Involuntary act of defecation in adults. What to do with fecal incontinence

Fecal incontinence is a medical condition characterized by a disorder in which a person cannot control bowel movements. Colon cleansing is spontaneous. The patient loses calm, becomes psychologically unbalanced.

Fecal incontinence has a special medical term- encopresis. The disease is usually associated with the development of organic pathology. All factors are significant and require elimination, urgent medical attention.

Fecal incontinence in adults is an unpleasant and dangerous phenomenon. A person loses the ability to control internal processes, bowel cleansing is not controlled by the brain.

Fecal masses can be of different consistency - solid and liquid. The emptying process itself does not change from this. Fecal incontinence in women is diagnosed less frequently than in the strong half of humanity. Statistics give figures - one and a half times less. But this does not allow women to be calm and confident that they are not afraid of such a pathology. The disease is nearby, waiting for favorable conditions and manifests itself, violating the usual way of life.

There is an opinion that a pathological disorder is characteristic of old age. Fecal incontinence in the elderly is an optional sign of age, doctors have proven that the opinion is erroneous. Statistical data provide figures that explain the emergence of such opinions. Half of the patients are people over the age of 45. Age is only one of the reasons that leads to illness.

To understand why fecal incontinence occurs, you need to understand the process of managing bowel movements. Who controls at what level of physiology it is laid down. Fecal mass output is managed by several systems. Their consistency leads to the normal functioning of the body.

1. In the rectum, a large number of nerve endings are concentrated, which are responsible for the work of muscle structures. The same cells are located in the anus. The muscles hold the stool in and push it out.
2. The rectum is located inside the intestine in such a way as to hold feces, send it in the right direction. The feces, once in the rectum, are already acquiring their final state. It is dense, compressed into voluminous ribbons. Anus closes his exit without control.
3. The compressed state of the bowel is preserved until the exit, when the person is ready for the act of defecation, he understands that he has come. In a normal state, a person can restrain the process until he can go to the toilet. The delay time can be calculated in hours.

If the process is disturbed, this state is not controlled, the feces exit occurs instantly. The muscles of the pelvis and anal region do not maintain intestinal tone.

The sphincter plays an important role in the process. More precisely, the pressure in his area. Normally, it varies from 50 to 120 mmHg. Men have a higher rate. The anal organ in a healthy state should be in good shape, a decrease in its functionality leads to a deterioration in defecation. The vegetative NS controls its activity. It will not be possible to consciously influence the sphincter. Stimulation of the exit of feces occurs at the level of irritation of receptors in the walls of the rectum.

Scientific Explanation of Excretion:

• simultaneous vibration of the muscles of the peritoneum and closure of the main opening (slit passage);
• increased pressure on the sphincter;
• delayed compression of intestinal segments;

All processes lead to promotion, pushing feces to the anus. The process is slow and does not tolerate acceleration. The muscles of the pelvis enter a relaxed state, the muscles open the rectal outlet. Relaxes the internal and external sphincter. When a person cannot get into the sanitary room, he strains the internal receptors, the anorectal opening remains closed, tight. The degree of tissue tension stops the urge to go to the toilet.

Causes of fecal incontinence

There are a number of factors that cause fecal incontinence in adults.

The most common reasons:

• constipation phenomena;
• liquid stool;
• weakness and damage to muscle mass;
• nervous conditions;
• decrease in muscle tone relative to the norm;
• dysfunction of the pelvic organs;
• hemorrhoids.

You can consider and analyze the reasons for fecal incontinence in detail.

1. Constipation. In the intestines, there is an accumulation of solid waste products from food processing. In the rectum, tissues are stretched, which relieve pressure on the sphincter. When constipated, a person has a desire to soften the feces. Loose stools accumulate over hard feces. There is leakage of them and damage to the anus.
2. Diarrhea. Diarrhea changes the state of the stool, this becomes a factor in the development of pathology. Treatment of fecal incontinence becomes the first and necessary action to eliminate symptoms.
3. Problems of the innervation plan. The impulses are subject to two types of disturbance. In the first version, the problem is based on nerve receptors, the second - on deviations in the brain. Often this is characteristic of the senile state, when the activity of brain processes decreases.
4. Scars on the walls of the rectum. Due to the decrease in the strength of the walls of the esophageal membrane, enuresis and encopresis begin to appear. Unpleasant processes violate the state of an adult organ, scars are formed. Sometimes scars form after inflammation, surgery, radiation.
5. Hemorrhoidal venous seals. The knots do not allow the hole to close, the muscles become weak and inactive. In older people, hemorrhoids alter the entire bowel movement.

It comes from certain principles:

• adjustment of the regimen and diet;
• medicines;
• training the muscles of the intestinal systems;
• stimulation of work with the help of electrical equipment;
• operational activities.

Each principle will be analyzed by a specialist. Treatment of encopresis is aimed at eliminating the problem - the cause that caused the violation of the bowel movement.

Medicines

Among the drugs that help normalize the work digestive system, Imodium tablets are considered one of the most popular. In medical language they are called Loperamide.

Drug groups:

• antacids;
• laxatives;
• therapeutic.

Other antidiarrheals intervene in the disease and produce additional healing effects:

1. Atropine, Belladonna. Anticholinergic drugs, they reduce the development of secretion, increase peristalsis. The motility of the intestinal walls returns to normal. It can be used at various stages.
2. Codeine. The tool relieves pain, as it is one of the derivatives of the opium group of drugs. More often it happens that it is included in the group of dangerous contraindications. It is prescribed only on the advice of a doctor.
3. Lomotil. A medicine with this name reduces the movement of feces, creates conditions for its hardening.

The most common are tablets. activated carbon. The substance is named after the active element of the composition. Coal absorbs liquid, expands the feces in volume. In addition, the drug removes toxic substances from the body.

Causes and treatment are studied by doctors. They will pick up special devices if medication formulations do not help.

The problem may arise when it is impossible to contact medical institution. Then you have to turn to the advice of healers, healers from the people. At home, the disease has been eliminated for many centuries. Treatment of fecal incontinence was carried out in villages where grandmothers picked up healing herbs and created miraculous tinctures.

You can use folk remedies, but such an action should not be permanent. What reasons led to loose stools, why did the intestines malfunction? Questions can be answered after complete examination and carrying out diagnostic procedures.

