Fecal incontinence treatment with folk remedies. Causes and features of treatment of fecal incontinence in adults and children Involuntary defecation in adults

Encopresis, or fecal incontinence, occurs in people regardless of age. Such a delicate problem causes discomfort and has negative consequences if left untreated. The pathology in question is not an independent diagnosis; it is one of the symptoms of a malfunction of the body. In this article, we will look at what causes encopresis in children and adults, and why successful treatment involves the use of psychotherapy.

Types and symptoms of encopresis

The brain regulates reflexes and signals from a large number of nerve endings that are responsible for the process of defecation. When a certain volume of feces accumulates in the large intestine, pressure arises in the rectum, a signal is sent to the brain that relaxes the sphincter, and emptying occurs. Fecal incontinence in a child is regarded as a pathology only after 4 years. At an earlier age, due to the physiological development and formation of the central nervous system, spontaneous bowel movements are normal.

Classification of defecation disorders

For example, in newborns and infants up to 6–12 months of age, frequent bowel movements (up to 7 times a day) are normal. Closer to 2 years, almost all children are able to control the urge to defecate, but doctors allow periodic encopresis in children at this age.

There are true and false incontinence. The first is rare and is associated with changes in brain function. A person loses control over the urge to defecate, and the deviation is difficult to treat. False incontinence is more common and its causes lie in problems with the gastrointestinal tract or nervous system. With this form of disorder, stool accumulates in the large intestine, which stretches it. As a result, the sensitivity of the receptors responsible for the urge to defecate decreases.

In addition to this classification, primary and secondary encopresis are also distinguished. Primary means that the child has not developed the reflexes necessary for proper bowel movements. Secondary is said to occur when the patient suddenly loses the ability to control bowel movements.

The symptoms of the pathology depend on its type. True encopresis is characterized by the constant manifestation of the following symptoms:

• anointing;
• the sphincter does not close completely;
• the perianal area is irritated;
• possible development of enuresis (as urinary incontinence is called);
• an unpleasant odor from a person that is perceived by others.

With false encopresis note:

• constant constipation (delayed bowel movements for more than 3 days over 2-3 months), which can alternate with loose stools;
• increased gas formation;
• abdominal pain on palpation;
• high stool density.

Physiological and psychological features of encopresis

Spontaneous excretion of feces occurs against the background of the development of various diseases. True ecopresis is diagnosed for pathologies and abnormalities of intestinal development. It is necessary to undergo an examination to exclude or confirm diseases such as celiac disease, ulcerative colitis, Hirschsprung's disease and diabetes mellitus. With fecal incontinence, there may also be disturbances in the development of the brain and injuries to the colon mucosa. In some cases, neurotic diseases are added to organic pathologies. To obtain positive dynamics in treatment, several doctors from different fields of medicine must deal with the correction of the condition.

The cause of false encopresis is chronic constipation and damage to the rectum. Subsequently, pain leads to fear of defecation. It may also be the other way around: the patient restrains the urge to have a bowel movement, which leads to the development of constipation. As a result, the muscles that are responsible for keeping feces inside stop working. In adolescents and children, involuntary stool leakage is often triggered by stressful situations at home or at school. Scandals in the family, the death of a loved one greatly hurt the unformed psyche. Most often, with ecopresis, a combination of psychological and physiological problems occurs. If incontinence is associated with fear or embarrassment due to the need to use a public toilet, then the patient may leak feces into his underwear without developing constipation.

Attempts to solve the problem without the participation of doctors often have disastrous results. Parents do not always consider this condition as a disease and scold the child. This provokes the development of psychological problems in children of primary school age and adolescence. If the pathology develops in an adult, then the feeling of discomfort and shame does not allow him to go to the hospital in time.

The causes and possible treatments for fecal incontinence in men and women are almost the same. Many people consider encopresis a disease of old age. But according to WHO, this phenomenon often occurs in adults between the ages of 40 and 60; men suffer more often than women. Conditions accompanied by involuntary passage of feces in adulthood are provoked not only by the reasons mentioned above.

An unbalanced diet, a small amount of fiber in the diet and insufficient fluid intake lead to defecation disorders.

This may manifest as diarrhea or constipation. In addition, hemorrhoids, especially in the acute stage, disrupt the functioning of the sphincter muscles, which provokes the involuntary release of mucus or feces. Anal sex can cause disruption of the recto-anal reflex, which also leads to incontinence. Among the main neurological causes of encopresis are damage to the central nervous system, deliberate ignoring of body signals, and stroke. In old age, diseases such as dementia and Alzheimer's disease are added to these causes. Often older people find themselves isolated without proper care and assistance.

The causes of fecal and gas incontinence in women may be associated with difficult pregnancy and difficult childbirth, which resulted in ruptures in the perianal area. Anal incontinence may appear immediately after childbirth or several years later. The postpartum period is psychologically difficult for a young mother. Often she does not seek help from a doctor, although timely examination will allow her to limit herself to conservative therapy.

Encopresis in childhood

In this category of patients, the root cause of the pathology is usually a psychological factor. Boys are diagnosed with this condition more often than girls. The problem can also exist from infancy. Psychologists say that if parents are too persistent in trying to potty train their child by refusing to use diapers, the baby may begin to hold back the process of bowel movements out of fear and misunderstanding. This will manifest the protective reaction of his body in a stressful environment.

At school age, starting from 8–10 years old, the psychological load increases. If, in addition, an unfavorable environment at home remains, then encopresis can be the result of the manifestation of psychosomatics without any organic abnormalities (encopresis of an inorganic nature has an ICD-10 code F98.1). This way the child is relieved of tension. If cases of fecal incontinence occur only at night, then parents should form the child's habit of defecation in the evening, shortly before bedtime. The psychological mood of the little patient and the timing of treatment depend to a large extent on the attitude of the parents to the problem that has arisen.

Basic treatment approaches

Like many pathological conditions, encopresis requires a comprehensive diagnosis. The first task is to exclude the presence of autoimmune diseases and congenital pathologies that can cause incontinence. An examination by a proctologist is recommended to exclude neoplasms and abnormal growths in the rectum. After a thorough examination, medical history and a series of tests, the therapist or pediatrician will refer you for a consultation with a psychologist and neurologist.

Treatment is carried out at home. Therapy begins with cleansing the intestines of accumulated feces. For these purposes, doctors usually prescribe cleansing and training enemas. Their goal is to cleanse the intestines and cause the formation of a reflex to empty them at the same time. Modern products with a laxative effect, for example, Microlax, are also used. Unlike cleansing enemas, this drug in gel form has a gentle effect on accumulated feces without negatively affecting the intestinal microflora. The drug Duphalac has also proven itself well. What distinguishes it from microlax is its ability to remove toxins from the body. Both products are approved for use in childhood and have virtually no contraindications. However, the dosage and treatment regimen should be determined only by a doctor.

After cleansing procedures, the patient’s clinical manifestations of encopresis disappear. For prevention, maintenance doses of cleansing drugs are prescribed for up to six months. The main requirement throughout the treatment is hygiene. In case of irritation of the perianal area, the use of special hygiene products (moisture-absorbing pads) and creams is recommended.

If the patient has the underlying cause of the disorder described is dementia or other psychopathology, then treatment is carried out with antipsychotic drugs, for example, Eridone. The medicine is available in tablet form and is approved for use in adults and children over 6 years of age.

