What Factors Contribute to Bowel Incontinence?
Inability to control gas or stool through the rectum can be due to a variety of causes such as constipation, diarrhea, and damage to nerves or the anal sphincter muscle. Damage to pelvic nerves or the sphincter muscle can occur with delivery or with disease processes. Sphincter repair surgery involves reuniting the severed ends of the sphincter muscle so it can squeeze and act as a valve to help us hold our stool. It is helpful to obtain an ultrasound of the damaged sphincter to help direct the surgical repair. Continence outcomes are higher when the ends of the sphincter muscle are overlapped. It is essential to cleanse the bowel prior to surgery to prevent stressing the new repair with constipation. It is also necessary to keep the stool soft post op for the same reason. Peripheral Nerve Stimulators have been shown to improve bowel incontinence and may be especially helpful in situations where the anatomy has been reconstructed (or sometimes where it can not be reconstructed fully) and desirable function has not been achieved. Follow this link for more information: https://www.augs.org/assets/2/6/ABL.pdf
Sometimes a rectocele (fallen rectum) acts as a pouch where stool collects during a bowel movement and comes out later without the person being aware it is happening. Treatment can include diet manipulation, the English bowel regimen where fiber is taken at bedtime so that the stool is “packaged” and waiting at the rectum in the morning for evacuation. A glycerin suppository is used to ensure the evacuation is complete. Surgery can be used to repair the rectocele and eliminate the reservoir. Physical therapy is used to maximize the effect of the available muscle and nerves to control stool.