The major sign/symptom of fecal incontinence is the loss of bowel control during flatus or occasional episodes of diarrhea.  Other serious conditions causing fecal incontinence include neurologic conditions that affect the spinal cord. In many cases, these conditions cause irreversible fecal incontinence of full bowel movements without warning or control.  In this patient population, the symptoms may include increased the urgency to defecate, with the inability to voluntarily control the expulsion of stool. Fecal incontinence is when these patients have the urge to defecate so unexpectedly, that they are unable to make it to the toilet in time.  Another form of fecal incontinence is Passive Incontinence. This is a type of fecal incontinence in which patients do not feel the urge to defecate, or even acknowledge that they have to defecate, but still unexpectedly empty their bowels.

It is important to remember that these symptoms can be resolved in many cases. Therefore, it is important that you speak with a healthcare provider so that the appropriate physical examination can be performed and the appropriate treatment plan can be initiated.

Diagnosis of Fecal Incontinence:
Your physician will begin by performing a thorough history and physical examination to determine the potential causes of fecal incontinence.  Your physician may wish to perform laboratory work and imaging studies to better understand the root cause.  In some instances, surgery may even be recommended to help alleviate fecal/bowel incontinence.    Your physician will likely perform a digital rectal examination to determine if there is normal sphincter tone within the anus.  An ultrasound may be helpful to evaluate the anal sphincters; this is better known as a transanal or endoanal ultrasound.  This allows for evaluation of both the internal and external sphincters to determine if one, the other, or both sphincters are responsible for the fecal incontinence.  It allows for real-time evaluation and the results are very specific.  

A test known as the Balloon Expulsion test may also be recommended.  During this medical study, a medical balloon is inserted into the rectum and the balloon is filled with water. At this point, the patient is instructed to use the restroom and expel the balloon.  The length of time it takes for the patient to be able to expel the balloon is the time that is useful in determining if there is a disorder resulting in fecal incontinence.  The time recorded is then documented and if it is greater than one minute, it means the patient took at least a minute or longer to expel the balloon from the rectum. This indicates that the patient likely has a disorder that is responsible for the fecal incontinence.

Another more commonly used tool is the Anal manometry. The anal manometry is a flexible, thin tube that is inserted through the anus into the rectum.  There is a small medical balloon located at the tip of the flexible tube, and the balloon is expanded within the rectum.  The use of this technology allows for proper evaluation of the actual anal sphincter tone, as well as the rectum’s functioning.  If these studies do not provide enough information, it indicates that further workup and other imaging studies or procedures might be required.  Anorectal ultrasound is similar to a trans-vaginal ultrasound, except for the fact that the ultrasound wand is inserted into the anus and rectum, as opposed to the trans-vaginal ultrasound that is inserted into the vaginal canal to evaluate the uterus.  The anorectal ultrasound provides images that will allow the physician to evaluate the anatomy of the anus and determine if there are any structural abnormalities of the sphincter.  

A Proctography is another imaging study that utilizes x-rays to evaluate the patient while they are actually having a bowel movement on a medically designed toilet.  The Proctography actually measures how much stool is expelled from the rectum as well as how much stool can actually be held within the rectum.  These studies can be very beneficial to the physician to help determine if there is a mechanical/structural or neurological reason why the fecal incontinence is occurring.

If these tests are not conclusive, it is imperative that a Gastrointestinal physician is consulted so that appropriate procedure can be conducted.  Sometimes it is necessary to actually look inside the gastrointestinal tract to determine what is actually causing the bowel incontinence.  A colonoscopy can be very beneficial to better understand any mechanical or anatomical anomalies.  A colonoscopy is a tube with a camera on it that looks inside the anus, rectum and large intestines.  It will evaluate the entire structures to determine if there is any anatomical reason why the fecal incontinence is occurring.

If the fecal incontinence is thought to be as a result of denervation of muscles, then an MRI may be an appropriate imaging study to better evaluate the muscles and the sphincters.  This imaging study may also be performed during a bowel movement to further evaluate the functioning of the anatomy.  This study during defecation, in which an MRI is performed, is known as a Defecography.

With the aforementioned information at your disposal, you will now be better placed when you consult your physician and discuss the tests and studies you need to go through.