Traditional medicine methods

In addition to drug therapy, folk remedies are used. To normalize the gastrointestinal tract and psycho-emotional background, valerian or motherwort is prescribed, provided that the patient does not have allergies. Baths using calendula, lavender or sage are recommended. In order to strengthen the sphincter muscles, it is recommended to perform special exercises and gymnastics on a ball.

The methods described above are effective in the initial stages of encopresis and are mainly used to treat children. In adult patients, surgical methods are most often used. If anal incontinence is caused by hemorrhoids, proctologists remove hemorrhoids. The postoperative period should be under the supervision of a surgeon, since unsuccessful operations on the rectum can again lead to fecal incontinence.

In bedridden patients who have suffered a stroke, encopresis is complicated by exacerbation of chronic diseases of the gastrointestinal tract; feces can leak continuously. Not only medications help alleviate the condition, but also physical therapy, which is prescribed by a neurologist. In people suffering from alcoholism, incontinence develops due to the destructive effects of ethanol on the gastrointestinal tract. Alcohol leads to excessively rapid contractions of the intestines, water does not have time to be absorbed, which leads to spontaneous waste of feces.

Prognosis and methods of prevention

It is impossible to cure intestinal pathology without diet and proper drinking regimen. Food should be easily digestible. The diet includes fresh vegetables and salads, dried fruits, and rice, flour products and meat are limited or excluded completely. The body needs 1.5–2.5 liters of water per day. These rules work for both children and adults.

The main prevention of ecopresis in children is a calm environment at home and minimizing stressful situations.

If you go to the hospital in a timely manner, the prognosis for the course of the disease is favorable. It is necessary to monitor your diet, daily routine, do screening examinations and follow the advice of a psychologist. This way the patient will be able to live a full life and forget about encopresis forever. In some cases, when the therapy does not produce an effect for several years, disability is issued.

Fecal incontinence is a condition that invariably has a severe impact on a person’s life, both in social and moral aspects. In long-term care facilities, the prevalence of fecal incontinence among residents is up to 45%. The prevalence of fecal incontinence is similar among men and women, at 7.7 and 8.9%, respectively. This indicator increases in older age groups. Thus, among people 70 years and older it reaches 15.3%. For social reasons, many patients do not seek medical help, which most likely leads to an underestimation of the prevalence of this disorder.

Of primary care patients, 36% report episodes of fecal incontinence, but only 2.7% have a documented diagnosis. Healthcare system costs for patients with fecal incontinence are 55% higher than for other patients. In monetary terms, this translates into an amount equal to US$11 billion per year. In most patients, proper treatment achieves significant success. Early diagnosis helps prevent complications that adversely affect the quality of life of patients.

Causes of fecal incontinence

• Gynecological trauma (childbirth, hysterectomy)
• Severe diarrhea
• Coprostasis
• Congenital anorectal anomalies
• Anorectal diseases
• Neurological diseases

The passage of feces provides a mechanism with a complex interaction of anatomical structures and elements that provide sensitivity at the level of the anorectal zone and the pelvic floor muscles. The anal sphincter consists of three parts: the internal anal sphincter, the external anal sphincter and the puborectalis muscle. The internal anal sphincter is a smooth muscle element and provides 70-80% of the pressure in the anal canal at rest. This anatomical formation is under the influence of involuntary nervous tonic impulses, which ensures the closure of the anus during the rest period. Due to the voluntary contraction of the striated muscles, the external anal sphincter serves as additional retention of feces. The puborectalis muscle forms a supportive cuff surrounding the rectum, which further strengthens existing physiological barriers. It remains in a contracted state during the rest period and maintains an anorectal angle of 90°. During defecation, this angle becomes obtuse, thereby creating conditions for the passage of feces. The angle is sharpened by voluntary contraction of the muscle. This helps retain the contents of the rectum. Fecal masses gradually filling the rectum lead to stretching of the organ, a reflex decrease in anorectal resting pressure and the formation of a portion of feces with the participation of the sensitive anoderm. If the urge to defecate appears at an inconvenient time for a person, the activity of the smooth muscles of the rectum, controlled by the sympathetic nervous system, occurs with simultaneous voluntary contraction of the external anal sphincter and puborectal muscle. To shift defecation over time, sufficient compliance of the rectum is required, as the contents move back into the expandable rectum, endowed with a reservoir function, until a more suitable moment for defecation.

Fecal incontinence occurs when the mechanisms that maintain fecal retention are disrupted. This situation of fecal incontinence can occur due to loose stools, weakness of the striated pelvic floor muscles or internal anal sphincter, sensory disturbances, changes in colonic transit time, increased stool volume, and/or decreased cognitive function. Fecal incontinence is divided into the following subcategories: passive incontinence, urge incontinence, and fecal leakage.

Classification of functional fecal incontinence

Risk factors for fecal incontinence

• Elderly age
• Female
• Pregnancy
• Traumatization during childbirth
• Perianal surgical trauma
• Neurological deficits
• Inflammation
• Haemorrhoids
• Pelvic organ prolapse
• Congenital malformations of the anorectal area
• Obesity
• Condition after bariatric surgery
• Limited mobility
• Urinary incontinence
• Smoking
• Chronic obstructive pulmonary disease

Many factors contribute to the development of fecal incontinence. These include loose stool consistency, female gender, old age, and multiple births. The greatest importance is given to diarrhea. Urgency to stool is the main risk factor. With age, the likelihood of fecal incontinence increases, mainly due to weakening of the pelvic floor muscles and decreased anal tone at rest. Childbirth is often accompanied by damage to the sphincters as a result of trauma. Fecal incontinence and surgical delivery or traumatic birth through the birth canal are certainly interrelated, but there is no evidence in the literature of the advantage of cesarean section over non-traumatic natural birth in terms of preserving the pelvic floor and ensuring normal fecal continence.

Obesity is one of the risk factors for NC. Bariatric surgery is considered an effective treatment for advanced obesity, but after surgery, patients often experience fecal incontinence due to changes in stool consistency.

In relatively young women, fecal incontinence is clearly associated with functional bowel disorders, including IBS. The causes of fecal incontinence are numerous, and they sometimes overlap. Sphincter damage may go unnoticed for many years until age-related or hormonal changes, such as muscle atrophy and atrophy of other tissues, disrupt established compensation.

Clinical examination of fecal incontinence

Patients are often embarrassed to admit incontinence and complain only of diarrhea.

In identifying the causes of fecal incontinence and making the correct diagnosis, one cannot do without a detailed history and a targeted rectal examination. The medical history must necessarily reflect an analysis of the drug therapy being carried out at the time of treatment, as well as the characteristics of the patient’s diet: both can affect the consistency and frequency of stool. It is very useful for the patient to keep a diary recording everything related to the stool. These include the number of episodes of urinary incontinence, the nature of incontinence (gas, loose or hard stools), the volume of involuntary passage, the ability to feel the passage of stool, the presence or absence of urgency, straining and sensations associated with constipation.

A comprehensive physical examination includes examining the perineum for excess moisture, irritation, fecal matter, anal asymmetry, fissures, and excessive sphincter relaxation. It is necessary to check the anal reflex (contraction of the external sphincter to a prick in the perineal area) and make sure that the sensitivity of the perineal area is not impaired; note prolapse of the pelvic floor, bulging or prolapse of the rectum when straining, the presence of prolapsed and thrombosed hemorrhoids. Rectal examination is crucial to identify anatomical features. Very severe cutting pain indicates acute damage to the mucous membrane, for example, an acute or chronic fissure, ulceration or inflammatory process. A decrease or sharp increase in anal tone at rest and during straining indicates a pathology of the pelvic floor. During a neurological examination, attention should be paid to the preservation of cognitive functions, muscle strength and gait.

