WHAT IS INCONTINENCE?
Incontinence (also called anal or bowel incontinence) is the impaired ability to control the passage of gas or stool. This is a common problem, but often not discussed due to embarrassment. Failure to seek treatment can result in social isolation and a negative impact on quality of life.
WHAT CAUSES INCONTINENCE?
- Childbirth-related injury: The most common cause of incontinence results from a tear in the anal muscles during childbirth. Additionally, the nerves controlling the anal muscles may also be injured, leading to incontinence. Some injuries may be detected immediately following childbirth, though many go unnoticed until they cause problems later in life. Since it may be years after giving birth, childbirth is often not recognized as the cause of the problem.
- Trauma to anal muscles: Anal operations or traumatic injury to the tissues near the anal region can damage the anal muscles and/or nerves and lessen bowel control.
- Age-related loss of anal muscle strength: Some people gradually lose anal muscle strength as they age. A mild control problem may have existed when they were younger may progress later in life.
- Neurological diseases: Severe stroke, advanced dementia or spinal cord injury can cause lack of control of the anal muscles, resulting in incontinence.
- Diarrhea may be associated with a feeling of urgency or stool leakage due to the frequent liquid stools passing through the anal opening. If bleeding accompanies lack of bowel control, consult your physician. These symptoms indicate inflammation within the colon (colitis), a rectal tumour, or rectal prolapse - all conditions that require prompt evaluation by a physician.
HOW IS THE CAUSE OF INCONTINENCE DETERMINED?
An initial discussion of symptoms with your physician will help determine the degree of incontinence and the effect it has on your life. Possible underlying factors are often found during a review of your medical history, such as:
- Multiple pregnancies, large weight babies, forceps deliveries or prior episiotomies (surgical incisions to aid childbirth)
- History of prior anal or rectal surgeries
- Medical illnesses or conditions
- Medication side effects
WHAT TREATMENTS ARE AVAILABLE?
There are nonsurgical and surgical treatment options that can be used based on the cause and severity of the problem. Your colon and rectal surgeon will discuss the different treatment methods and help you decide on the approach that is best for you.
NONSURGICAL OPTIONS
Dietary changes: Mild problems may be treated simply by changing one’s diet.
Constipating medications: Specific medications can result in firmer stools, enabling improved bowel control.
Medications: Inflammatory bowel diseases (such as Ulcerative Colitis or Crohn’s disease) can cause diarrhea and contribute to bowel control problems. Treating these underlying diseases may improve or even eliminate symptoms of incontinence.
Muscle strengthening exercises: Simple home exercises to strengthen the anal muscles can help in mild cases.
SURGICAL OPTIONS
There are several surgical options for the treatment of incontinence.
Surgical muscle repair: Injuries to the anal muscles may be surgically repaired.
Stimulation of the nerves: Insertion of a nerve stimulator can help nerves that control muscles and skin of the anus work more efficiently.
Bulking agent injections: Injecting a substance into the anal canal can bulk it up and strengthen the “squeeze” mechanism of the anal muscles used during bowel movements.
Surgical colostomy: In severe cases, a colostomy may be the best option for improving quality of life. During this procedure, part of the colon (large intestine) is brought out through the abdominal wall to drain into a bag.
WHO IS A COLON & RECTAL SURGEON?
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions.
