists in accustoming to timely bowel movements. Passing feces at the same time of day minimizes the risk of uncontrolled bowel movements. For a young child, it is especially important to create a supportive environment that will help form positive associations with going to the toilet.
- Correction of diet. The child must be fed easily digestible food. It is desirable 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, senna.
Basic baby routines
Training the sphincter apparatus is one of the invariable conditions for strengthening the muscles of the rectum:
- A thin rubber tube (3-4 cm) is inserted into the anus.
- The child should alternately contract and relax the anal sphincter, push and hold the training object.
Appropriate for treating fecal incontinence in older children.
In parallel with the training sessions, the child is prescribed a course of electrical stimulation of the muscular 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.
Drug treatment of encopresis involves the injection of Prozerin. A solution of this drug in 0.05% concentration contributes to the speedy restoration of neuromuscular conduction. Welltreatment with Prozerin lasts about two weeks.
Finally
Social isolation, which this problem often leads to, causes apathy and depression in patients. But you can't despair! With a responsible attitude towards one's own he alth, encopresis can be cured. The main thing is not to delay and consult a doctor at the first alarming symptoms. Despite the sensitivity of the problem and the feeling of shame, visiting a doctor is the first step on the road to recovery.
A child suffering from fecal incontinence requires a particularly reverent attitude. Parents should explain to him that it is not his fault in what is happening. The child must be introduced to the physiological characteristics of the human body and try to explain in accessible words how this problem appeared. Difficulties are not permanent, everything takes time. In no case should you reproach the baby, scold him or threaten punishment for every "embarrassment". If a child gets rid of emotional experiences, tunes in to a positive solution to the problem, the result will not be long in coming.