Instrumental studies of fecal incontinence

Endoanal ultrasound is used to assess the integrity of the anal sphincters, and anorectal manometry and electrophysiology may also be used if available.

There is no specific list of studies that should be carried out. The attending physician will have to weigh the negative aspects and benefits of the study, the cost, the overall burden on the patient with the ability to prescribe empirical treatment. The patient's ability to tolerate the procedure, the presence of concomitant diseases, and the level of diagnostic value of what is planned to be done should be taken into account. Diagnostic studies should be aimed at identifying the following conditions:

1. possible damage to the sphincters;
2. overflow incontinence;
3. pelvic floor dysfunction;
4. accelerated passage through the colon;
5. significant discrepancy between anamnestic data and the results of a physical examination;
6. exclusion of other possible causes of NK.

The standard test to check the integrity of the sphincters is endoanal sonography. It shows very high resolution when examining the internal sphincter, but with respect to the external sphincter the results are more modest. MRI of the anal sphincter provides greater spatial resolution and is therefore superior to the ultrasound method, both for the internal and external sphincters.

Anorectal manometry allows one to obtain a quantitative assessment of the function of both sphincters, rectal sensitivity and wall compliance. With fecal incontinence, pressure at rest and during contraction is usually reduced, which allows us to judge the weakness of the internal and external sphincters. In the case where the results obtained are normal, one can think about other mechanisms underlying NK, including loose stools, the appearance of conditions for fecal leakage and sensory disturbances. The rectal balloon test is designed to determine rectal sensitivity and elasticity of the organ walls by assessing sensory-motor responses to an increase in the volume of air or water pumped into the balloon. In patients with fecal incontinence, sensitivity may be normal, weakened or enhanced.

Carrying out a test with expulsion of a balloon from the rectum involves the test subject pushing out a balloon filled with water while sitting on a toilet seat. Expulsion within 60 seconds is considered normal. This test is usually used in a screening examination of patients suffering from chronic constipation to identify pelvic floor dyssynergia.

Standard defecography allows for dynamic visualization of the pelvic floor and detection of rectal prolapse and rectocele. Barium paste is injected into the rectosigmoid colon and then dynamic x-ray anatomy is recorded - the motor activity of the pelvic floor - of the patient at rest and during coughing, contraction of the anal sphincter and straining. The defecography method, however, is not standardized, so each institution performs it differently, and the study is not available everywhere. The only reliable method for visualizing the entire anatomy of the pelvic floor, as well as the anal sphincter area, without exposure to radiation is dynamic pelvic MRI.

Anal electromyography allows us to identify sphincter denervation, myopathic changes, neurogenic disorders and other pathological processes of mixed origin. The integrity of the connections between the endings of the pudendal nerve and the anal sphincter is checked by recording the terminal motor latency of the pudendal nerve. This helps determine whether sphincter weakness is due to damage to the pudendal nerve, a disruption in the integrity of the sphincter, or both. Due to the lack of sufficient experience and lack of information that could prove the high significance of this method for clinical practice, the American Gastroenterological Association opposes the routine determination of terminal motor latency of the pudendal nerve during the examination of patients with NK.

Sometimes stool analysis and determination of intestinal transit time help to understand the reasons underlying diarrhea or constipation. To identify pathological conditions that aggravate the situation with fecal incontinence (inflammatory bowel disease, celiac disease, microscopic colitis), an endoscopic examination is performed. It is always necessary to understand the cause, as this determines treatment tactics and ultimately improves clinical results.

Treatment of fecal incontinence

Often very difficult. Diarrhea is controlled with loperamide, diphenoxylate, or codeine phosphate. Exercises for the pelvic floor muscles, and in the presence of defects of the anal sphincter, improvement can be achieved after sphincter restoration operations.

Initial treatment approaches for all types of fecal incontinence are the same. They involve changes in habits aimed at achieving stool consistency, eliminating defecation disorders and ensuring access to the toilet.

Lifestyle change

Medicines and diet changes

Older people usually take numerous medications. It is known that one of the most common side effects of medications is diarrhea. First of all, you should review what the person is being treated with that can trigger NK, including over-the-counter herbs and vitamins. It is also necessary to determine whether there are components in the patient’s diet that aggravate the symptoms. This includes, in particular, sweeteners, excess fructose, fructans and galactans, and caffeine. A diet rich in dietary fiber may improve stool consistency and reduce the incidence of urticaria.

Container type absorbents and accessories

Not many materials have been developed to absorb feces. Patients tell how they get out of the situation with the help of tampons, pads and diapers - everything that was originally invented to absorb urine and menstrual flow. The use of pads in cases of fecal incontinence is associated with the spread of odor and skin irritation. Anal tampons come in different styles and sizes and are designed to block the leakage of stool before it happens. They are poorly tolerated, which limits their usefulness.

Toilet accessibility and “gut training”

Fecal incontinence is often a problem for people with limited mobility, especially the elderly and psychiatric patients. Possible measures: visiting the toilet on a schedule; making changes to the interior of the house to make visiting the toilet more convenient, including moving the patient’s sleeping place closer to the toilet; location of the toilet seat directly next to the bed; Place special accessories in such a way that they are always at hand. Physiotherapy and exercise therapy can improve a person's motor function and, due to greater mobility, make it easier for him to access the toilet, but, apparently, the number of episodes of fecal incontinence does not change from this, at least it should be noted that the results of studies on this topic are contradictory .

Differentiated pharmacotherapy depending on the type of fecal incontinence

Fecal incontinence due to diarrhea

At the first stage, the main efforts should be directed to changing the consistency of the stool, since formed stool is much easier to control than liquid stool. Adding dietary fiber to your diet usually helps. Pharmacotherapy aimed at slowing bowel movement or stool binding is usually reserved for patients with refractory symptoms that do not respond to milder measures.

Antidiarrheals for fecal incontinence

Patients with IBS-D deserve special attention, since their use of dietary fiber can increase abdominal pain and bloating, which makes them refuse this measure. If there is no improvement, they switch to pharmacotherapy that is more effective for this group of patients, including loperamide, TCAs, probiotics and alosetron.

Fecal incontinence due to constipation

Chronic constipation can lead to distension of the rectum as a result of a persistent tendency towards overcrowding and suppression of sensitivity. Both create conditions for overflow incontinence. This type of incontinence is especially common among older people. In case of overflow incontinence, it is advisable to increase the amount of dietary fiber in the diet as an initial measure, and only then, if necessary, can laxatives be prescribed.

Fecal leakage

Leakage is not the same as NDT. In this case, they mean the passage of a small amount of liquid or soft feces after normal bowel movements. The patient may talk about wetting in the perianal area, changes in the frequency of bowel movements, or symptoms more characteristic of dysfunction of the anal sphincters, which, upon an objective examination of the anorectal area, is not always regarded by the doctor as a violation of physiological functions. Leakage is more common in men with preserved anal sphincter function. It can be explained by hemorrhoids, poor hygiene, anal fistula, rectal prolapse, hypo- or hypersensitivity of the rectum. In patients suffering from leakage, proper diagnosis and treatment of the specific pathology can completely eliminate symptoms. If manifestations still remain, it is recommended to empty the rectal ampulla using an enema or suppositories every day, regardless of the urge to defecate. For enemas, it is better to use plain water, since repeated administration of sodium phosphate or glycerin can damage the mucous membrane and lead to rectal bleeding. The desired time for a regular procedure is the first 30 minutes after eating in order to enhance the normal reflexes characteristic of the colon after eating.

