SEARCH RESULTS FOR: Fecal-Incontinence

Fecal Incontinence

Authors: Britney Wong Timothy Fu Reviewers: Shahab Marzoughi Jake Thorsteinson Jessica Revington Yan Yu* Erika Dempsey* * MD at time of publication **See corresponding Calgary Guide slide Legend: Pathophysiology Mechanism Fecal Incontinence: Pathogenesis, mechanisms, & complications Chronic bowel straining Complex vaginal delivery Stretch injury of pudendal nerve (innervates the pelvic muscles & external anal sphincter) Rectal or genital prolapse** Pelvic surgery Local neuronal damage Direct impairment of internal anal sphincter which controls approximately 70% of anal resting tone Pelvic trauma Impaired motor control of pelvic muscles & the external anal sphincter Direct impairment of external anal sphincter ↓ Resting tone in internal anal sphincter Voluntary external anal sphincter contraction is no longer sufficient to close the anus Continence (voluntary ability to control release of stool) mechanisms are impaired ↓ Control over an essential bodily function ↑ Assistance required with toileting & basic hygiene Colon inflammation (e.g., ulcerative colitis, radiation proctitis) ↓ Stretch capacity of rectal smooth muscle ↓ Stool storage capacity in rectum ↑ Defecation urgency Internal anal sphincter reflex relaxes ↑ Caretaker burden ↑ Perception of & exposure to various social stigmas associated with poor hygiene practices ↑ Feelings of shame or significant embarrassment ↑ Stress & anxiety ↓ Confidence & sense of agency ↓ Engagement in social activities or work Complications Sign/Symptom/Lab Finding Diarrhea- predominant irritable bowel syndrome Movement disorders (e.g., arthritis, Parkinson’s) Age-related ↓ in mobility Sensory neuropathy (e.g., diabetic neuropathy) Conditions altering mental status (e.g., stroke, dementia) Chronic constipation Chronic diarrhea Solid & immobile mass of stool builds up in the rectum Laxatives ↓ Mobility can impact timely toileting access & habits Rectal hyposensitivity (↓ perception of rectal distension) ↑ Stool volume ↑ Loose stools Loose stool is more prone to escape through the anal canal, compared to solid stool Failure to sense rectal fullness leads to voluntary relaxation of the external anal sphincter Loose stool can flow around impacted stool mass & exit the anal canal (overflow diarrhea) Continence mechanisms are intact. Mechanisms are subsequently overwhelmed or bypassed Fecal Incontinence Unintentional loss of solid or liquid stool ↑ Prolonged skin contact with an irritant (stool) Prolonged skin exposure to digestive enzymes (e.g., proteases, lipases) in stool ↑ Skin pH, repeated mechanical abrasion (wiping) & excessive moisture degrade built-in protective barriers in the skin ↑ Skin inflammation ↑ Skin erythema (redness) Incontinence-associated dermatitis (degradation & loss of protective skin layers) ↑ Pain & skin irritation Bacteria from residual stool can colonize eroded & damaged tissue ↑ Risk of skin infection ↓ Help-seeking behaviours ↓ Access to & pursuit of treatment Published May 2, 2020; updated October 19, 2025 on www.thecalgaryguide.com