1. Enemas. For their implementation, chamomile decoctions are used. Take 50 g medicinal herb, put it in a liter of boiling water. On a slow fire, they are waiting for the complete dissolution of the components of chamomile. Then cool to room temperature and injected into the rectum. You need to keep the medicine inside for a very long time, you can help with the help of medical devices or hands.
2. Infusions for internal use. The base is calamus grass. It is steamed in boiling water, proportions of 20 g of grass, 200 ml of liquid. Water compositions can not be done a lot. A liter of healing infusion is sufficient for a course of 7 days. Drink 1 spoon after meals.
3. Rowan juice. The fruits of the tree help fresh and pressed into a drink. The norm of admission is one spoon no more than 3 times a day.
4. Honey products. Honey, 1 tablespoon per day, will become both a curative and a preventive method for eliminating the disease.

A change in bowel movements occurs during pregnancy. Women hope that everything will be over after childbirth. More often the illness continues to be observed, to amplify. The problem becomes not so much physiological as psychological.

Fecal incontinence after childbirth is due to the following reasons:

• violation of the innervation of the muscles of the bladder;
• abnormalities in muscle function pelvic organs;
• pathologies of the urethra;
• dysfunction of the closure of the bladder and urinary systems;
• pressure instability within the bladder.

Pathology goes along with another process - gas incontinence is observed. A large number of women seek medical attention after childbirth with such symptoms. They are trying to understand the reasons why gas incontinence appears after childbirth.

The reason for the phenomenon is not one, it is a whole complex:

1. Anus injury during labor activity.
2. The birth of a large fetus against the background of ruptures of external and internal.

Part of the damage occurs with special medical methods assistance to the woman in labor - the use of surgical equipment.

Gas incontinence after childbirth may have other explanations:

• violation anatomical structure organs responsible for defecation (fistulas, cracks, wounds);
• organic damage (diseases of the spinal cord or brain);
• trauma of the birth process;
• consequences of surgical interventions;
• mental disorders (neurosis, depression).

There are also medical pathologies that, with fecal incontinence, often become noticeable after childbirth.

• epilepsy;
• dementia;
• catatonic syndrome.

What to do to eliminate unpleasant symptoms, the attending physician will tell you.

The methods were developed by specialists, based on the experience of doctors in studying the cause of fecal incontinence.

1. Operations to introduce a special gel into the canal. This type of therapy is used to fix the walls of the anus. The method does not promise a complete cure, a relapse may occur.
2. Fixation internal organs. Operations are rarely used. Surgeons fix the channel of fluid emission, the cervix, bladder. After the intervention, a long recovery period will be required.
3. Loop method. One of the most frequently performed methods of surgical intervention. To eliminate urinary and fecal incontinence, a support is created from a loop of special medical material.

Treatment after an injury to the sphincter region or damage to the muscle tissue of the pelvis consists in the method modern technologies- sphincteroplasty. The surgeon stitches torn, stretched muscles. Another way is an artificial organ, it can be controlled by a person himself. The surgical cuff is inflated and deflated. Fecal incontinence after surgery can be covered with simple measures: clean, changeable clothes, taking medications that reduce the smell of stools accompanied by gas.

Fecal incontinence in the elderly

Treatment for encopresis depends on the age of the patient. Fecal incontinence in the elderly is a common problem.

The main manifestation is observed after a stroke. In a patient, the consequences are disorders of the pelvic organs.

Because of this, the work of internal systems begins to deteriorate:

• constipation phenomena;
• urinary retention;
• incomplete exit of faeces and urine from the intestines;
• gas incontinence;
• pain during defecation and urine output;
• false desire to visit the toilet;
• impotence.

What is diarrhea, almost everyone knows. Under certain conditions, a single aggravation becomes a frequent ailment. Knowing the causes and factors of its development will help to avoid pathology, to maintain the usual way of life.

The content of the article:

Fecal incontinence is a condition that requires a comprehensive examination. Encopresis is rare hereditary disease. If there are several episodes of involuntary bowel movements within 1 month, you should immediately consult a doctor. Finding out the cause without the intervention of a specialist and self-treatment is impractical and unsafe.

Causes of fecal incontinence in children

Involuntary defecation, like urination, in a child is justified only in infancy. As they grow older, the functions develop accordingly. digestive tract the ability to respond to physiological urges. Uncontrolled bowel movement ceases to be normal- goes into the category of pathologies.

The task of parents is not to justify the fact of the development of fecal incontinence, not to explain it by any factors, but to rush to the pediatrician. After examination and questioning, he will refer you to a pediatric gastroenterologist or independently prescribe the necessary, and most importantly, competent treatment.
Pediatric encopresis (like enuresis) is most often detected in preschool age, at the stage of the child's medical examination before entering an educational institution. Since, upon reaching the age of 6-7, children should already be able to control digestion and know how to behave correctly when they have the urge to defecate, the question of the psychological climate within the family is raised. They find out how favorable the situation is, whether violence occurs there. Treatment of pathology requires the mandatory participation of a psychologist.

One of the causes of fecal incontinence in a child:

Infection in infancy (mainly associated with intestinal damage);
mother's illness during pregnancy;
smoking, alcoholism, difficult psychological conditions and exhausting work of a woman carrying a child;
intrauterine fetal hypoxia.

These factors have a detrimental effect on the body, in which organs are just being laid. Underdevelopment of the sphincters of the alimentary canal is an understandable complication in this case.

Also, children born as a result of problematic labor activity are more prone to encopresis. The entanglement of the umbilical cord, improper presentation and position of the fetus in the womb, the need to apply obstetric forceps can complicate its course. It was revealed that children born in the process of physiological childbirth suffer from fecal incontinence more often, and not caesarean section.

Additional reasons:

Conflict situation in the family;
social and pedagogical neglect;
transferred fear, emotional shock;
congenital or acquired mental disorders - epilepsy, schizophrenia, neurosis, psychosis, hysteria, as well as combinations of these pathologies;
tendency to outrageous - fecal incontinence in childhood is one form of protest.

Given these factors, at the stage of consultation and examination by a specialist, it is necessary to report on the features and difficulties that arose during pregnancy and / or childbirth.

