From the Guidelines
Yes, sarcoidosis can potentially cause fecal incontinence issues, though it is not a common symptom. Sarcoidosis is a systemic inflammatory disease that can affect multiple organs, including the nervous system. In rare cases, it can impact the nerves controlling bowel function, leading to fecal incontinence. This is most likely to occur if sarcoidosis affects the spinal cord or peripheral nerves involved in bowel control. According to the most recent guidelines, patients with fecal incontinence should undergo a thorough evaluation to determine the underlying cause of their symptoms 1.
Evaluation and Treatment
If a patient with sarcoidosis experiences fecal incontinence, they should consult their doctor immediately. Treatment would typically involve managing the underlying sarcoidosis, often with corticosteroids like prednisone, and potentially immunosuppressants like methotrexate or hydroxychloroquine. Additionally, symptomatic treatment for fecal incontinence may include:
- Pelvic floor exercises
- Dietary changes to avoid irritating foods
- Anti-diarrheal medications if loose stools are contributing
- In severe cases, sacral nerve stimulation or surgical interventions might be considered, as suggested by the guidelines for the investigation of chronic diarrhoea in adults 1.
Importance of Thorough Evaluation
It's essential to note that fecal incontinence in sarcoidosis patients could also be due to other factors, such as structural or functional etiologies, including rectocele, enterocele, sigmoidocele, rectal intussusception, or rectal prolapse 1. Therefore, a thorough evaluation, including a digital rectal examination, anal manometry, and balloon expulsion test, is necessary to determine the exact cause and appropriate treatment. Imaging may also be obtained for further evaluation, particularly in patients with discordant findings on manometry and the balloon expulsion test 1.
From the Research
Sarcoidosis and Fecal Incontinence
- There is no direct evidence to suggest that sarcoidosis can cause fecal incontinence 2, 3, 4, 5, 6.
- Sarcoidosis is a multisystem disease that can affect various organs, including the gastrointestinal tract, but its involvement in the hollow organs is rare 4.
- Gastrointestinal symptoms, such as digestive and abdominal symptoms, can occur in patients with sarcoidosis, but these are often nonspecific and may not be directly related to fecal incontinence 2.
- Fecal incontinence is a complex condition that can result from the interplay of multiple pathogenic mechanisms, including disruption or weakness of the external anal sphincter, damage to the endovascular cushions, and pudendal neuropathy 6.
- While sarcoidosis can cause gastrointestinal symptoms, there is no clear evidence to suggest that it can cause fecal incontinence, and other factors, such as obstetric trauma, are more commonly associated with this condition 6.