The Intestine Does not Need to Dictate the Rhythm

At least 1.5 million Germans suffer from anal incontinence. Many of them do not even know what this means and that their intestine deficiency is treatable. However, there are ways to deal with their bowel movement – by the help of auxiliary means, the right nutrition or surgeries.

01.12.2008

Incontinence of stool: What is it?

Anal incontinence is an intestine deficiency. It is divided into three degrees: “Degree 1, if somebody cannot hold back his winds. Degree 2, if a person cannot hold back his winds and stool from time to time and degree 3, when nothing can be bottled up”, explains Doctor Franz Raulf, specialist for intestine illnesses (proctologist) and surgeon.

Everyone can get incontinent; especially older people. Since in old age muscle nerves of the intestine get weaker. Women are affected the most. “Short after delivery it occurs in 15 percent”, tells Raulf. Especially through pregnancy and births the anal sphincter and nerve endings can be hurt.

The pelvic base plays an important role in stool incontinence. It supports the organs in the stomach with muscles and conjunctive tissue. The older you get the weaker the muscles become – especially if someone is overweight. Therefore, the pelvic base sags and the anus gets stretched. The organs which are situated in the pelvic - bladder, uterus and straight intestine – can emerge so that bladder and intestine cannot close properly.

Another reason can be nerve damages which for instance have been caused by senile dementia, multiple sclerosis, paraplegia and spina bifida (also called split spine). Further, through tumour surgeries in the pelvic and slipped discs. Often chronic inflammatory bowel diseases like Crone’s disease induce it. In other cases the anus is located wrongly by birth.

Diagnosis and examination

Affected people who want to get help can go to the general practitioner or a proctologist who is solely concerned with the lower intestine. The physicians examine how the sphincter or the pelvic work. Then a colonoscopy is done. “For a more detailed examination of muscle defects we use ultrasonic measurements”, describes Raulf.

Treatment options

There are quite different methods for treating stool incontinence – from changing nutrition up to surgeries. The physician has to decide which treatment is suitable for which patient.

Auxiliary means: In many cases anal incontinence cannot be cured completely but only be lessened. However, there are auxiliary means which can achieve that affected people in public do not have to fear uncontrollable malodour or even stool.

Pelvic re-education: In most cases pelvic re-education is named one of the main treatments. Thereby, the muscles between pubis, tailbone and ischial tuberosity are to be tightened.

Eating differently: Many people with anal incontinence have quite liquid stool. Raulf gives the advice to eat differently to make it harder: “Solid stool is easier to control. You should better eat white bread instead of grain bread, cooked instead of raw vegetables and drink red wine instead of beer.”

Drugs: Raulf prescribes anti-diarrhoeal medicine. “If you know you will be on the move the next day, you can take the drug and know that you will get along.” This improves quality of life.

Surgeries: „Only in two kinds of stool incontinence a surgery might help: a rectal prolapse and a torn muscle”, explains Raulf. There are devices like artificial sphincters which can be set into the body. With their help one can decide at the touch of a button when one wants to defecate. “These devices are only used when other treatments did not work since they have many side effects. It is only for younger people who can deal with it.”

Natascha Mörs
REHACARE.de

- Read more about anal incontinence in the interview with Doctor Franz Raulf