Causes of fecal incontinence in adults

The etiological factors of fecal incontinence in children and adults are not particularly different. The only difference is that the child, due to age, is more prone to demonstrative behavior, and therefore a defecation can serve as a response even to a parental prohibition. In adults, encopresis occurs the following reasons:

malignant neoplasm rectum. Growing in the tissue of the sphincter, the tumor affects nerve fibers. As a result, the sensitivity of the intestine decreases, the patient's ability to timely control the urge that has arisen. Removal of the tumor (even if it is operable) does not promise an improvement in the defecation process. Therefore, the best option for the patient is the creation of favorable conditions, first of all, the use of diapers, especially if you have to stay away from home. Given the specifics of the pathology, it is preferable for the patient to minimize the stay in in public places.

Diseases of the digestive tract. In gastroenterology, there are pathologies that lead, among other things, to scarring of the rectal tissue. These include ulcerative colitis, Crohn's disease. Pathologies affect the loss of elasticity of the rectum - it does not withstand the urge to defecate and the influence of feces.

Constipation, violation metabolic processes . A predisposing factor is a chaotic diet, the presence in the diet of an excessive amount of cereals, bakery products, potatoes, fatty milk. Insufficient blood supply to tissues also leads to insufficiency of the organs of the digestive tract. First, constipation develops, then stretching of the intestines with feces, weakening of the sphincters and, as a result, it becomes difficult to restrain the urge to defecate.

Strong intoxication, state after use drugs. Alternate relaxation of all muscle groups leads to involuntary defecation.

Condition after complex surgical interventions, especially if the drains are removed to the patient.

Spinal cord injury, stroke, condition after a fracture of the spine, lack of sensitivity in the hip region. The patient does not feel the urge, cannot respond to them, defecation occurs involuntarily.

Fecal incontinence in women in half of all cases studied is the result of difficult labor, more often if an episiotomy was performed. The weakening of the muscles of the pelvic floor occurs due to multiple pregnancy, a large volume of amniotic fluid. Involuntary defecation in women occurs due to prolonged pressure of the enlarged uterus on the intestines, which creates a load on the sphincters, worsens their tone.

Also, encopresis in women occurs due to unprofessional tactics of obstetricians. Sometimes only in the process of labor activity there is a need for a caesarean section. However, gynecologists with little practice are not ready to admit that surgery is required, and continue to supervise the birth process. Then, due to the discrepancy between the size of the fetus and the proportions of the woman, her perineum is damaged.
Despite suturing directly in the delivery room, in the future there is a high probability of incontinence of urine, feces, and intestinal gases. In addition, recovery takes a very long time (up to 1 year).

The following factors contribute to the development of fecal incontinence in men, in addition to the tumor process and previous operations on the intestines:

1. Hemorrhoids of severe forms. Inflammation hemorrhoids may, in turn, be the result of excessive physical activity. Therefore, fecal incontinence is also found among men. Also, increased physical activity is a separate risk factor for fecal incontinence.

2. Excessive use of laxatives. Especially common cause involuntary bowel movements in men over 60 years of age, when drugs have to stimulate the bowels.

3. Frequent enemas also cause involuntary defecation in men and women. Constant irritation of the intestinal walls negatively affects the motility of the digestive canal. As a result, it becomes more difficult to control it.

Anomalies in the development of the intestine- a less common, but also an actual cause of fecal incontinence. Predisposing factors include a violation of the structure of the brain and spinal cord. Also among the causes of uncontrolled defecation is diarrhea against the background of food poisoning or intestinal infection. Impact on pathological condition comes down to eliminating the root cause - immediately after the relief of diarrhea, episodes of fecal incontinence do not occur.

Causes of fecal incontinence in the elderly

Among the elderly, fecal and urinary incontinence is the most common physical condition disorder. Encopresis develops due to 3 main problems associated with the natural aging of the body.

1. Problems with the functioning of the digestive tract. The main cause of fecal incontinence in the elderly is associated with a violation of the metabolic processes of the intestine. Low motility of the gastrointestinal tract contributes to the accumulation of food mass - constipation develops. favorable condition- sedentary lifestyle. Constipation is the precursor to fecal incontinence. Elderly people can hardly influence the sphincters - the feces move and are evacuated involuntarily. Often - after the release of intestinal gases.

2. Mental disorders. Irreversible changes occur in every 10 elderly people in the centers of the brain. They entail a disorder of memory, thinking, coordination of movements. Also, against the background of a mental disorder, there are failures in the innervation of the intestine. However, the primary reason is problems with the activity of the brain. These pathologies include Alzheimer's disease, Parkinson's disease, senile dementia, manic-depressive syndrome, schizophrenia, insanity. Relatives need patience in caring for such a person, since encopresis is complemented by other equally severe symptoms.

3. Atrophy, weakness of the muscular apparatus, characteristic of the aging process, leads to insufficiency of sphincters. It becomes difficult to restrain the intestines during the urge.

The list of the most common causes of fecal incontinence in the elderly can be supplemented by impaired elasticity of the muscles of the rectum, its prolapse, and chronic bowel diseases throughout the life span.

A specialist can reliably establish the causes of fecal incontinence in a patient of any gender and age - based on the results of instrumental and auxiliary types of research.

Fecal incontinence is not only medical, but also social problem which significantly impairs the quality of human life. Symptom occurs in diseases of the gastrointestinal tract, pathology nervous system, mental disorders, complicated childbirth. For treatment, conservative and surgical methods are used.

Diseases for which a characteristic symptom:

• haemorrhoids;
• nonspecific ulcerative colitis;
• Crohn's disease;
• schizophrenia;
• senile dementia;
• stroke;
• tumors and spinal cord injuries.

Defecation - the principle of action

The intestine is made up of two sections: the small intestine and the large intestine. The duodenum, jejunum, and ileum are parts of the small intestine. This department is responsible for the digestion of food. The large intestine consists of the caecum, colon and rectum. This is where water is absorbed and stool is formed.

The crushed food enters the stomach, where, under the influence of enzymes and hydrochloric acid, it begins to be digested. Chyme (partially digested food) enters duodenum where the ducts of the gallbladder and pancreas open. IN small intestine absorbed by the villi nutrients. Chyme moves to the large intestine, moisture is absorbed in it. Formed feces presses on the rectum, relaxes the sphincters and the person feels the desire to empty himself.