Rectally injectable blocking agents

Several means have been proposed to block the anal sphincter with the formation of an obstacle to the involuntary passage of feces. Among them are silicone, carbon-coated beads and, the newest, dextranomer in hyaluronic acid [(Solesta) Solesta]. A 2010 Cochrane systematic review found that, due to the small number of trials conducted, no clear conclusion could be reached regarding the effectiveness of injectables. Nevertheless, this approach remains the subject of close attention as it is promising and promises the emergence of new drugs that are truly capable of eliminating NK. Side effects include pain, bleeding and, rarely, abscess formation.

Non-pharmacological treatment options

Biofeedback method

The biofeedback method is one of the forms of psychotherapy based on the principle of reinforcement, in which information about a physiological process, which in a normal situation is transmitted at a subconscious level, is visually demonstrated to the patient so that he can influence the process, but already controlling it with his own by will. The essence of what is happening is to monitor the work of the striated muscles of the pelvic floor, so that the patient, taking this into account, voluntarily coordinates the performance of special exercises for strength training. Simultaneously with the development of strength, the ability to separate sensitive signals can be trained. According to the opinion of the majority of specialists dealing with this problem, this method of treatment is suitable for patients with mild to moderate manifestations of the disease, who meet the physiological criteria for dysfunction of the anal sphincters, who are ready for cooperation in work, are well motivated, and are able to put up with a certain severity of the feeling of rectal distension, retaining the ability to voluntarily compress the external sphincter.

Sacral nerve stimulation

Initially invented for the rehabilitation of patients with paraplegia, stimulation of the sacral nerves, instead of its main purpose, as it turned out later, promotes defecation. Later, promising results were obtained with NK. The first reports on this subject indicated the success of this technique in a large percentage of cases, which made sacral nerve stimulation a popular intervention and prompted the rapid development of the method.

Currently, publications have begun to appear on the results of long-term follow-up of patients, but they are much less optimistic and describe a smaller percentage of success. Among elderly patients, the number of postoperative complications reaches 30%. Complications include pain at the implant site, inflammation in the subcutaneous pocket, electrical sensation, and rarely battery displacement or failure, requiring repeat surgery.

Surgery

Surgical treatment is indicated when the cause of fecal incontinence is anatomical changes. Most often, sphincteroplasty is used to restore the sphincter by stitching the defect together with an overlap. After surgery, the edges of the wound often diverge, which significantly prolongs the healing time. Up to 60% of patients report improvement, but the long-term results of lap sphincteroplasty are poor. For patients with an extensive anatomical defect of the sphincter, for whom simple sphincteroplasty is unacceptable, graciloplasty and transposition of the gluteus maximus muscle have been developed. When performing graciloplasty, the gracilis muscle is mobilized, the distal tendon is split in half, and the muscle is enclosed around the anal canal. With dynamic graciloplasty, electrodes are applied to the muscle and connected to a neurostimulator, which is sutured into the abdominal wall, its lower part. Complications include inflammation, problems with stool passage, leg pain, intestinal damage, perineal pain and the formation of anal strictures.

If other options for surgical treatment have been exhausted, the option remains with implantation of an artificial anus. The artificial sphincter is passed around the natural sphincter through the perianal tunnel. The device remains inflated until it is time to defecate. During defecation, the artificial sphincter is deactivated (deflated). In general, a positive effect from the intervention is observed in approximately 47-53% of patients, that is, in those who tolerate the artificial sphincter well. The majority require surgical revision, and in 33% of cases, removal. Complications include inflammatory processes, destruction of the device or its malfunction, chronic pain syndrome and obstruction during the passage of feces. Colostomy or permanent stoma for fecal incontinence is considered an option for patients who have failed or where all other methods have been completely insufficient.

Key aspects of patient management

• Fecal incontinence is actually a disabling disorder that dramatically reduces a person's quality of life.
• For the development of diagnostic and therapeutic tactics, the collection of anamnesis with a detailed elucidation of how the pathology of defecation was formed, and an anorectal examination are crucial.
• Treatment of all types of fecal incontinence begins with analysis and lifestyle correction. The goal is to outline measures aimed at improving stool consistency, coordinating bowel dysfunction, and ensuring toilet accessibility.
• Intrarectal occlusive agents and sacral nerve stimulation have been shown to reduce the number of incontinence episodes.
• Surgical interventions should be reserved for those rare cases that do not respond to conservative treatment methods, in particular for patients with obvious anatomical defects.

Fecal incontinence is not an independent disease. The causes of such a symptom can be many serious diseases, in which successful treatment is closely related to early diagnosis. According to statistics, men are much more likely to become hostages of this problem. However, women are also not immune from the occurrence of a pathological process.

Features of fecal incontinence

According to medical terminology, fecal incontinence is called encopresis or incontinence. For certain reasons, a woman ceases to control the process of defecation, which explains incontinence. Quite often, along with this symptom, another symptom occurs - urinary incontinence. This phenomenon is explained simply: the nerve centers responsible for controlling the two processes are very similar in nature, which means that the same reason can cause both ailments. Most often, the problem occurs in the age range from 45 to 60 years. Fecal incontinence is not directly related to age-related changes in the body, so such manifestations cannot be attributed solely to old age.

The act of defecation is a joint work of muscles and nerve endings located in the sphincter and rectum. Their uninterrupted functioning ensures the exit of feces or its retention. At the moment of retention of feces in the rectum, the entire section is under tension. Intestinal tone is maintained by the pelvic floor muscles. Thus, to perform the act of defecation or, conversely, to prevent it, many elements of the body are simultaneously involved. And when one of them fails, the development of a disease begins. Disturbances in bowel movement may be caused by the following conditions:

• loss of the defecation reflex due to the influence of external or internal factors of an unfavorable environment;
• reduction in the rate of formation of the necessary reflex.

It is extremely rare to encounter a congenital pathology in which reflexes predisposing to defecation are completely absent. But at the same time, the moment of fecal incontinence is present from birth. Loss of control over bowel movements is divided into three different degrees of severity. The first, most harmless, characterizes incontinence of intestinal gases. However, there are no serious problems with defecation. The second degree of severity reflects the inability to contain unformed feces. The third degree, the most severe, is noted if the patient cannot control the release of formed feces.

Causes of fecal incontinence in women

It is worth noting that fecal incontinence can occur in different ways: the release of feces, formed or not, occurs constantly, without preliminary characteristic urges; uncontrolled release of feces occurs immediately after the urge to defecate; Fecal incontinence occurs when pressure in the rectum changes during sneezing, coughing, or physical stress. Each of these options for fecal incontinence is preceded by some reason. For the most part, the main culprits in the development of pathology are:

• Weakening of the muscles of the external and internal sphincters - loss of muscle strength leads to the fact that keeping the anus closed and at the same time preventing the passage of stool becomes an extremely difficult task. Muscle damage in this area can be caused by surgical interventions or mechanical injuries;
• Diarrhea. The rectum fills with unformed stool much faster. Unlike solid stool, retaining liquid stool is much more difficult. In this case, quite often fecal incontinence occurs under conditions of short-term stress;

• Constipation. One of the most common reasons is characterized by excessive hardening of stool and bowel movements less than three times a week. Accumulated stool can cause sphincter muscles to stretch, causing them to become weaker. Otherwise, hard stool may become stuck in the rectum, and liquid stool will leak through it.
• Loss of elasticity of the rectum, decreased muscle tone. When the urge to defecate is not possible to go to the toilet, holding back the stool, the rectum has the ability to stretch. This is a normal reaction, due to which the intensity of the desire to immediately defecate decreases. If the intestine loses its elasticity due to surgery, radiation therapy or inflammatory diseases, then the ability to stretch may disappear altogether. This course of events increases the risk of uncontrolled excretion of feces.
• Dysfunction of the muscles and nerve endings of the pelvic floor. The development of this pathology may be preceded by: weakening of the pelvic floor and, as a result, its sagging, prolapse of the rectum, weakening of the pelvic floor muscles that are directly involved in the process of defecation, and a decrease in the level of sensitivity of the rectum.

