Fecal incontinence in adults and children: causes and treatment

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2018-03-27 14:23:35

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Fecal Incontinence medicine termed “encopresis”. We are talking about involuntary bowel movement with the release of feces from the anus. Patients suffering from fecal incontinence, not able to consciously manage and control the process of defecation. This problem can touch anyone, regardless of age, gender and status in society. Despite the fact that encopresis is not dangerous to human life, is a pathological phenomenon negatively affects its quality, reflected not only on physical health, but also affecting the emotional side of the patients with this pathology often become outcasts in society.

Physiological characteristics

According to statistics, encopresis most often affects children (mostly boys) under 7 years. Among adults the problem diagnosed in 5 % of patients with a history of pathology of the anus. Often encopresis occurs in women. Cause of fecal incontinence in predominant number of cases be a difficult birth.

The Ability to control natural processes of defecation may be oppressed with age: the disease develops on the background of degenerative processes caused by the inevitable aging. For example, fecal incontinence in elderly persons appears much more often than men and women of Mature age.

As an independent disease, encopresis speak only in the presence of fetal anomalies of formation of the pelvic organs. If no congenital abnormalities it is not, then the inability to control the urge to defecate – not that other, as a sign of disorders that have a physiological or neurogenic nature. In some cases, the problem is combined with urinary incontinence.

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Thanks to the work of a natural mechanism of bowel movement of a healthy person produces regular emptying. The entire process of promoting food, which when passing through the lower parts of the accumulated in the stool, is due to the functioning of the ANS and receptors of the rectum. This gastrointestinal tract consists of the upper and distal gaps (from the sigmoid colon to the anus).

fecal incontinence in children treatment

By Itself, the defecation is partly arbitrary. Control over the bowel movement carries out “the centre of defecation”, which is available in an oblong brain. Due to the downward impact of brain impulses to the spinal division of lumbar-sacral segment, the act of emptying occurs consciously. In the end, the external sphincter relaxes, and the abdominal muscles and diaphragm begin to decline. Normal people capable of managing defecation in situations where it is inappropriate or untimely.

Why develop encopresis

According to the etiology of the cause of fecal incontinence is divided into two categories:

  • Organic;
  • Psychogenic.

The first group includes disorders resulting from injury or suffering a pathology. The second category includes disorders of regulation, a think tank associated with the mechanism of formation of conditioned reflexes on the discharge of feces from the digestive tract.

Organic causes of incontinence of feces most often diagnosed in adult patients. In predominant number of cases, the disease becomes a consequence of:

  • External hemorrhoids;
  • Chronic untreated constipation;
  • Persistent diarrhea;
  • Weakening of the muscles of the anal sphincters;
  • Low sensitivity of the nerve receptors of the anus;
  • Reduced elasticity of the muscles in both the rectum;
  • Disorders of nerves of the pelvic floor.

The Development of encopresis is in close causal connection with one of these violations.

Anorectal pathology

One of the most common causes of encopresis believe hemorrhoids. When the outer form of the disease hemorrhoidal cones are located outside, in close proximity to the entrance of the anus. This location may interfere with the required closure of the anus, resulting in involuntary release of meager amounts of unformed stool or mucus.

Constipation-another problem that if left untreated can lead to various complications, including encores. Difficulty in defecation or prolonged absence of desires also cause involuntary release of feces. The most dangerous think is chronic constipation. When the accumulation of hard feces in large volumes reduced muscle tone, and when you consider that stool when constipation is almost always present in the rectum, dystrophic processes develop very quickly, literally within a few months. The result of sphincter apparatus loses its ability to contract and ceases to cope with its main purpose. And if to retain the solid muscle mass of the lower section in condition, diarrhea may spontaneously drain and stand out through the anus.

fecal incontinence in children

A Similar situation occurs with diarrhea. Due to disorders of the digestive system liquid mass quickly accumulate in the intestine and to retain them requires considerable effort. For anybody not a secret that even a healthy person with diarrheasometimes difficult to get to the restroom, so if unfavorable physiological factors in a patient suddenly can happen the act of emptying.

Weakness of the muscles of the anal sphincters

Damage to muscles one of the elements of the sphincter apparatus can deprive a person of the ability to control your bowel movements. To a greater extent all depends on the severity of the injury: the ability to hold closed the anus and prevent the leakage of liquid faeces may be lost completely or partially. Therefore, the causes of fecal incontinence and the treatment of this disease are in direct relationship.