The normal frequency of bowel movements is from 1-3 times a day to 3 times a week. The act of defecation proceeds painlessly, without bringing discomfort.

Encoprese: general characteristics

Fecal incontinence defines the medical term encopresis. It denotes the inability to control the act of defecation. A person cannot delay the excretion of feces until the moment when it becomes possible to visit the toilet for this purpose. This also includes the release of solid or liquid feces during the passage of gases. More than 70% of cases of encopresis occur in children under 5 years of age. Often, fecal incontinence is preceded by constipation. It also occurs in people over 50 years of age. It leads to social isolation along with diseases such as dementia and Alzheimer's.

Fecal incontinence is a social problem (photo: www.mojdoktor.pro)

Kinds

Depending on the causative factor, there are four types of encopresis:

• regular excretion of feces without the urge to defecate;
• fecal incontinence with the urge to excrete stools;
• partial incontinence of feces during exercise, coughing, laughing, sneezing;
• age-related encopresis under the influence of degenerative processes in the body.

It is also worth noting what types of fecal incontinence are:

• functional;
• postpartum;
• congenital;
• traumatic.

To assign proper treatment, it is necessary to determine the classification and origin of the pathology.

Development mechanism

Encopresis is associated with dysregulation of the centers that are responsible for the formation of conditioned reflexes. There are three mechanisms that contribute to the appearance of a symptom:

• the absence of mechanisms responsible for the appearance of a conditioned reflex of the act of defecation. This pathology is congenital. The human does not have the rectoanal inhibitory reflex that stimulates bowel movements;
• delayed formation of a conditioned reflex;
• loss of reflex, which arose due to the action of adverse factors.

There are two development options: primary and secondary. In the first case, the pathology is considered congenital. Secondary incontinence occurs after a violation mental state patient, injury, damage to the nervous or excretory system.

Causes

The main cause of fecal incontinence is nervous regulation and weakness of the anal sphincter. Normally, the muscular apparatus of the small intestine should hold stools of any consistency.

Causes of encopresis are congenital and acquired:

• anatomical defects in the development of the anal apparatus;
• organic pathologies that can occur after childbirth and brain injuries;
• mental illness (neurosis, schizophrenia, hysteria);
• constipation;
• diarrhea;
• muscle weakness, decreased tone;
• dysfunctional pelvic floor disorders;
• haemorrhoids.

Constipation is a condition in which the number of bowel movements does not exceed three in one week. This leads to the fact that part of the solid feces is retained in the intestines. At the same time, some of the liquid stool may also accumulate, which will seep through the hard stool. In the event that constipation lasted for a long time, this will be the result of overstretching of the muscle layer of the rectum and anal sphincter, which will lead to fecal incontinence.

Diarrhea can also cause fecal incontinence. This is because the accumulation of loose stools is much faster and the pressure on the rectum is greater. The body cannot resist the urge to defecate, which leads to incontinence.

Muscular weakness of the sphincters. Occurs when nervous regulation is disturbed. Also often found in postpartum period when some women experience a perineal tear. The same applies to people who have undergone surgical interventions on the intestines.

Doctor's advice! When the first signs of fecal incontinence appear, do not self-diagnose and treat folk remedies. Seek immediate medical attention

Subsequently, some diseases (Crohn's disease, ulcerative colitis) scars and ulcers form on the intestinal mucosa. This prevents the normal contraction of the muscular layer of the intestine, peristalsis weakens, the tone decreases. These conditions can lead to fecal incontinence.

Dysfunctional disorders of the pelvic floor are associated with improper functioning of the nervous system. This happens when there is a violation of the sensitivity of the perineum, relaxation of the pelvic floor with a tendency to sag the pelvic diaphragm. Often occurs after childbirth and episiotomy (operative incision of the perineum).

Risk factors

Risk factors include the presence chronic diseases the lower part of the large intestine. People with weakness in the pelvic floor muscles are at increased risk. Also, people who have undergone surgery on the gastrointestinal tract, young mothers with a perineal rupture.

Clinical picture

The clinical picture of fecal incontinence is that the act of defecation occurs involuntarily. That is, a person cannot prepare for a bowel movement and does not have time to visit the toilet for this purpose. For some, involuntary bowel movements occur when sneezing, coughing, laughing, or physical activity. Some people suffer from fecal incontinence without the urge to defecate, while others have the urge. The circumstances under which bowel movements occur vary and depend on the cause of the symptom.

Associated symptoms in various diseases

At inflammatory diseases intestines, in addition to fecal incontinence, pain in the lower abdomen, fever (38-39º C), weight loss, weakness, fatigue, false urge to defecate join the main symptoms.

Hemorrhoids are characterized by permanent pain in the anal region, gaping of the rectum, bloody issues, burning sensation and itching. Patients complain of pain in the anus when walking, sneezing, coughing, sitting, the appearance of hemorrhoids, which increase with straining.

At mental illness in the first place comes the main symptomatology in the form of hallucinations, illusions, impaired cognitive properties.

With regard to Alzheimer's disease, it is characterized by memory loss, impaired speech, impaired reading and speech skills. The patient is not able to manage everyday skills, so he needs the help of relatives and friends.

Incontinence in children

In children under four years of age, fecal and urinary incontinence is a normal condition. This is explained by the fact that everyday habits are only being formed and the child is learning these skills. As for older children, their incontinence is more likely to occur due to frequent constipation.

Encopresis in children can also be primary and secondary. In the primary, the child lacks skills regarding the act of defecation. Secondary occurs against the background of stress, illness, overstrain. At the same time, these children did not previously have problems with bowel movements.

A common cause of encopresis in children is the feasible desire of parents to teach the child to go "on the potty". Thus, it is formed stressful situation for the baby and he reacts accordingly. Therefore, parents should approach the issue of education with all seriousness, without harming the child.

Incontinence in women during pregnancy and after childbirth

During pregnancy, namely after the 34th week, fecal incontinence occurs in 5 percent of women. This is due to the pressure of the uterus on the rectum and bladder. After delivery, factors that affect fecal incontinence are:

• first birth;
• delivery using obstetric forceps or a vacuum extractor;
• prolonged second stage of labor;
• the weight of the fetus is more than 4 kilograms;
• polyhydramnios;
• multiple pregnancy;
• median episiotomy (dissection of the perineum along the midline);
• rear view of the occipital presentation;
• previous rupture of the anal sphincter.