• External hemorrhoids, which are characterized by the formation of specific nodes around the anus. Fecal incontinence may occur due to the inability to fully compress the anus.
• Postpartum pelvic floor disorder. A reason unique to women. The risk of developing uncontrolled release of liquid or solid stool increases when using obstetric forceps during childbirth, as well as due to surgical incision of the vagina. The latter procedure prevents traumatic brain injuries in the newborn, and prevents arbitrary ruptures in the mother.

• Disorders of the central nervous system. Various diseases, stroke, childbirth, trauma, as well as prolonged neglect of the need to go to the toilet can provoke a malfunction in the functioning of the central nervous system. In this case, the nerve endings lose the ability to respond in a timely manner to a particular process. As a result, the woman may not feel the urge to defecate or may lose the ability to relax and contract both sphincters. After birth complications, central nervous system disorders occupy second place among the factors causing fecal incontinence in women.

Comprehensive pathology diagnostics

At the first visit to a medical institution, the doctor collects an anamnesis to begin drawing up a general clinical picture. First of all, he finds out the details of the manifestation of the symptom: under what conditions does uncontrolled stool discharge occur, the consistency of stool, does the patient feel the need to visit the toilet or not, are there other complaints, any chronic diseases, etc. At the discretion of the doctor, the following may be prescribed diagnostic procedures:

• general and biochemical blood tests;
• ultrasound examination of the pelvic organs, rectum;
• anal manometry - allows you to analyze the tone of the anal sphincters;
• balloon sphincterogram - an x-ray study that also makes it possible to evaluate the functioning of the sphincters;
• assessment of rectal sensitivity - depending on the level of the obtained indicator, the doctor makes a conclusion about the presence or absence of a timely urge to defecate.

If abnormalities in the functioning of the central nervous system are suspected, the proctologist can give a referral to a neurologist. During a personal conversation, a highly specialized specialist has the right to recommend undergoing a number of studies that will certainly help determine the diagnosis. Based on the results of the research, the attending physician prescribes the most optimal treatment, which will not only eliminate the unpleasant symptom, but will also effectively combat the underlying pathology.

Treatment of fecal incontinence in women

Drug treatment is most effective if the cause of fecal incontinence is diarrhea. In this case, to normalize the process of defecation, the following may be prescribed: Imodium or Loperamide - reduce intestinal motility and increase intestinal tone; Kaopectate or Activated Carbon - reduces the fluid content in stool. Prozerin in subcutaneous injections can restore neuromuscular conduction, and Strychnine is prescribed to stimulate sensitivity. For nervous system disorders, a neurologist may prescribe tranquilizers, sedatives, B vitamins and other drugs. The list of possible medications is very long, since there are also many reasons that can cause fecal incontinence.

If there is a specific sphincter defect or due to trauma, surgery may be required to relieve the symptom. The doctor chooses a certain type of operation based on the size of the damage and its location:

• sphincteroplasty - it is advisable only if no more than a quarter of the sphincter is damaged. After a successful plastic surgery, the rehabilitation period can range from 2 months to six months;
• sphincterogluteoplasty - in comparison with the previous option, it is a more complex operation, which is performed in case of serious violations of the integrity of the sphincter. A portion of the gluteus maximus muscle is used to reconstruct the anal ring. The prognosis is usually good, but the rehabilitation period also takes several months;
• post-anal reconstruction - used for functional disorders not accompanied by sphincter damage.

A few years earlier, the Thiersch operation and the Faerman operation were used as therapeutic methods. The first involves the use of silver wire to narrow the lumen of the rectum, the other involves the use of the thigh muscle as a plastic material. Both types have not proven their effectiveness, so today surgeons do not practice them. When the functioning of the sphincter is impaired due to a malfunction of the nervous system, plastic surgery does not bring a positive result.

Complex treatment, in addition to medication and surgery, includes nutritional correction and physical therapy. Dietary measures are necessary to normalize the digestion process and eliminate the likelihood of developing diarrhea or constipation. Particular attention should be paid to products containing a large amount of plant fiber: vegetables, fruits, nuts, berries, whole grain pasta and bread, bran, dried fruits and legumes. To speed up the healing process and enhance the positive effect of the chosen treatment, therapeutic physical activity is necessary. To train the anal ring, special exercises have been developed, the regular implementation of which will help improve muscle tone. For example, from 1 to 15 minutes the patient should compress and relax the sphincter. In this case, you can insert a thin rubber tube lubricated with Vaseline into the anus.

In the physiotherapy room, you can conduct several sessions of electrical stimulation, which has a corresponding effect on the nerve centers responsible for the urge and the process of defecation itself. Several sessions of acupuncture will help get rid of fecal incontinence if the main cause is excessive nervousness and stress. In the latter case, psychotherapeutic methods are also successfully used. Psychotherapy is effective only in cases where there are no organic changes in the sphincters and rectum.

With early diagnosis of diseases that have become the main cause of fecal incontinence in women, in most cases a complete recovery is recorded. The prognosis is considered unfavorable for serious mental disorders and strokes. Therefore, it is very important to seek medical help in a timely manner and not rely on the effectiveness of self-medication at home. Fecal incontinence is an extremely unpleasant symptom, but you should not shut yourself off from the outside world when it appears. The sooner the doctor determines the diagnosis and prescribes proper treatment, the sooner the patient will return to her normal life.

Encopresis, or in other words, fecal incontinence, is the spontaneous release of feces from the anus.

This problem can affect any person, regardless of his gender and position in society.

Encopresis does not pose a threat to life or health, but makes its quality significantly worse.

People affected by this problem can become outcasts in society, and sometimes even in their own family.

Causes of fecal incontinence in the elderly

All the reasons that lead to the occurrence of the disease can be divided into:

1. Organic;
2. Psychological.

Organic causes of fecal incontinence include:

Anorectal diseases

Hemorrhoids

Due to the fact that hemorrhoids are located too close to the anus, it cannot be completely blocked.

A small amount of loose stool or mucus may leak through this opening.

Constipation

This simple phenomenon can also cause incontinence.

You especially need to be wary of chronic constipation, since a large amount of hard feces accumulates in the rectum and muscle strain occurs.

Because of this, the sphincter ceases to cope with its functions. Solid feces, of course, will not come out, but liquid feces can easily flow down the walls.

Diarrhea

It is very difficult to retain liquid feces even for young people, let alone for older people.

Sphincter muscle weakness

Fecal incontinence occurs due to injury to the sphincter. Most often this happens after rolls.

Decreased rectal muscle tone

Under normal conditions, the rectum is elastic and can handle any amount of stool. If various inflammatory processes occur in it, then it loses this feature.

In addition, due to surgical diseases, scars may occur, which can also affect fecal retention.

Dysfunctional pelvic floor disorder

This reason may include:

• Rectal prolapse;
• Decreased muscle tone;
• Sagging of the pelvic floor.

