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Gastroenterology – Fecal Incontinence: What You Need to know
Whiteboard Animation Transcript
with Wayne Rosen, MD
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True Fecal Incontinence can be a socially and psychologically devastating problem for many patients. Fortunately, in most instances patients actually have pseudo-incontinence, that is, just seepage secondary to poor stool consistency and minor issues around the anus.

Pseudo-Incontinence

Patients with pseudo-incontinence (i.e., seepage) usually have mild soiling of their underwear. They can usually control flatus when necessary. And they may complain of prolapsing tissue from Anus.

On exam, the anus appears normal, the resting tone is normal and they have good voluntary squeeze when being examined. These will be the findings in almost all men, but only some women complaining of incontinence.

Initial treatment of patients with pseudo-incontinence includes increased dietary fiber and, Metamucil to improve stool consistency. I advise patients to minimize time sitting on the toilet. That means no reading or texting. And sometimes Kegel exercises will help. These suggestions will solve the problem in almost all instances. Occasionally a small procedure to remove a prolapsing haemorrhoid also needs to be done.

True Fecal Incontinence

True fecal incontinence is due to one of three causes:

1. Sphincter injury (usually secondary to obstetrical trauma,
2. Nerve damage and
3. A combination of these two causes.

It is much more common in women than men

True fecal incontinence usually involves:

History

• Obstetrical trauma
• Rectal prolapse.
• Patients will frequently have fecal urgency, need to wear a pad or diaper, and express fear of going out for social activities.

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