Damage to the sphincter muscles often happens during childbirth. The risk of such complications is particularly high when dissection of the perineum and its ineffective treatment. Cause of fecal incontinence in women in most cases is bad conduct episiotomy or the use of obstetric forceps to extract the fetus from the womb.

fecal incontinence causes

Wrong with the nerve receptors

In the submucosa of the rectum, in addition to blood and lymphatic vessels, nerve endings are present and intertwined. Once achieved necessary for the implementation of bowel movements, stool bulk, the receptors signal to the brain. Thus, a person consciously controls the anal sphincters.

Until the bowel is not emptied, the nerve endings cease to apply the appropriate impulses to the brain. This, in turn, causes sphincters to contract almost all the time. Relax muscles can only during the act of excretion of stool from the digestive tract. Dysfunction of the submucosal nerve plexus of the man does not feel the urge to defecate, and therefore not able to retain feces or to visit the toilet on time. This violation most often occurs in stroke patients with diabetes and multiple sclerosis.

Inelasticity rectal muscles

In a healthy person, the lower intestine can stretch to hold large volumes of stool until the next emptying. This gut must have a high elasticity. However, inflammatory-anorectal diseases, surgical operations on the intestine or radiation therapy lead to the fact that on the walls of the rectum are formed of rigid scars. Formed scar tissue such a property is not, and therefore the intestinal wall lose their natural elasticity.

Violations within the pelvic floor

These include:

  • A prolapse or protrusion of the walls of the rectum beyond the anus;
  • The low tone of the muscles involved in defecation;
  • Prolapse and prolapse of the pelvic organs.

All of these problems indicate poor bowel function and therefore may cause fecal incontinence in men and women.

Psychosomatic and neurogenic causes

Here we are talking about violations of the regulation of brain centers that are responsible for triggering conditioned reflexes. The starting mechanisms of the disease caused by these reasons is associated with rectoanal inhibitory reflex, which is:

  • Not produced at all or is late;
  • Lost on the background of adverse factors (CNS lesions).

The First mechanism of disease is neurogenic in nature and is always congenital, the second – purchased, and the third occurs because of mental disorders, the list of which is:

  • Mental retardation;
  • Schizophrenia;
  • Depression;
  • Manic obsessive-compulsive disorder;
  • Neurosis;
  • Personality disorders;
  • The strongest emotional turmoil.

The presence of any of the above problems, the chain of neuromuscular transmission is impaired, therefore, a deliberate and controlled act of defecation becomes impossible. These patients may experience incontinence of feces and urine at the same time.

incontinence treatment

Stage encopresis

Fecal Incontinence in women, men and children in medical practice is divided into three degrees. Depending on the stage of disease and determine the most effective treatment option:

  • Grade I – the inability to retain the gases may have a small masana feces.
  • II – the inability to control the act of emptying a liquid chair.
  • Grade III – full incontinence of solid faeces.

In addition, the treatment of encopresis will depend on:

  • Does the patient feel the preliminary urging before stool;
  • If there is a periodic selection of a chair without signals about the emptying;
  • Whether there is fecal incontinence with physical labor, coughing, sneezing.

Diagnosis

The easiest task for a proctologist – diagnosis "incontinence". Women have to find the cause that in the predominant number of cases, lies in the consequences of a difficult birth, simple. Much more difficult task – to determine what triggered the pathology in men and kids. Of particular importance:

  • The duration of the disease;
  • The frequency of episodes of involuntary excretion of feces;
  • Character allocated feces;
  • Ability to controlthe discharge of gases.

To confirm the disease and detect its causes the patient is directed to the passage of the following diagnostic procedures:

  • Anorectal manometry. The study is to determine the sensitivity of the nerve endings of the rectum, evaluating the status of muscles of the anal sphincters.
  • Proctography. Is a type of x-ray procedure that is carried out to determine the volume and placement of feces in the rectum. According to the results of proctography possible to draw conclusions about the functionality of the intestine.
  • Magnetic resonance imaging. The most informative method of investigation which allows to obtain three-dimensional images of organs and soft tissues of pelvis, without x-ray radiation.
  • Transrectal ultrasound. Screening involves the introduction into the anus of a special sensor, which sends ultrasonic waves to the organs and tissues.
  • Sigmoidoscopy. The purpose of this practice was to explore the state of the upper and lower rectum. In the anus of the patient is entered rektorska – flexible thin hose with a camera.
  • Electromyographic. The study was conducted to determine the electrical activity of muscles.

Conservative treatment

Fecal Incontinence in adults and children requires systemic therapy. Most often when encopresis surgery, however, this method is most radical. When incoprate the first degree most often prescribe a comprehensive conservative therapy, which is a course therapeutic and preventive measures aimed at strengthening the muscles of the sphincter and reduced severity of the disease. These include:

  • Diet;
  • Bowel movements;
  • Training of the muscular system;
  • The use of drugs;
  • Electric stimulation.