Psychological reasons include:

1. There is no reflex that is responsible for defecation;
2. Various .

Types of fecal incontinence in older people

• Feces are constantly excreted regardless of the urge to defecate;
• Feces are released during the urge;
• Incontinence occurs during exercise or coughing.
• Feces are released involuntarily due to age-related changes in the body.

Fecal incontinence in older men occurs mainly due to nervous pathologies.

Fecal matter is passed during sleep or during strong emotions. To decide on treatment, it is necessary to accurately determine the type of disease.

Video: Training the intimate muscles of the pelvic floor, Kegel exercises

Treatment of stool incontinence

At the first stage of treatment, it is necessary to establish normal functioning of the gastrointestinal tract.

The patient must be prescribed a diet that clearly states how much and what foods to eat per day.

After normalization of the digestive system, the doctor prescribes furazolidone and imodium.

In order for the treatment to give a positive result, it is necessary, in parallel with drug treatment, to perform special exercises to train the pelvic muscles.

Thanks to simple exercises, you can restore the normal activity of the sphincter and the anal apparatus as a whole.

In case of serious damage to the anus, the patient is prescribed surgical intervention.

There is also a conservative treatment method. During it, the patient undergoes a course of medication, gentle exercises and electrical stimulation.

Diet

Due to the characteristics of each person’s body, it is impossible to select a specific list of products that will help get rid of this problem.

Therefore, the attending physician prescribes an individual diet for each patient.

Most often, products containing plant fiber are prescribed. Thanks to fiber, stool becomes larger, softer and easier to manage.

What to exclude from your daily diet:

1. Any dairy products;
2. Coffee sweets and drinks;
3. I eat salty, spicy and fried foods;
4. All smoked products;
5. Hard fruits and vegetables;
6. Alcoholic drinks.

People who suffer from fecal incontinence need to drink as much water as possible. Every day you need to drink at least 2 liters of water. Tea and juices are not included in this amount.

If the body does not absorb vitamins and minerals through natural products, then it is necessary to use special vitamin complexes.

Pelvic floor muscle training

If the pelvic muscles are toned, then this is the key to good intestinal function.

To begin such activities, it is necessary to find out the true causes of fecal incontinence.

These trainings involve the patient independently contracting the pelvic muscles 50-100 times.

To achieve the desired result, you need to systematically perform such exercises for 3 months.

Electrical stimulation

During such procedures, a special device is inserted under the skin, which delivers electrical impulses.

The electrodes of this device must be placed on the nerve endings of the rectum. Thanks to the impulses, the process of defecation is normalized.

Surgical intervention

This method is used only if all of the above are not beneficial.

Assessing the condition of each patient, the doctor individually selects the method of surgical intervention.

1. Sphincteroplasty. This type of intervention is selected if involuntary fecal excretion occurs due to a violation of the integrity of the sphincter. During the operation, all muscles are reconnected and normal bowel movements are resumed.
2. Transposition of muscles. It is used if the previous type of operation could not eradicate the problem.
3. Colostomy is used for pelvic floor injuries. During such an operation, part of the rectum is brought out into the abdominal cavity, through which bowel movements will subsequently be carried out.
4. Implantation of an artificial sphincter is a modern type of surgical intervention. A special rubber cuff is placed near the anus, and a pump is built into the rectum itself, which is activated by a person from the outside. When he needs to go to the toilet, he uses a pump to relax the cuff and then tighten it again.

Conclusion

No one is immune from the problem of fecal incontinence, but with the help of modern medicine you can get rid of it.

Video: Fecal incontinence in the elderly

Fecal incontinence (or encopresis) is a disorder in which the ability to control bowel movements is lost. Fecal incontinence, the symptoms of which are mainly observed in children, manifests itself in adults, as a rule, is associated with the relevance of a particular pathology of an organic scale (tumor formations, injuries, etc.).

general description

Fecal incontinence, as we noted, is understood as a loss of control over the process related to bowel movement, which, accordingly, indicates an inability to delay bowel movements until it becomes possible to visit the toilet for this purpose. Fecal incontinence is also considered an option in which involuntary leakage of feces (liquid or solid) occurs, which, for example, can occur during the passage of gases.

In almost 70% of cases, fecal incontinence is a symptom (disorder) that occurs in children from 5 years of age. Often its occurrence is preceded by stool retention (hereinafter, stool is an interchangeable synonym for the definition of “feces”).
As for the predominant gender in terms of the development of encopresis, the disease is more often observed in males (with an approximate ratio of 1.5:1). When considering adult statistics, this disease, as already noted, also cannot be excluded.

There is an opinion that fecal incontinence is a disorder common in old age. It, despite some common facets, is not correct. At the moment, there are no facts that would indicate that all older people, without exception, lose the ability to control the excretion of feces through the rectum. Many people believe that fecal incontinence is a disease of old age, but in reality the situation looks somewhat different. So, about half of the patients, if you look at certain statistical data on this matter, are middle-aged people, and this age, accordingly, ranges from 45 to 60 years.

Meanwhile, this disease is also related to old age. So, it is this reason, following dementia, that becomes the second most important in that elderly patients adhere to social isolation, which is why fecal incontinence in the elderly is a specific problem classified as age-related problems. In general, regardless of age, the disease, as can be understood, negatively affects the quality of life of patients, leading not only to social isolation, but also to depression. Due to fecal incontinence, sexual desire is also subject to changes, against the background of the overall picture of the disease, depending on each aspect, this picture is a component, problems arise in the family, conflicts, divorces.

Defecation: principle of operation

Before we move on to consider the characteristics of the disease, let us dwell on how the intestines control bowel movements, that is, how it occurs at the level of physiological characteristics.

The control of bowel movements is carried out through the coordinated functioning of nerve endings and muscles concentrated in the rectum and anus; this occurs through a delay in the release of feces or, conversely, through its exit. Fecal retention is ensured by the final section in the large intestine, that is, by the rectum, which must be in a certain tension for this.

By the time it reaches the final section, feces generally already have sufficient density. The sphincter, based on a circular type of muscle, is in a tightly compressed state, thus it provides a tight ring in the final part of the rectum, which is the anus. They remain in a compressed state until the feces are prepared for release, which, accordingly, occurs as part of the act of defecation. The pelvic floor muscles maintain intestinal tone.

Let us dwell on the features of the sphincter, which plays an important role in the disorder we are considering. The pressure in its area is on average about 80 mm Hg. Art., although options in the range of 50-120 mm Hg are considered as the norm. Art.

This pressure in men is higher than in women, over time it undergoes changes (decrease), which, meanwhile, does not cause patients to develop a problem directly related to fecal incontinence (unless, of course, there are no factors that cause this pathology provoking). The anal sphincter is constantly in good shape (both during the day and during night rest), and does not show electrical activity during defecation. It should be noted that the anal internal sphincter acts as a continuation of the circular smooth muscle layer in the rectum, for this reason it is controlled by the autonomic nervous system and is not subject to conscious (or voluntary) control.

Stimulation of an adequate act of defecation occurs due to irritation exerted on the mechanoreceptors in the wall of the rectum, which occurs as a result of the accumulation of feces in its ampulla (preliminary entry from the sigmoid colon). The response to such irritation is the need to adopt an appropriate position (sitting; squatting). With simultaneous contraction of the muscles of the abdominal wall and closure of the glottis (which determines the so-called Valsalva reflex), intra-abdominal pressure increases. This, in turn, is accompanied by inhibition of segmental contractions on the part of the rectum, which ensures the movement of feces in the direction of the rectum.

