Q: I need your help to figure out what is wrong with me. My bowels move without advance notice. My stools are usually a combination of hard fecal matter and very runny. The fecal matter just starts to come out and I cannot stop it. It does not occur daily but happens every few days. I do not get cramps before, nor do I get a feeling of needing to empty my bowels. The other day I bent over to cut some flowers and everything came blasting out while I was in my yard.
I have seen my general practitioner. My GP sent me to a gastroenterologist who ran some tests and said my anal sphincter was torn. I went through surgery to tighten the anal sphincter so that I would be able to control the problem. It has not helped. He then suggested hat I take Immodium every day!
At this time I am wishing I had a colostomy so I can go places without fearing that I might have an accident. My life is literally on hold. I spend all my time cleaning myself, my clothes and my bathroom after each accident. I want to lead a relatively normal life. Can you give me some direction or tell me where to go for some help?
A: The internal sphincter is part of the inner surface of the anal canal, composed of concentric layers of muscular tissue. The external sphincter is a layer of striated muscle that encircles the outside wall of the anal canal and opening and is divided into three parts known as the subcutaneous, superficial and deep external sphincters. Early repair for fecal incontinence often produces good results. However, reports indicate the longer a person delays surgery, the less his or her chances are for a successful outcome.
Fecal incontinence may result from a disruption to the anal sphincter muscles because of such things as trauma, nerve damage, for obstetrical reasons, repeated straining during bowel movements, a spinal cord injury, stroke, or from prior surgery. As a general rule, the rectum stretches to accommodate the size of the stool. However, if the rectum is scarred or if the walls of the rectum have become stiffened from inflammatory bowel disease, surgery or radiation treatments, the rectum is unable to stretch as much as it should and excess stool can leak out – often in the form of diarrhea. The majority of patients undergoing repair are female who have incurred an obstetrical injury at the time of a vaginal delivery.
Surgical treatment secondary to sphincter injury varies, leading to creative attempts at repair to provide the greatest durability and least complications. Thus, overlapping repair known as sphincteroplasty has emerged as successful short-term outcomes. Despite this, published reports of long-term information have revealed a decreased function with time, raising questions as to whether this is, indeed, the best possible treatment after all. Some of the concerns are whether surgical repair is beneficial, if a patient’s age has any bearing on the outcome, and the optimum timing from injury to repair. Randomized controlled trials are obviously lacking in this regard.
Depending on the cause for your fecal incontinence, a program of Kegel exercises to help strengthen your pelvic floor muscles might help increase muscle strength, as might biofeedback, sacral nerve stimulation, bowel training, dietary changes such as eliminating spicy foods, carbonated beverages, drinks containing alcohol, sugar free gum, and all foods with artificial sweeteners. Ask your gastroenterologist his opinion, and get the help you need. If you remain dissatisfied and without progress, request a second opinion.