Diet for patients with fecal incontinence

What to do in the first place? Of course, to review the food. There is no universal diet for all persons with encopresis does not exist. What often happens is that product which is recommended to drink one patient, the other, on the contrary, increases the incontinence.

fecal incontinence in women

Typically, the diet consists of foods containing dietary fiber and vegetable proteins. Thanks to ingredients stool becomes softer, does not interfere with normal intestinal peristalsis. Daily allowance of fiber should be not less than 20 g To fill in their number take fiber supplements. Among the foods rich in it are:

  • Legumes (soybeans, peas, lentils, beans);
  • Bran;
  • Potatoes with the skin;
  • Brown rice;
  • Whole wheat pasta;
  • Oatmeal;
  • Flaxseed;
  • Nuts;
  • Fruits;
  • Carrots;
  • Pumpkin;
  • Fruits.

It is Strongly recommended not to consume dairy products, caffeinated beverages, processed foods and meats. Banned sweets and cakes, fatty and spicy dishes. Apples, peaches and pears-fruits that cannot have women or men with fecal incontinence. The reason: these fruits have a laxative effect on the body.

In addition, considerable importance is the sufficient fluid intake during the day, especially with frequent diarrhea. For the purpose of prevention of deficit of nutrients and trace elements the patient is prescribed vitamin-mineral complexes.

Establishment of a regime of defecation

For the successful treatment of encopresis is extremely important bowel training. To bowel movement is stabilized, you must develop the habit to visit the toilet at a particular time of day. For example, in the morning, after meals or before sleep. Proctologists pay special attention to this condition for the treatment of fecal incontinence, because it is the right mode of conduct of the intestine will reduce the frequency of unpleasant episodes. The process of “learning” is quite long, can take from two weeks to several months.

fecal incontinence in children causes

Strengthen pelvic muscles

The Strong muscles of the pelvic floor – one prerequisite for good functioning of the intestines. The crux of training comes down to regular exercise, promoting the contraction and relaxation of the pelvic muscles. You need to engage in throughout the day for a few minutes. To achieve good results may take 3-4 months. Such treatment of fecal incontinence, women are often recommended after a difficult birth.

Drug effects

Once Again one and all a suitable medication to correct the problem does not exist. In predominant number of cases, the doctors advised to take laxatives on the basis of plant components. In addition, the regular application of such remedies, the patient is much easier to come to the correct mode bowel movement.

Electric stimulation

This method of treatment of fecal incontinence involves embedding under the epidermis of the electrical stimulator. Its elements will be placed on the nerve endings of the rectum and anus. Electrical impulses, which will send a stimulant, transmitted to the nerve receptors, whereby the process of defecation becomescontrolled.

Operation

With the low efficiency of the methods described, there arises the indication for surgical treatment. Taking into account the cause of fecal incontinence in humans, the specialist selects the most optimal variant intervention:

  • Sphincteroplasty. If encopresis was caused by the rupture of the sphincter muscles during childbirth or household trauma to the external anal sphincter, it is preferred that this type of operation. Its principle is to connect damaged tissue, which returns the valve to its former functionality. After sphincteroplasty people will again be able to control the release of gases, solid and liquid stool.
  • Transposition of the muscle. To this kind of intervention used in the case of failure of sphincteroplasty. During the operation the lower part of the gluteal muscles are separated from the coccyx and form a new anus. To the transplanted muscles can contract, they are inserted in the electrodes.
  • A Colostomy. This method of surgical treatment of select injuries of the pelvic floor, congenital anomalies and cancer diseases that affect the lower intestine and the sphincter apparatus. During surgery part of the colon output, having a corresponding hole in the abdominal wall. After the intervention patients are forced to use colostomy bags – tanks for collection of excreta. Such treatment of fecal incontinence is carried out in exceptionally complicated cases.
  • Implantation of an artificial sphincter. This is one of the newest methods of surgical treatment of encopresis, which is the location around the anus special inflatable cuffs. At the same time as under the skin, install a small pump, which actuates the man himself. When the patient feels the need to visit the toilet, he blows off the cuff, and after defecation inflate again, which completely eliminates the possibility of passing feces through the anus.

Disease in children

In a healthy child the ability to control defecation can be formed up to 4-5 years. A common symptom of fecal incontinence in children is the continuous or periodic package the underwear with stool. Diagnosis “encopresis” the doctors don't put kids under 5 years of age. If some time later, after the child was able to control the acts of defecation, had a relapse, talking about secondary fecal incontinence.

