Normal Bowel Control

• There are 2 rings of muscle (internal and external anal sphincter) around anus to hold faeces inside anal canal
• Under normal circumstances, internal anal sphincter is closed except during defecation. When stool reach rectum, ‘urge’ feeling is sent to the brain, we can voluntary contract the external anal sphincter to resist defaecation

Types of fecal incontinence

• Involuntary passage of flatus, liquid stool or formed stool without awareness
• Flatus / stool incontinence when there is urge for bowel opening

• Leakage of small amount of stool after normal defaecation

Causes

• Neurological dysfunction: Neurological damage like DM neuropathy, spinal cord injury resulted reduced neurological control in defecation
• Damage of anal sphincter: Any cause that damage anal sphincter resulted incontinence
• Fecal impaction: Bulky hard stool in rectum distended anal sphincter and allow watery stools to leak out
• Decreased rectal capacity: For example in inflammatory bowel disease or after irradiation

Management

• Sphincter exercise: to strengthen muscle around anus in order to improve fecal and flatus incontinence.
• Other points to note:

If loose stool

• Diet related：Reduce food / drinks containing caffeine or irritating bowel
• Increase roughage intake e.g. fiber, vegetables or fruit

If constipated

• Maintain adequate roughage intake
• Perform exercise to aid peristalsis
• Maintain adequate fluid intake to aid defecation
• Maintain good bowel habit
• Consult doctor for drug treatment if necessary