Incontinence of stool or anal incontinence is most often due to a tear in the anal sphincter or circular muscle that keeps stool and gas from escaping. Traumatic childbirth and or anal surgery are causes of this. Immediate repair is preferred, however, many women have undiagnosed tears in the anal sphincter at the time of childbirth and may present much later in life with inability to control gas and stool.
The evaluation for this issue involves a pelvic exam and usually an ultrasound of the anal sphincter. Sometimes a test called defecography is also done to further evaluate the function of liquid (contrast) in the rectum and the defecation process.
Treatment options include:
Bowel regimen: includes bulking the stool with insoluble fiber (food and supplements)
Pelvic Floor Physical Therapy: promotes the strengthening of muscles of the pelvic floor which surround the anal opening. Biofeedback and vaginal weights can be also be used.
Interstim Sacral Nerve Neuromodulation: reduces stool loss by increasing pelvic floor tone and reducing fecal urgency through sensory nerves.
Anal Sphincter Repair: outpatient repair of torn or interrupted anal sphincter. Best results for reduction of leakage of stool is achieved if repair done as soon as injury occurs, but improvement can be 50-85% even if done 20+ years later.