In babies the main cause of encopresis is chronic constipation. Thus cause fecal incontinence in children and other factors:

  • Emotional stress. The body kids sensitive to any feelings. Family problems, fear of parents or teachers, an accident, a fright – all this depresses the immature psyche of the child and is able to lead to the development of encopresis.
  • Ignoring the urge to visit the toilet. The systematic suppression of natural needs rectum overflowed with excrement, the pressure on the sphincter and increases the muscles cease to deal with it. Long delay stool causes a stretching of the colon and loss of sensitivity of the receptors, which subsequently exacerbates the problem.
  • Neurological disorders, including spinal cord lesions, cerebral palsy, congenital myotonia, epilepsy.
  • Developmental Abnormalities of rectal walls (Hirschsprung's disease).
fecal incontinence in men

Regardless of the causes of fecal incontinence in children unconsciously the allocation of faeces is most often observed in the afternoon. Nocturnal encopresis is much rarer. Treatment begins as soon as the doctor diagnosed "incontinence". After establishing the reasons for embarking on therapy which is carried out sequentially in several stages:

  • Start with bowel cleansing. Morning and evening for one-two months the boy put a cleansing enema which will not only evacuate the stagnant feces, but also to develop the reflex to regular defecation.
  • The Next stage is closely connected with the previous one and is accustomed to the timely bowel movements. Discharge of feces at the same time of day minimizes the risk of uncontrolled defecation. For young children it is especially important to create favorable atmosphere that will help form positive associations with going to the toilet.
  • Adjust diet. The child should be fed easily digestible food. In the diet it is advisable to include fiber and laxative products: yogurt, greens, prunes, fresh bread, cabbage, carrots. To complement the menu with the decoction of buckthorn, Senna.

Basic procedure for kids

Training sphincter apparatus – one of the invariant conditions for strengthening the muscles of the rectum:

  • In the anus inserts a thin rubber tube (3-4 cm).
  • The Child should alternately compress and relax the anal sphincter to push out and hold the training object.

Methods suitable for treating fecal incontinence in older children.

In Parallel with training training a child is prescribed a course of electrical stimulation of the muscular system, which consists of 8-10 procedures. The currents used in the session, helps to restore the relationship between the sphincter apparatus and the nerve endings of the rectum. The procedure is not performed at home.

Medical treatment of encopresis involves injecting“Neostigmine”. The solution of this drug in a concentration of 0.05% promotes early recovery of neuromuscular conduction. Treatment ‘Neostigmine” lasts about two weeks.

fecal incontinence in the elderly

In conclusion

Social isolation, which often leads this problem causes in patients with apathy, depression. But despair not! With the responsible attitude to own health of encopresis can be treated. Most importantly, do not tighten and contact your doctor at the first sign of symptoms. Despite the delicacy of the issues and a sense of shame, visit a doctor – is the first step on the road to recovery.

Very reverent attitude requires a child who suffers from fecal incontinence. Parents should explain to him that his guilt in what is happening there. The child must be acquainted with the physiological characteristics of the human body and try available words to explain how there was this problem. Difficulty is not constant for the entire required time. In any case, you can't blame the kid, blame him or threaten to punish each “embarrassment”. If the child get rid of the emotional experience, tune into the positive solution, the result will not keep itself waiting long.


Article in other languages:

AR: https://tostpost.com/ar/health/14267-fecal-incontinence-in-adults-and-children-causes-and-treatment.html

BE: https://tostpost.com/be/zdaro-e/25476-netrymanne-kala-daroslyh-dzyacey-prychyny-lyachenne.html

DE: https://tostpost.com/de/gesundheit/25500-stuhlinkontinenz-bei-erwachsenen-und-kindern-ursachen-und-behandlung.html

ES: https://tostpost.com/es/la-salud/25519-la-incontinencia-fecal-en-adultos-y-ni-os-causas-y-tratamiento.html

HI: https://tostpost.com/hi/health/14288-fecal.html

JA: https://tostpost.com/ja/health/14290-fecal-incontinence-in-adults-and-children-causes-and-treatment.html

KK: https://tostpost.com/kk/densauly/25459-n-zh-st-eresekter-men-balalarda-y-sebepter-men-emdeu.html

PL: https://tostpost.com/pl/zdrowie/25388-nietrzymanie-stolca-u-doros-ych-i-dzieci-przyczyny-i-leczenie.html

PT: https://tostpost.com/pt/sa-de/25401-incontin-ncia-fecal-em-adultos-e-crian-as-causas-e-tratamento.html

TR: https://tostpost.com/tr/sa-l-k/25463-fekal-inkontinans-yeti-kin-ve-ocuklarda-nedenleri-ve-tedavisi.html

UK: https://tostpost.com/uk/zdorov-ya/25443-netrimannya-kalu-u-doroslih-d-tey-prichini-l-kuvannya.html

ZH: https://tostpost.com/zh/health/14944-fecal-incontinence-in-adults-and-children-causes-and-treatment.html






Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."

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