Evaluating Fecal Incontinence - Fecal Incontinence: Bladder Conditions

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Evaluating fecal incontinence

A surprising number of people with fecal incontinence don't seek medical attention. Half of those with severe incontinence and 95% of people with occasional accidents try to cope on their own and therefore miss getting the help that is available. Your primary care physician is likely to be a good place to start, but don't be surprised if you are referred to a specialist for evaluation (see "Choosing a clinician"). Ideally, your physicians will work together to arrive at the best approach to the problem.

Talking to your doctor about fecal incontinence can cause embarrassment. Keep in mind that, to your physician, fecal incontinence is not a personal problem, but a medical symptom like any other — one that needs to be investigated thoroughly because there are so many possible causes. To that end, you can help by being prepared to answer detailed questions:

• When did the incontinence start?

• How often do you have an accident? What happens? Do you lose a large or small amount of stool? Do you have any warning? Does anything seem to bring it on (such as physical activity, stress, time in menstrual cycle, particular foods)?

• Is it getting worse over time? Does anything seem to make it better or worse?

• When your rectum is full, can you distinguish whether it is solid, liquid, or gas? Do you sometimes think you are passing gas, only to be surprised that stool has come out?

• When you feel the need to have a bowel movement, how long can you wait?

• After you defecate, do you feel like there is stool left inside?

• What are your regular bowel habits? Do you often have diarrhea or constipation? Do you often have cramps or see blood in your stool?

• Are you using pads or other means to manage the incontinence? How is it working?

• Do you use any products to prevent constipation?

• Do you also experience urinary incontinence?

Because a wide variety of medical conditions and traumas can affect continence (and the symptoms may not appear until much later), the doctor will need a detailed medical history. If you have delivered one or more babies, it may be helpful to provide the length of your labors, how much the babies weighed, whether deliveries involved the use of forceps or episiotomies, whether you had any tears that needed repair, and how your bowels functioned after the deliveries.

Let the physician know about other medical conditions you have and any medications (over-the-counter or prescription) you take. Also relevant are any injuries or treatments in your pelvic region. For example, have you had prostate or hemorrhoid surgery? Radiation to the pelvic area? An injury involving your spine or your anus?

Be frank about your concerns. Although fecal incontinence is rarely the first sign of rectal cancer or another serious medical condition, let your doctor know about your fears. And make sure the doctor knows exactly how the incontinence is affecting your life and how you are attempting to manage it. During your evaluation, your physician — or a nurse who specializes in incontinence — may be able to suggest more effective ways to manage the problem.

Last updated:	September 05, 2008