The previously noted muscles of the pelvic floor are subject to relaxation, which causes its prolapse. The sacrorectalis and puborectalis muscles, when relaxed, open the anorectal angle. Being irritated by feces, the rectum provokes relaxation of the internal sphincter and external sphincter areas, resulting in the release of feces.

Of course, there are situations in which defecation is undesirable, impossible for certain reasons, or inappropriate, which is why this is initially taken into account in the defecation mechanism. In the above cases, the following occurs: the external sphincter and puborectal muscles begin to voluntarily contract, which leads to the closure of the anorectal angle, the anal canal begins to compress tightly, thereby ensuring the closure of the rectum (exit from it). In turn, the rectum, in which feces are located, undergoes expansion, which becomes possible by reducing the degree of tension in the walls, and the urge to defecate, accordingly, passes.

Causes of fecal incontinence

The impact on the mechanism of defecation determines the principles of manifestation of the disorder we are interested in; accordingly, for this reason, we should dwell in more detail on the reasons that provoke it. These include:

• diarrhea;
• muscle weakness, muscle damage;
• nerve failure;
• decreased muscle tone in the rectal area;
• dysfunctional pelvic floor disorder;

Let us dwell in more detail on the listed reasons.

Constipation. Constipation specifically refers to a condition that is accompanied by fewer than three bowel movements per week. The result of this, accordingly, may be fecal incontinence. In some cases, during constipation, a significant volume of hardened feces forms and subsequently gets stuck in the rectum. At the same time, there may be an accumulation of watery stool that begins to leak through the hard stool. If constipation continues for a significant period of time, it can cause the sphincter muscles to stretch and weaken, which in turn results in a decrease in the holding capacity of the rectum.

Diarrhea. Diarrhea can also cause the patient to develop fecal incontinence. Filling of the rectum with liquid stool occurs much faster, but retaining it is accompanied by considerable difficulties (compared to hard stool).

Muscle weakness, muscle damage. If the muscles of one of the sphincters (or both sphincters, external and internal) are damaged, fecal incontinence may develop. When the muscles of the internal and/or external anal sphincter are weakened or damaged, their inherent strength is lost. As a result, keeping the anus closed while preventing stool leakage becomes much more difficult or impossible. The main reasons contributing to the development of muscle weakness or muscle damage include trauma in the specified area, surgery (for example, for hemorrhoids or cancer), etc.

Nerve failure. If the nerves that control the muscles of the internal and external sphincters do not work correctly, the possibility of them compressing and relaxing accordingly is excluded. In the same way, a situation is considered in which the nerve endings that respond to the degree of concentration of feces in the rectum begin to function in a disrupted mode, due to which the patient does not feel the need to visit the toilet. Both options indicate, as is clear, the failure of the nerves, against the background of which, in turn, fecal incontinence can also develop. The main sources that provoke such incorrect functioning of the nerves are understood as the following variants: childbirth, stroke, diseases and injuries that affect the activity of the central nervous system (central nervous system), the habit of ignoring body signals for a long time indicating the need for defecation, etc.

Decreased muscle tone in the rectal area. In a normal (healthy) state, the rectum can, as we discussed in the description of the section on the mechanism of defecation, stretch, and thereby retain feces until the moment at which defecation becomes possible. Meanwhile, certain factors can cause scars to appear on the wall of the rectum, as a result of which it loses its inherent elasticity. Such factors can be considered various types of surgical interventions (rectal area), intestinal diseases accompanied by characteristic inflammation (ulcerative colitis, Crohn's disease), radiation therapy, etc. Accordingly, based on the relevance of such an effect, we can say that the rectum loses the ability to adequately stretch its muscles while simultaneously holding stool, which, in turn, provokes an increase in the risk associated with the development of fecal incontinence.

Dysfunctional pelvic floor disorder. If the nerves or muscles in the pelvic floor are not functioning properly, fecal incontinence may develop. This, in turn, may be facilitated by certain factors. In particular these are:

• decreased sensitivity of the rectal area to the feces filling it;
• reduced compressive ability of muscles directly involved in bowel movements;
• rectocele (a pathology in which the wall of the rectum protrudes into the vagina), rectal prolapse;
• functional relaxation of the pelvic floor, as a result of which it becomes weak and tends to sag.

In addition, pelvic floor dysfunction often develops after childbirth. The risk is especially increased if obstetric forceps were used during labor (they make it possible to remove the baby). An equally significant degree of risk is assigned to the episiotomy procedure, in which surgical dissection of the perineum is performed as a measure to prevent the formation of arbitrary forms of vaginal ruptures in the woman in labor, as well as the child receiving a traumatic brain injury. In such cases, fecal incontinence in women appears either immediately after delivery, or several years after that.

Haemorrhoids. With external hemorrhoids, which develop in the area of ​​skin surrounding the anus, the actual pathological process can act as a reason that does not allow the sphincter muscles to completely close the anus. As a result, a certain amount of mucus or liquid feces may begin to leak through it.

Fecal incontinence: types

Fecal incontinence, depending on age, is determined by differences in the nature of its occurrence and types of disorder. So, based on the features we have already discussed, we can highlight that incontinence can manifest itself in the following ways:

• regular passage of stool without the accompanying urge to defecate;
• fecal incontinence with a preliminary urge to defecate;
• partial manifestation of fecal incontinence that occurs under certain stress (physical activity, straining when coughing, sneezing, etc.);
• Fecal incontinence, which occurs against the background of the effects of degenerative processes associated with the aging of the body.

Fecal incontinence in children: symptoms

Fecal incontinence consists in this case in the unconscious excretion of feces by a child aged 4 years and older, or in his inability to retain feces until such conditions arise in which defecation becomes acceptable. It should be noted that until a child reaches the age of 4 years, fecal incontinence (including urinary incontinence) is absolutely normal, despite certain inconveniences and stress that may accompany it. The point in particular lies in this case in the gradual acquisition of skills relating to the excretory system as a whole.

Symptoms of fecal incontinence in children are also often observed against the background of previous constipation, the nature of which we generally discussed above. In some cases, the cause of constipation in children during the first years of their life is excessive insistence on the part of parents in terms of potty training the child. Some children have a problem with insufficient contractile function of the intestines.

The relevance of a mental disorder accompanying fecal incontinence can be considered in frequent cases when bowel movements are in the wrong place (the discharge has a normal consistency). In some cases, fecal incontinence is associated with problems associated with impaired development of the child's nervous system, including his inability to maintain attention, impaired coordination, hyperactivity and easy distractibility.

A separate case considers the occurrence of this disorder in children from disadvantaged families, in which parents do not instill in them the required skills in a timely manner and, in general, do not devote enough time. This may be accompanied by the fact that children, faced with the persistence of this disorder, simply do not recognize the characteristic odor of feces and do not react in any way to the fact that it leaves.

Encopresis in children can be primary or secondary. Primary encopresis is associated with the child’s virtual lack of defecation skills, while secondary encopresis appears suddenly, mainly against the background of previous stress (the birth of another child, conflicts in the family, parental divorce, starting to attend kindergarten or school, change of place of residence and etc.). The peculiarity of secondary fecal incontinence is that this disorder occurs with previously acquired practical skills for defecation and the ability to control them.

Most often, fecal incontinence occurs during the daytime. When it occurs at night, the prognosis is less favorable. In some cases, fecal incontinence may be accompanied by urinary incontinence (enuresis). Somewhat less often, intestinal diseases relevant to the child are considered as a cause of fecal incontinence.

