Fecal Incontinence And IBD

Bathroom Accidents Can Happen, But It Is Not Hopeless, And Your Doctor Can Help

Running To The Toilet
Many people with IBD know what it's like to dash for the toilet. It's possible to have a situation where you don't make it on time. Thankfully, there's so much that can be done to help. Image © Peter Cade / The Image Bank / Getty Images

People with inflammatory bowel disease (IBD) might experience incontinence for a variety of reasons. Get a group of people with IBD together and you'll hear the "almost didn't make it" and "didn't make it" and "weirdest places I pooped" stories. When in a flare-up, it's possible to experience fecal incontinence (fecal soiling, or bathroom accidents), but it's usually a temporary problem that resolves when the flare-up is gotten under control.

Many people think that incontinence is a problem that only affects older adults. The truth is that incontinence can happen to anyone, at any stage of life. It's estimated that as many as 18 million people in the U.S. experience fecal incontinence. Even healthy people might experience temporary incontinence if they are infected with a bacteria (such as from undercooked meat) or a gastrointestinal virus (sometimes called the "stomach flu").

Incontinence is a difficult subject to talk about, and even tougher to deal with, but even so it should not be ignored. This article will focus primarily on the causes and conditions of fecal incontinence that are related to IBD.

What Is Incontinence?

Incontinence is when stool leaves the body involuntarily. This includes a range of concerns -- anything from a small amount of stool leaking from the anus (such as while passing gas) to uncontrollable diarrhea.

Incontinence could be a result of a problem with the muscles in the anorectal area, or from nerve damage that impairs the ability to recognize when it is time to move the bowels.

We learn as children how to manage our body's waste and to stay clean. Defecation is something, most of us are taught, to be done in private into the toilet.

Therefore, incontinence is one of the more taboo subjects in our culture, and people who publicly admit to it are subject to ridicule. Unfortunately, most people do not ever discuss the problem with a healthcare provider.

Who Gets Incontinence?

Incontinence can happen to anyone, although it is marginally more common in women than in men. Some of the conditions that are associated with fecal incontinence include stroke and nervous system disease. People who have serious chronic illnesses and those over the age of 65 are also more likely to experience incontinence. Women may develop incontinence as a result of injury to the pelvic floor during childbirth.

What Can Cause Incontinence?

Diarrhea. Incontinence related to IBD could be a result of fecal urgency, which is the immediate need to use the toilet. Most people with IBD can relate to the need to run for the toilet, especially when in a flare-up and experiencing diarrhea. It is during these times that bathroom accidents can, and do, happen.

Incontinence from diarrhea is a result of the inflammation in the anus and rectum that is caused by the IBD, as well as the fact that liquid stool (diarrhea) is more difficult for the the anal sphincter to hold in than a solid stool. The urgency to move the bowels should improve when the flare-up is treated and the diarrhea starts to subside.

Abscesses. People with IBD, especially those with Crohn's disease, are at risk for abscesses. An abscess is an infection that results in a collection of pus, which can create a cavity at the infection site. An abscess in the anus or the rectum could lead to incontinence, although this is not common. In some cases, an abscess can cause a fistula. A fistula is a tunnel that forms between two body cavities or between an organ in the body and the skin. If a fistula forms between the anus or rectum and the skin, stool could leak out through the fistula.

Scarring. Scarring in the rectum is another possible cause of fecal incontinence. IBD that is causing inflammation in the rectum could lead to scarring of the tissues in that area. When the rectum is damaged in this way, it can cause the tissue to become less elastic. With a loss of elasticity, the rectum is not able to hold as much stool, and this could cause incontinence.

Surgery. Surgery in the rectal area could also damage the muscles in the anus. A problem common to many adults, and those with IBD are no exception, is hemorrhoids. Hemorrhoids are enlarged blood vessels in the rectum that can bleed or cause other symptoms. While hemorrhoids are typically treated with home measures such as consuming more fiber, drinking more water, and using over-the-counter creams and suppositories, surgery is used for some severe cases. If the muscles in the sphincter are damaged during hemorrhoid surgery, it could lead to incontinence.

What Is The Treatment For Incontinence?

There are many treatments for fecal incontinence, which range from at-home remedies to surgical repair of the anal and rectal muscles. When the ultimate cause is determined to be a flare-up of IBD, the treatment would be to get the IBD under control. The resolution of the inflammation in the anus and rectum and the abatement of the diarrhea may help to stop the incontinence.

Medications. For some people, medications may be prescribed to treat incontinence. For diarrhea, an anti-diarrheal agent may be used, although these types of medications are not usually used for people who have IBD (especially ulcerative colitis). In a case where fecal incontinence is linked to constipation, laxatives might be prescribed (again, this is not often the case for people who have IBD).

Injectable medications. Recent years have seen the development of a dextranomer gel for incontinence that is injected directly into the anal canal wall. The gel thickens the wall of the anal canal. The administration of this medication is done in the doctor's office in a few minutes, and typically patients can resume most normal activities about a week after receiving the injection.

Biofeedback. Another treatment for people who have bowel dysfunction is biofeedback. Biofeedback is a way of re-educating the mind and the body to work together. It has shown some effectiveness in treating certain bowel disorders in some patients, and is typically used after other therapies have proven to be ineffective. Biofeedback is an outpatient therapy that is usually done over a period of weeks. In biofeedback sessions, patients learn how to get in touch with the muscles of their pelvic floor and to get better control over them.

Bowel retraining. For some people, it may help to focus on healthy bowel habits. In bowel retraining, patients focus on their bowel movements for a period of time each day, in order to facilitate a regular routine. This is often augmented by changes in diet, such as drinking more water or eating more fiber.

Surgery. If the problem is determined to be a physical one (such as nerves and tissues being damaged by inflammation or childbirth), surgery to repair the muscles may be used. In a type of surgery called sphincteroplasty, damaged muscles in the anal sphincter are removed, and the remaining muscles are tightened up. Sphincter repair surgery is done by taking muscle from another part of the body (such as the thighs), and using it to replace the damaged muscles in the sphincter. In other cases, a sphincter replacement might be done. In this surgery, an inflatable tube is inserted in the anal canal. Patients use a pump to open it for passing stool, and then close it again after defecating. The most radical of the surgeries used to treat fecal incontinence is the colostomy, which is when the colon is brought through the abdominal wall (creating a stoma) and stool is collected in an external appliance worn on the side of the body. A colostomy is usually only done when all other therapies have failed.

Sources:

American Society of Colon & Rectal Surgeons. "Bowel Incontinence." FACRS.org. 2012.

Ansari P. "Anorectal Abscess." The Merck Manual Home Health Handbook. May 2012.

Life And IBD. "Urgency and Incontinence." European Federation of Crohn's and Ulcerative Colitis Associations (EFCCA). 2013.

Palsson OS, Heymen S, Whitehead WE. "Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review." Appl Psychophysiol Biofeedback. 2004 Sep;29:153-174.

US. National Institutes of Health. Department of Health and Human Services. "Fecal Incontinence." National Digestive Diseases Information Clearinghouse. 20 Apr 2012.

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