Incontinence

author/s: Dr Mª Carmen Peña Cala

 

What is it?

It is the repeated loss of voluntary control of anal continence.

 

What people suffer from it?

Between 3 and 7% of the population suffers from incontinence, although the majority of affected individuals do not seek medical help because they are embarrassed or because of a lack of knowledge of current techniques.

It is more frequent in:

    • Women.
    • People over 65.
    • People with mobility difficulties.

 

What is it caused by?

Alterations or loss of strength of the muscles or anal sphincters:

    • Following anorectal interventions (fissures, fistulas, haemorrhoids).
    • Multiple or difficulties deliveries.
    • Trauma.
    • Pulling of pelvic nerves (constipation).

Decrease of rectal sensibility:

    • Dementia, old age.
    • Medular lesions.
    • Cerebrovascular accidents.
    • Multiple sclerosis.

Decrease of rectal capacity:

    • Infectious proctitis (inflammation of the rectum).
    • Actinic proctitis (following radiotherapy).
    • Intestinal inflammatory disease.
    • Some rectal tumours.

 

How is it diagnosed?

    1. Detailed patient clinical history.
    2. Physical examination including a rectal palpation.
    3. Psychological support.
    4. Endoanal ultrasound to evaluate if the sphincters are damaged.
    5. Anorectal manometry to assess anorectal function.

 

Can it be treated?

Depending on the type and severity of the incontinence, there are several possibilities that can be applied either in combination or separately.

    1. Diet: intake of fibre and mass-forming agents.
    2. Drugs: Loporamide.
    3. Anorectal biofeedback.
    4. Reconstructive surgery or prosthetic surgery.

 

What is biofeedback?

It is a painless, computer-based technique where patient has to follow a series of body exercises to strengthen the anal sphincters. Later on, the patient can follow these exercises at home.