Often the problem of incontinence in children arises from deliberately holding stool before. In this case, the reasons for fecal retention can be considered, for example, the occurrence of unpleasant emotions when learning to use the toilet, or the embarrassment that arises when it is necessary to use a public toilet. Also, the reasons may be that children do not want to interrupt the game or experience fear associated with the possible occurrence of discomfort or pain during bowel movements.

Fecal incontinence, the symptoms of which are primarily based on the act of defecation in places inappropriate for this, is accompanied by voluntary or involuntary release of excrement (on the floor, into clothes or into the bed). In terms of frequency, such bowel movements occur at least once a month, for a period of at least six months.

An important point in the treatment of children is the psychological aspect of the problem; it is with psychological rehabilitation that treatment should begin. It consists, first of all, in explaining to the child that the problem happening to him is not his fault. Naturally, in relation to the child against the background of the existing problem of fecal incontinence, in no case should there be intimidation or ridicule, or any humiliating comparisons on the part of the parents.

This may seem strange, but the listed approaches from parents are not uncommon. Everything that happens to a child causes them not only a certain discomfort, but also irritation, which spills out in one form or another onto the child. It should be remembered that this approach only aggravates the situation in which, we repeat, the child is not to blame. Moreover, due to this, there is a risk of the child developing a number of psychological problems in the near future, of varying degrees of severity and the controversial possibility of their correction and complete elimination. Taking this into account, it is important for parents not only to focus on solving the child’s problem, but also to do some work on themselves in terms of restraint, accepting the situation and finding a solution to it. The child needs help, support and encouragement; only through this can any treatment achieve appropriate effectiveness with minimal losses.

Behavioral treatment of fecal incontinence in a child involves the following principles:

• The child should be seated on the potty for 5-10 minutes every time after eating. Due to this, the reflex activity of the intestines is enhanced, the child learns to monitor the urge to defecate that arises in his own body.
• If it has been noticed that feces are “missed” at a certain time during the day, you should put him on the potty several times before such “skips”.
• Again, reassurance is important. You should not put him in a potty against his will. Children aged 4 years, as a rule, react positively to the invention of any games, therefore, with actual encopresis, this approach can be used. So, you can, for example, apply a certain reward scheme that applies when a child agrees to sit on the potty. Accordingly, when excreting feces during such squats, it is advisable to slightly increase the reward.

By the way, the listed options for approaching a child will not only teach the child to acquire adequate toilet skills, but will also determine the possibility of eliminating possible stagnation of feces (constipation).

Diagnosis

When diagnosing a disorder, the doctor takes into account the patient’s medical history, medical examination data and data obtained during diagnostic tests (a survey of important points related to the existing problem). In addition, a number of instrumental diagnostic techniques are used.

• Anorectal manometry. To carry it out, a pressure-sensitive tube is used, the use of which determines the sensitivity of the rectum and the features associated with its functioning. This method also allows you to determine the current compression force on the part of the anal sphincter, the ability to adequately respond to emerging nerve signals.
• MRI (magnetic resonance imaging). Due to the influence of electromagnetic waves, this method allows one to obtain detailed images concerning the studied area, soft tissue muscles (in particular, in case of fecal incontinence, the emphasis in this study is on studying the muscles of the anal sphincters by obtaining such an image).
• Proctography (or defectography). An x-ray examination method that determines the amount of feces that the rectum can contain. In addition, the features of its distribution throughout the rectum are determined, and the features of the effectiveness of the act of defecation are revealed.
• Transrectal ultrasound. The method of ultrasound examination of the rectum and anus is implemented by introducing a special sensor into the anus (transducer). The procedure is absolutely safe, without associated pain.
• Electromyography. A procedure for studying the muscles of the rectum and pelvic floor, aimed at studying the correct functioning of the nerves that control these muscles.
• Sigmoidoscopy. A special flexible tube equipped with a light is inserted into the anus (and then to other lower sections of the colon). Thanks to its use, it is possible to examine the rectum from the inside, which, in turn, determines the possibility of identifying local concomitant causes (tumor formation, inflammatory process, scars, etc.).

Treatment

Treatment of fecal incontinence in adults and children (in addition to the noted items discussed in the corresponding paragraph), depending on the factors causing the disease, is based on the following principles:

• diet adjustments;
• use of drug therapy measures;
• bowel training;
• training the muscles of the pelvic floor (special exercises);
• electrical stimulation;
• surgical intervention.

Each of the points is worked out only on the basis of a visit to a specialist and only in accordance with his specific instructions, based on the results of the research measures being carried out. Let us separately dwell on surgical intervention, which may well be of interest to the reader. This measure is resorted to if improvement does not occur with the implementation of other listed measures, as well as if fecal incontinence is caused by injury to the anal sphincter or pelvic floor area.

The most commonly used method of surgical intervention is considered sphincteroplasty . This method focuses on reuniting sphincter muscles that have been separated due to rupture (for example, during childbirth or injury). This operation is performed by a general surgeon, colorectal surgeon or gynecological surgeon.

There is another method of surgical intervention, which involves placing an inflatable cuff around the anus (“artificial sphincter”) with subcutaneous implantation of a small “pump”. The pump is activated by the patient (this is done to inflate/deflate the cuff). This method is used infrequently and is performed under the supervision of a colorectal surgeon.

Fecal incontinence, as you can understand, can cause a number of problems, ranging from banal embarrassment to deep depression against this background, a feeling of loneliness and fear. Therefore, the implementation of certain practical methods is extremely important to improve the quality of life of patients. The first and main step, of course, is to contact a specialist. It is necessary to cross this barrier, despite possible embarrassment, shame and other emotions, due to which going to a specialist in itself looks like a problem. But the problem itself, which is fecal incontinence, is for the most part solvable, but only if patients do not “drive themselves into a corner” and do not react to everything by giving up and choosing a position of reclusion for themselves.

So, here are some tips that, if you adhere to the actuality of fecal incontinence, you will be able to control this problem in a certain way in conditions that are least conducive to an adequate response to the situation that has arisen:

• when leaving home, visit the toilet, thereby trying to empty your bowels;
• again, when leaving, you should take care of having a change of clothes and materials with which you can quickly fix the “malfunction” (napkins, etc.);
• try to find a toilet in the place you are in before you need it, this will reduce a number of associated inconveniences and quickly get your bearings;
• if there is an assumption that loss of bowel control is a possible situation, then it is better to wear disposable underwear;
• Use tablets that help reduce the intensity of the odor of gas and feces, such tablets are available without a prescription, but it is better to trust the advice of a doctor in this matter.

Rectal prolapse is a disease in which the lower portion of the intestine falls out of the canal as it progresses. The clinical picture of the disease is always very pronounced - there is severe pain, sphincter incontinence, and the appearance of bloody or mucous discharge from the anus. Rectal prolapse is a dangerous condition that requires timely and complete treatment. It is worth noting that the disease has no restrictions regarding gender and age.

Hemorrhoids, the disease that will be discussed in our article today, cannot be called anything other than a delicate problem. Moreover, hemorrhoids, the symptoms of which we will consider today, in many cases patients try to cure on their own, which, unfortunately, in no way favors its course and the consequences that arise due to such an attitude towards it.

Intestinal obstruction is a severe pathological process, which is characterized by a disruption in the process of exiting substances from the intestines. This disease most often affects people who are vegetarians. There are dynamic and mechanical intestinal obstruction. If the first symptoms of the disease are detected, you must go to the surgeon. Only he can accurately prescribe treatment. Without timely medical help, the patient may die.