Among women in whom delivery took place with the application of obstetric forceps, fecal incontinence occurs in 16%. When using a vacuum extractor, the figure is slightly lower, only 7 percent.

Incontinence in the elderly

In older people (over 60 years old) fecal incontinence - secondary process. The symptom is often associated with the pathology of the nervous system, namely, a violation of the work of the cortical center of defecation. If there are problems with the functioning of the anal sphincter, involuntary bowel movements can be observed up to six times a day.

Encopresis in the elderly is associated with mental disorders, degenerative diseases of the brain. The person loses cognitive skills (reading, memory, speech). Along with this, adaptation in the environment worsens, he is not able to take care of himself on his own and requires outside help.

Which doctor and when to contact

At the first sign of incontinence, you should contact either. The doctor will collect an anamnesis, prescribe additional research methods and choose further therapy tactics. He will either treat himself, or direct him to,.

Diagnostics

Diagnosis of incontinence includes a detailed medical history. The doctor finds out the frequency of involuntary acts of defecation, the amount of discharge, their color, consistency, etc. It is also important to determine if there is an urge before bowel movements.

• anorectal manometry. This diagnostic method is aimed at determining the pressure in the anal sphincter;
• transrectal ultrasound procedure. Using the method, you can visualize the structural structure of the muscles of the anus;
• defectography (proctography) - an X-ray examination that shows the amount of feces in the intestine;
• sigmoidoscopy - endoscopic method showing the condition of the intestinal mucosa.

Diagnostics will give a complete picture of the origin of the disease. This will help you choose the most appropriate therapy tactics.

Treatment

Treatment of fecal incontinence is divided into two groups: conservative and surgical. Conservative is non-drug and drug.

Non-drug treatments include:

• diet therapy;
• physical exercise;
• electrical stimulation;
• acupuncture;
• psychotherapy.

Electrical stimulation is carried out with the aim of irritating the nerve endings, which leads to the formation of a conditioned reflex responsible for the act of defecation.

Acupuncture is used in cases where patients have increased excitability. Manipulation helps to relax a person.

Psychotherapy is used in patients whose cause of encopresis is mental disorders or traumatic diseases of the nervous system.

Among the drugs most often used:

• strychnine;
• prozerin;
• B vitamins;

Medications are prescribed for functional diseases of the gastrointestinal tract. They are aimed at both combating the underlying disease and relieving the symptom.

Surgical treatment is used in cases where the cause of the symptom is an injury to the anal sphincter. Plastic surgeries are often used in proctology.

The type of operation depends on the degree of damage to the anus. If the defect is observed on less than a quarter of the sphincter (in diameter), an operation called sphincteroplasty is applied. If the damage is more massive, the operation is called sphincterogluteoplasty. The name reflects the essence of the intervention: a part of the gluteal muscle is used as a material for plastic surgery.

Important! Fecal incontinence (encopresis) is a symptom characterized by the involuntary release of stool. It occurs due to diseases of the gastrointestinal tract, nervous system, perineal injury. Diet is used for treatment medications, surgical intervention. To prevent the symptom, strengthen the pelvic floor muscles and follow a diet

Diet food

Diet plays a leading role in the treatment of fecal incontinence. Sometimes it is enough to change eating habits to get rid of the symptom. Basic nutritional advice:

• eat more protein foods, fiber. These components improve the quality of digestion, forming a soft stool. Fiber is found in bran, almonds, flax, mushrooms, apricots, wheat. Daily rate from 20 to 30 grams. It should be introduced gradually, as an excessive amount can lead to advanced education gases;
• plentiful drink. The daily rate of water consumed is 30 ml per 10 kg of body weight. It is better to drink water than other liquids (tea, coffee, juices). Since water does not contain additional calories and does not interfere with the normal formation of feces;
• Based on the results of the blood test, vitamins and nutritional supplements may be prescribed.

The use of dairy products, smoked meats, sweeteners, caffeine, spicy and salty foods should be excluded.

Exercises

To get rid of an unpleasant symptom, doctors recommend using exercises aimed at strengthening the muscles of the pelvic floor. Kegel exercises help increase blood circulation and improve muscle tone. The complex consists of three parts:

• slow cuts. The muscles of the pelvic floor are strained, counted to 3, then relaxed;
• fast cuts. Muscles tense and relax as quickly as possible;
• extrusion. Women need to push moderately, as in childbirth. Men - as in the allocation of urine or the act of defecation.

Exercises are good because they can be performed anywhere and at any time of the day, as they do not require additional devices. Up to 5 repetitions per day are required to achieve the effect.

Consequences and complications

People suffering from the symptom try to lead an isolated lifestyle, as they feel psychological and physical discomfort in society. This leads to the fact that a person is prone to dysphoria and depression. Treating depression is a long and costly undertaking.

Complications from the anal canal include the addition of secondary bacterial flora, as well as the appearance of cracks.

The main advice is a timely visit to the doctor. The earlier treatment is started, the better and more favorable the prognosis will be.

People who suffer from fecal incontinence experience discomfort in society because of their problem. When leaving the house, you should follow a few rules:

• take with you the necessary hygiene materials (napkins, clean linen, change of clothes);
• before leaving, be sure to visit the toilet;
• in public places, find a toilet before you need it.

These simple tips help you feel more confident in the company of people.

Forecast

When encopresis is caused by diseases of the gastrointestinal tract, the prognosis for recovery, performance and life is favorable. This is possible with integrated approach to treatment: diet, medication and exercise.

If the cause of encopresis is mental disorders and organic diseases of the nervous system, the prognosis, alas, is unfavorable.

Prevention

Preventing fecal incontinence is easier than treating the symptom. To prevent the occurrence of encopresis, follow these rules:

• treatment of chronic diseases of the gastrointestinal tract;
• rational and complete nutrition with a high content of protein and fiber;
• avoidance of anal sex;
• timely excrement. Do not tolerate and delay the act of defecation;
• training the pelvic floor muscles by contracting and relaxing the muscles of the perineum.

The symptom of encopresis is sensitive and unpleasant. It brings discomfort not only to the sick person, but also to others. It is easier to do prevention than to spend a lot of effort and money on treatment.

