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Having fecal accidents? You are not alone.


Fecal incontinence (FI), or accidental defecation, affects 1/9 women over the age of 50, as well as fewer men. Risk factors for FI include prior childbirth, prior surgery on the anal region, obesity, a history of radiation, and passing menopause. FI can vary from leakage of stool to full accidents of feces. This condition affects a person’s self-esteem, their ability to interact with others, and their satisfaction in life. Affected patients often wear disposable undergarments, plan ahead by carrying changes of clothing, alter social activities, and plan ahead for all outings by first consulting destination maps to locate restroom facilities.


Fecal control requires three pillars for successful control of stool. The first pillar is the intact condition of the anal sphincter muscle. This muscle is a circular muscle, providing voluntary control of feces. This muscle can be damaged during childbirth, after episiotomy, after hemorrhoid surgery, after trauma, and following radiation treatment of the rectum. Sometimes surgery is required to return the shape of the anal sphincter to a circular or donut shape.


The second pillar for successful control is to have normal operation of the nerves running the anal region. The nerves, the external branch of the pudendal nerve, run the sphincter muscle activity by entering on both the right side and left side of the anus. These two nerves are end-of-the-line branches off of the spinal cord, and can be damage by age, obesity, straining during childbirth or in chronic constipation, after regional radiation treatment, or just by age. Damage to these nerves affects our ability to sense that stool is coming to the anal opening, can result in the need to rush to the restroom, and decrease our strength in holding our bowels until we reach a restroom. Modern science has provided an implantable device, the sacral nerve stimulator, which piggybacks on the nerve branches supplying the anal sphincter muscle to augment and strengthen our sensation of needing to defecate and our strength and ability to hold our bowels by willpower. Learn more about these devices at Medtronics and Axonics.


The last and third pillar of fecal control is affected by the consistency of our stool. Though we can hold watery stool in our youth, as we age our anal strength decreases and as a result, our ability to hold watery stool decreases. Firm stools are much easier to hold, but are simultaneously more difficult to expel when using the toilet. For a patient experiencing incontinence, using exercises prescribed under the care of a pelvic floor physical therapist, adding food products that thicken stools, and supplementing with medications that create constipation, can help improve our fecal control.


If you are experiencing problems with fecal accidents, you are not alone. Make an appointment today with a Colon and Rectal surgeon for evaluation and counseling.  Call Phoenix Unified Surgeons at (480) 707-9504 or find a board certified Colon & Rectal Surgeon in your area at this link: Find a Surgeon.

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