Let’s Begin Treatment
“Our goals in this website were to educate you about what fecal incontinence is, what causes it and what treatment options exist. It has also given me the opportunity to introduce myself and to let you know that there is hope. If you’re ready, it’s time to take the next step, beginning treatment. Below is a list of questions you might be asked at our first meeting, along with some tests that may or may not be needed. Together we’ll do everything we can to make your fecal incontinence a thing of the past.”
Dr. Liam Haveran
How is fecal incontinence diagnosed?
Health care providers diagnose fecal incontinence based on a person’s medical history, physical exam, and medical test results. In addition to a general medical history, the health care provider may ask the following questions:
• When did fecal incontinence start?
• How often does fecal incontinence occur?
• How much stool leaks? Does the stool just streak the underwear? Does just a little bit of solid or liquid stool leak out or does complete loss of bowel control occur?
• Does fecal incontinence involve a strong urge to have a bowel movement or does it happen without warning?
• For people with hemorrhoids, do hemorrhoids bulge through the anus? Do the hemorrhoids pull back in by themselves, or do they have to be pushed in with a finger?
• How does fecal incontinence affect daily life?
• Is fecal incontinence worse after eating? Do certain foods seem to make fecal incontinence worse?
• Can passing gas be controlled?
Will I be asked to fill out a questionnaire?
People may want to keep a stool diary for several weeks before their appointment so they can answer these questions. A stool diary is a chart for recording daily bowel movement details. A sample stool diary is available on the Bowel Control Awareness Campaign website at www.bowelcontrol.nih.gov.
Your doctor will perform a physical exam and may suggest one or more of the following tests:
• anal manometry
• anal ultrasound
• magnetic resonance imaging (MRI)
• flexible sigmoidoscopy or colonoscopy
• anal electromyography (EMG)
Anal manometry. Anal manometry uses pressure sensors and a balloon that can be inflated in the rectum to check the sensitivity and function of the rectum. Anal manometry also checks the tightness of the anal sphincter muscles around the anus.
Anal ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. An anal ultrasound is specific to the anus and rectum and is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician. The images can show the structure of the anal sphincter muscles.
MRI. MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x rays. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist. MRIs can show problems with the anal sphincter muscles.
Defecography. This x ray of the area around the anus and rectum shows how well the person can hold and evacuate stool. The test also identifies structural changes in the rectum and anus such as rectocele and rectal prolapse. The radiologist studies the x rays to identify problems with the rectum, anus, and pelvic floor muscles.
Flexible sigmoidoscopy or colonoscopy. These tests are used to help diagnose problems causing fecal incontinence. The tests are similar, but colonoscopy is used to view the rectum and entire colon, while flexible sigmoidoscopy is used to view just the rectum and lower colon. These tests are performed at a hospital or outpatient center by a gastroenterologist.
Anal EMG. Anal EMG checks the health of the pelvic floor muscles and the nerves that control the muscles. The health care provider inserts a very thin needle electrode through the skin into the muscle. The electrode on the needle picks up the electrical activity given off by the muscles and shows it as images on a monitor or sounds through a speaker. This shows whether there is damage to the nerves that control the external sphincter and pelvic floor muscles.