Fecal incontinence, also called encopresis, is normal in children younger than two or three years old, but in older children it may indicate the presence of various pathologies in organism.

If a child has this disorder, you should consult a doctor who will diagnose and establish causes. Treatment of fecal incontinence in children begins only after it is clear what exactly caused it.

General information about the violation

disease widely distributed in pediatrics: 1-5% of children have experienced this disorder.

Most often it is detected in children from 5 to 8 years old and may be a symptom of disorders of the nervous system or a sign of other pathologies, including mental disorders.

Boys fecal incontinence is several times more common than in girls.

30-35% of children with fecal incontinence also have bedwetting.

Many parents, when they see that the child has problems with holding feces, long time may not see a doctor, hoping that the problem will sooner or later will pass on its own.

Statements such as “this is such an age”, “this is all from the nerves”, but it is important to understand that encopresis in some cases is a sign serious illnesses, which must be urgently started to be treated, and in addition creates psychological discomfort for an adult child.

It is more difficult for children with this disease to adapt to school, they may become outcasts who will be ridiculed for years, even when the violation is gone.

Young children with incontinence also often endure humiliation and insults from relatives, including parents, many of whom, when they see feces in their underwear, begin to resent and shame the child, which only exacerbates the problem.

It is important for parents to learn: to humiliate and Shame on a child for fecal incontinence. He really cannot control the defecation process, and psychological abuse has never done anyone any good.

Reasons for the appearance

Why does my child have fecal incontinence? If the child is under 3 years old, the violation can be considered a variant of the norm, but if it persists when the child is 3-4 years old, the baby should be taken to the hospital.

At children and teenagers fecal incontinence usually has similar causes, but in older children (8-10 years) this disorder is more often associated with psychological problems, since incontinence due to somatic (physical) abnormalities is detected much earlier.

The main causes of true encopresis:

There is also a false encopresis, which appears for the following reasons:

1. Chronic constipation. A very common cause of incontinence. Fecal masses that collect in the lower zones of the rectum put pressure on the anus. It stretches and loses sensation. More liquid feces at this point may leak out.
2. The child holds feces for a long time for various reasons. For example, a school may have poor-quality toilets that don't even have partitions, let alone cubicles, so some children may be embarrassed to defecate there. Also, if a bowel movement causes pain in a child ( , ), he may try to hold on to feces. When enough fecal masses are collected, the anorectal area may temporarily lose sensitivity. Its walls will stretch, and the feces will fall on the underwear.

Early pregnancy and childbirth can also influence the onset of fecal incontinence in adolescent girls.

In most cases, fecal incontinence is observed when the child is awake and there is no problem at night.

Bedwetting is rare and usually indicates the presence of neurological abnormalities And mental (mental) disorders. If a child has a nocturnal form, this is an unfavorable prognostic sign.

Types and forms

Depending on the causes of the violation, the following types are distinguished:

1. Neurotic. The most common type of incontinence. Its appearance is associated with various mental disorders that have arisen due to the impact of psychotraumatic situations, which include different kinds violence, chronic stress and everything that in one way or another could negatively affect the child's psyche.

Contrary to the belief of some adults, neurotic deviations, especially severe ones, do not disappear completely on their own, except that they can soften with time, become less noticeable, so such children need support and psychological help.

2. Organic. This category includes all encopreses that were caused by organic disorders in the organs and systems responsible for the defecation mechanism, in particular the large intestine, sphincter, spinal cord and brain. In children, such disorders are usually congenital in nature, but can also be acquired (for example, traumatic injuries of the head and spinal column, neoplasms in the rectum).

According to the timing of the appearance of pathology, there are:

There is also a classification associated with the mechanism of development, according to which, encopresis is divided into:

1. True. Includes all cases that have arisen due to disturbances in the mechanisms of transmission of nerve impulses from the brain to the large intestine. This type of fecal incontinence is much less common than false incontinence: only 10-20% of cases fall into this category.
2. False. Associated with chronic constipation or intentional retention of feces.

In addition, fecal incontinence is divided into day and night.

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Symptoms

If the ailment is associated with constipation, parents may note characteristics this violation:

• the child goes to the toilet unproductively, may complain that he is unable to go, and discomfort in the abdomen;
• with long-term constipation, weakness, loss of appetite, nausea occur, the child may complain about the stomach, sleeps poorly.

In loving families, children are rarely afraid to talk about their condition, so constipation does not develop into chronic, except when it is associated with organic disorders.

Incontinence can be expressed in different ways. In most cases, traces of feces are found on the underwear, and not full-fledged fragments (but they are not uncommon).

One or more unsystematic cases of incontinence with perfectly understandable reasons(for example, a child enthusiastically played active games and did not react in time when urges appeared) should not cause concern.

neurotic incontinence accompanied by symptoms characteristic of mental disorders:

• apathy;
• insomnia, superficial sleep;
• anxiety, the presence of fears that prevent the child from sleeping and doing daily activities;
• Bad mood;
• deterioration in general well-being;
• irritability, in some cases aggressiveness;
• isolation, detachment;
• loss of interest in familiar activities and toys;
• fast fatiguability;
• violation of concentration;
• deteriorating grades in school.

Some of these symptoms may be absent. It all depends on what kind of violation the child has and what it is connected with.

You can talk about pathology if incontinence was observed in a child at least once a month for six months.

If fecal incontinence occurs in conjunction with enuresis ( urinary incontinence), which also often speaks in favor of psychological reasons, but in some cases indicates the presence of organic pathologies. Enuresis usually occurs at night, and encopresis occurs during the day.

Diagnostics

The main goals of diagnostics are to identify diseases that influenced the onset of the disorder so that they can be effectively eliminated or mitigated.

The doctor conducts conversations with the parents of the child and with the baby himself, finds out what kind of food he receives, whether there are other symptoms that allow for a diagnosis how the birth and pregnancy went.

Also held additional research, depending on the symptoms:

• rectal examination;
• X-ray of the large intestine;
• magnetic resonance and CT scan brain and spinal column;
• X-ray of the spine;
• clinical analysis of urine and blood.

Diagnosis of incontinence is carried out by a gastroenterologist and a pediatrician. If necessary, the child is also examined by psychiatrist or psychotherapist.

