Fecal incontinence

Fecal incontinence
Other names	Faecal incontinence, bowel incontinence, anal incontinence, accidental bowel leakage
A diagram showing normal anatomy of the anal canal and rectum.
Specialty	Gastroenterology
Causes	Puerperal disorder, ulcerative colitis
Medication	cholestyramine
Frequency	2.2%

Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred to as anal incontinence. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery (especially involving the anal sphincters or hemorrhoidal vascular cushions), altered bowel habits (e.g., caused by irritable bowel syndrome, Crohn's disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence).^[1] An estimated 2.2% of community-dwelling adults are affected.^[2] However, reported prevalence figures vary. A prevalence of 8.39% among non-institutionalized U.S adults between 2005 and 2010 has been reported, and among institutionalized elders figures come close to 50%.^[3][4]

Fecal incontinence has three main consequences: local reactions of the perianal skin and urinary tract, including maceration (softening and whitening of the skin due to continuous moisture), urinary tract infections, or decubitus ulcers (pressure sores);^[1] a financial expense for individuals (due to the cost of medication and incontinence products, and loss of productivity), employers (days off), and medical insurers and society generally (health care costs, unemployment);^[1] and an associated decrease in quality of life.^[5] There is often reduced self-esteem, shame, humiliation, depression, a need to organize life around easy access to a toilet, and avoidance of enjoyable activities.^[1] FI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse.^[6] People may be too embarrassed to seek medical help and attempt to self-manage the symptom in secrecy from others.

FI is one of the most psychologically and socially debilitating conditions in an otherwise healthy individual and is generally treatable.^[2] More than 50% of hospitalized seriously ill patients rated bladder or fecal incontinence as "worse than death".^[7] Management may be achieved through an individualized mix of dietary, pharmacologic, and surgical measures. Health care professionals are often poorly informed about treatment options,^[2] and may fail to recognize the effect of FI.^[5]