“You are a genius”. That is great to hear, I
certainly do not get that compliment at home, however
more important is the 42 year old patient, who
complimented me, has her dignity back.
Carolyn used to have a bowel movement 4-5 times a
day, without much or any warning. She had very frequent
incontinence episodes. Helped by modern technology she
had made pictures on her I-pad for her initial
consultation showing me how she had spoiled herself the
day before. Definitely not something she planned on
putting on Facebook.
It is already difficult enough to hide an accident
with urine, let alone with feces. The color and the
smell, will not allow much time and dignity.
It is hard to believe, there are millions of people
battling this problem. It has been estimated to affect
1-2% of the population over 40 years. Recently we have
made progress in not only recognizing the problem, but
also the treatments available.
There are numerous causes of fecal incontinence,
which also makes the treatment vary.
Some people are impacted with stool and are bothered
by spurious diarrhea. They often exacerbate their
problem by ingesting anti-diarrhea medication. Once the
real problem is treated by changing diet and or adding
daily medications securing regular normally formed bowel
movements, there suddenly is no more diarrhea. Just
because you have never been regular and “naturally” have
a bowel movement twice a week, does not make this a
normal, healthy habit; you are without a doubt
constipated. Unless you eat twice a week, you should
strive for daily bowel movements.
Diseases as diabetes or excessive alcohol consumption
can be associated with autonomic neuropathy, or trouble
with the nerves holding and recognizing the presence of
stool. Alcohol also tends to make the stool looser,
which makes it more difficult to hold.
Injury to the internal or external anal sphincter,
important in recognizing and holding stool may be caused
by trauma, childbirth or anorectal surgery. Injury to
the internal anal sphincter often leads to leakage of
mucus and fecal staining, requiring the use of a pad and
never feeling quite fresh and clean.
Neuropathy of the sphincter and pelvic floor muscles,
which was one of the reasons Carolyn had limited control
over her stool can be caused by spinal diseases or
injury, stroke or childbirth.
Some cancers can also be a reason for sudden fecal
incontinence and it is a good idea to have a colonoscopy
done as part of the work-up of the stool loss problem.
Radiation treatment or surgery of some colorectal
cancers may invoke involuntary stool loss.
Irritable and inflammatory bowel diseases are
also common reasons for incontinence.
Multiple causes require a thorough work-up and
numerous different treatment options. Also every patient
is different and brings a unique situation. Often
patients have more than one reason for their bowel
There are treatments available which may make
me look like a genius, others are just common sense and
would require a small adjustment or therapy. The
experience of bowel incontinence is often embarrassing
and causes anxiety and apprehension for a future episode
to occur. Do not hide inside your home; seek help, so
you can continue to enjoy life. Some treatments only
require several office visits, others use of medication,
surgery or nerve stimulation. Also visit the bathroom 30
minutes after breakfast; it is the best time to try to
have a bowel movement. Have a cup of coffee on me with
your breakfast, it may not be the suggestion you expect
of a genius, but it does help.
Marja Sprock, MD is board certified in female
pelvic medicine and reconstructive surgery
(urogynecology) and treats numerous women for
involuntary loss of stool. Call 321-806-3929 for an
appointment or check us out at
Florida UroGynecology where high tech and common sense