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Treatment

How to treat? In the treatment of incontinence, the following methods are used:

Alternative methods of treatment, especially herbal medicine, can improve the condition of the child. It is useful to brew soothing herbs (mint, lemon balm, motherwort, valerian, chamomile), you can also add decoctions to bathing water.

1. After eating, the child can be put on the toilet so that he strains the sphincter for some time: this stimulates intestinal motility, and the child learns to control defecation and feel call signs.
2. Compliance with the regime is very important: if the child gets used to pushing at a certain time, most of bowel problems will disappear.
3. If the child does not want to sit on the toilet, you do not need to force him: this will adversely affect his psyche. Also, the child should be told in a calm atmosphere about the work of the intestines and why it is important to follow the regimen.

Prevention

To reduce the chance of fecal incontinence in children, important:

• make sure that the atmosphere in the house is friendly and comfortable;
• solve problems through calm, balanced conversation (if the child is small, a lot can be explained to him in the form of a game or with the help of images);
• in time to form a reflex mechanism in the child (it is important to avoid punishments, insults);
• do not scold when traces of feces are found on underwear;
• reduce the consumption of junk food and increase the amount of vegetables and fruits in the diet.

Launched ailment it is quite difficult to cure completely, so it is necessary to take the child to the hospital if signs of incontinence appear. If treatment is started on time, the prognosis is favorable.

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toilet addiction

Encoporesis is a condition in which the defecation process becomes uncontrollable. Bowel incontinence in the rectum cannot be considered a disease, since it does not pose a threat to life. However, it is considered an organic pathology. Inaction leads to irreversible serious consequences.

Frequent problem- Fecal incontinence in men, there may be several causes and treatment options. The intestinal system ceases to regulate the process of emptying. Nerve endings, muscles of the anus begin to work inconsistently. Feces are thrown out involuntarily, the nerve plexuses of the anorectal zone stop sending signals to the spinal part, the brain. Causes - trauma, hemorrhoids, oncology of the anorectal region. Why is fecal incontinence manifested in men causes and treatment. Kegel exercises. When is surgery required? Basic preventive measures, expert advice.

What does old age bring with it?

For many men, as they age, the urge to empty the intestinal walls becomes uncontrollable. Feces depart involuntarily, at any time and before going to the toilet.

The mechanism of the development of pathology is due to a malfunction in the regulation of the brain center, which ceases to respond to conditioned reflexes, maintain intestinal tone, and retain feces in the rectum until the right moment comes.

It is in the elderly (unlike women) that the pathology progresses more often, when the average sphincter pressure can reach up to 125 mm / hg / st, remaining constantly in tension (during wakefulness, sleep).

If normally, mechanoreceptors stimulate the act of defecation in the rectal canal, causing the Valsava reflex and signaling to the brain that it is time to go to the toilet. With encoporesis, fecal accumulations begin to move away involuntarily. Self-control over the defecation process is partially (completely) lost. Affected men become unable to hold stones. As a result, gases and stools (solid, liquefied) begin to move away spontaneously.

The main provoking factor is a defecation disorder observed in men over the age of 65 years.

Other reasons:

Weakened by drugs

• chronic constipation;
• abuse of laxatives;
• the intestinal operation transferred the day before;
• violation of the sensitivity of the rectal area;
• hemorrhoids (terminal stage);
• prolonged diarrhea;
• degradation of the nervous system.

Reference!Stroke survivors often suffer from uncontrolled bowel movements. multiple sclerosis, brain injury, Parkinson's or Alzheimer's disease. The reason is in congenital anomaly pelvic region, obesity, .

Insolvency of the sphincter, fecal incontinence in young men can be observed due to stress, fear, depression, a sharp change in mood. In the elderly, this is a consequence of the defeat of the anal apparatus, a dysfunctional disorder of the pelvic floor.

Anorectal diseases

Stool incontinence in men is observed with external hemorrhoids, when hemorrhoidal bumps begin to fall out. The sphincter muscles stop completely blocking the anus. As a result, spontaneous seepage of liquid diarrhea with mucus or at the wrong time before a planned trip to the toilet.

Other diseases of the anorectal zone:

Intestinal disorders

1. Tumor (malignant, benign) of the rectum, sigmoid colon.
2. Paraproctitis in case of fistula formation, abscess on the perianal area.
3. Coccygodynia is a consequence of trauma to the sacrococcygeal region, causing severe pain in the gluteal region, perineum. A clear sign of the disease is paroxysmal soreness, not associated with the urge to empty.
4. Proctitis is an inflammation of the mucous membrane of the rectal canal, accompanied by pain. Forms of the disease: catarrhal, ulcerative, fibrous, purulent, necrotic.

Can cause urinary incontinence infectious diseases caused by a sexual infection, when patients begin to experience particular discomfort in the anorectal zone, constipation alternating with diarrhea, or constant difficulty in defecation.

sphincter muscle weakness

Fecal incontinence in men often provokes a lesion or anus, when even in the closed position, men stop holding feces.

Causes of Sphincter Weakness:

• surgery to remove hemorrhoids;
• oncology (cancer) of the rectal canal.

Decreased muscle tone in the rectum

Normally, in healthy men, the intestine is perfectly stretched, it completely keeps the feces within the limits of the possible. In the case of a decrease in muscle tone, the walls of the rectum become inelastic. Muscles no longer adequately stretch and hold stones, causing fecal incontinence.

Causes of decreased muscle tone:

• diarrhea, intestinal disorders;
• Crohn's disease;
• ulcerative nonspecific colitis;
• operation of the anorectal region;
• radiation therapy.

Dysfunctional pelvic floor disorder

Incontinence in men can be the result of dysfunction of the muscles (nerves) of the pelvic floor. This reduces the sensitivity and self-contracting ability of the muscles.

Dysfunctional disorder is a whole complex of pathologies of the pelvic organs, the reasons why in older men:

Accompanying illnesses

• atherosclerosis;
• encephalitis;
• brain tumor;
• Alzheimer's disease;
• sphincter muscle weakness;
• nocturnal enuresis;
• prostatitis;
• trauma of the urinary system;
• constipation.

The result of provoking factors is false urge to defecate or uncontrolled discharge of feces. The pelvic floor is constantly in a relaxed state or sags, falls out, and the rectum protrudes out of the anus.

Types of fecal incontinence in the elderly

Encoporesis in the elderly has several varieties that differ in symptoms, the frequency of fecal leakage intervals.

Doctors distinguish between incontinence:

• partial, when the feces go out when excessive pressure is applied to the sphincter of the anorectal zone at the time of coughing, sneezing, lifting weights;
• regular with a course in severe conditions in the elderly on the background of a heart attack, stroke, Alzheimer's disease.

Encoporesis has 4 stages of development:

1. Stage 1 - no retention of accumulated gases inside the rectum.
2. Stage 2 - no retention of gases, loose stools.
3. Stage 3 - no retention of gases, liquid and even solid stones.

Reference! Each of the varieties of pathology proceeds in a special way, therefore, before conducting therapeutic therapy, patients must undergo a thorough diagnosis.

We train the intimate muscles of the pelvic floor, Kegel exercises

Physical exercise

It is Kegel exercises that gradually begin to restore the lost functions of the rectal apparatus, train the sphincter and pelvic floor muscles. The complex is developed together with the doctor. The essence of therapy is squeezing and unclenching the anal sphincter after inserting a rubber tube lubricated with petroleum jelly into the rectum. The main goal is to train the weakened anal sphincter and muscle to hold feces before going to the toilet.

The course of therapy is 3-8 weeks. The duration of 1 session is 1-16 minutes. Doctors recommend up to 5 sessions daily. Additionally, strengthen the muscles of the gluteal region and pump the abdominal press by performing other physical exercises.

Treatment of stool incontinence

Encoporesis requires an integrated approach to treatment. On the initial stage when there is slight gas incontinence, it is enough to empty the intestines regularly, review the diet to normalize the functions of the digestive organs and exercise regularly. At stages 2-3 of fecal incontinence, medications and non-traditional methods are prescribed. In advanced cases, surgical intervention.

Medicines can stop prolonged diarrhea, increase sensitivity in the sphincter, improve the condition of the anal muscles, and make men feel better with severe anorectal pain:

Doctor's recommendations

• painkillers (Diphenoxylate, Codeine) to reduce intestinal motility, increase muscle tone;
• drugs to minimize water in the feces (Polysorb, Metamucil, Kaopektat);
• anticholinergics in the composition with belladonna, atropine to slow down peristalsis and reduce intestinal secretion;
• tranquilizers, sedatives, sedatives to regulate behavior in psychological disorders in patients who have led to uncontrolled stools;
• vitamin complexes (Furazolidone, Imodium).

Medications are prescribed only by the attending physician based on the results of the diagnostics, the general well-being of patients, the type of fecal incontinence.

Other non-drug methods of exposure:

1. electrical stimulation
2. BFB is a technique using special devices with sensors. The patient begins to hold the external sphincter in a tense state. The received data is displayed on the monitor. The goal of treatment is to achieve long-term contraction of the anal muscles, conscious control of the process of bowel movements.

If medical, non-drug methods of exposure become useless for fecal incontinence in men, then the only way out is surgery. Especially if the failure of the anal sphincter is caused by oncology, a tumor in the rectum.

Surgery methods:

Surgical treatment

1. Sphincteroplasty, used for rupture (trauma) of the muscle ring. The main thing is to achieve sphincter reconstruction.
2. Surgery by sewing sphincter muscles to the anus.
3. Installation of an artificial sphincter, in which a girdle cuff and an air pump are attached to the anus. The main goal is to keep the anus closed until going to the toilet and having a bowel movement.
4. Colostomy with excision of the affected colon, collection of feces in a colostomy (special bag), bringing the anus and sewing to the anterior wall of the peritoneum.

Psychotherapy plays a significant role in stone incontinence in the elderly, since often in old age the pathology is caused by psychological disorders. The technique is aimed at training a conditioned reflex that is responsible for events and signals the situation in which defecation should be performed. In addition, patients must strictly observe the regimen of visiting the toilet, at about the same time: in the morning after sleep or after eating.

Fecal incontinence in the elderly

Unfortunately, fecal incontinence, dysfunction of the cortical center and psychiatric disorders often seen in older men. This is an acquired condition, when emptying becomes involuntary up to 5-6 times a day. To obtain beneficial results, the relatives of a sick man suffering from nervous disorders, reduced memory. The help of close people is invaluable in attention, tips, giving commands when the patient needs to visit the toilet, adhering to the established regimen.

Often, old people lose partially (completely) mobility and, for physical (nerve paralytic) reasons, do not feel the urge to defecate. It may be necessary to track diaper changes in advance and teach them to show reactions to going to the toilet after eating, immediately after waking up.

Big role in case of incontinence of the stool, it is given to a diet with the intake of products with vegetable fiber to increase the volume of softened fecal accumulations. It is important to exclude alcoholic and carbonated drinks, coffee, milk, spices, salt, smoked meats. You need to drink at least 2 liters of clean liquid per day.

It is important to protect elderly patients from stress, anxiety, negative situations. Constantly train the sphincter, pelvic floor muscles through simple exercises.

Fecal incontinence is a serious problem for older men, although it can be successfully treated if you turn to specialists in a timely manner. But with such a delicate problem, not many patients rush to the doctors, choosing a reclusive position, driving themselves into a corner.

The failure of the anal sphincter is an unpleasant disease that cannot be ignored.

If you had to deal with encopresis, then experts advise:

doctor and patient

• empty the intestines more often, avoiding overflow with feces;
• take diapers, a set of removable linen, wet wipes with you to the street;
• find out in advance where the toilet is located if you have to stay away from home for a long time;
• keep drugs with you to alleviate the specific smell of feces with uncontrolled discharge to the outside.

Fecal incontinence is not dangerous in itself. Successfully corrected at the initial stage, eliminated with an integrated approach to treatment.

Often, pathology in the elderly is the result of a stroke, an ischemic crisis, a fracture of the spine, and oncology. Of course, the prognosis in most cases is unfavorable. That is why the first manifestations of sphincter weakness and fecal incontinence cannot be ignored. Do not try to correct the situation yourself by applying folk recipes Houses. To keep the sphincter in good shape means to train it daily, squeezing and loosening the muscles. For prevention purposes, doctors do not advise restraining the urge to defecate. It is important to empty the intestines in a timely manner, treat diseases of the gastrointestinal tract, rectum (sigmoid) colon.