From the Guidelines
Yes, hemorrhoids can cause a sensation of fecal incontinence or incorrect passage of stool. This sensation, often described as incomplete evacuation or fecal leakage, occurs because hemorrhoids are swollen blood vessels in the rectal area that can interfere with normal bowel function. When hemorrhoids become enlarged, they can partially block the anal canal, making it difficult to completely empty the bowels. Additionally, internal hemorrhoids that prolapse (protrude outside the anus) can create a physical obstruction that alters the normal passage of stool.
Causes and Mechanisms
The pathogenesis of enlarged, prolapsing cushions is unknown, but many clinicians believe that inadequate fiber intake, prolonged sitting on the toilet, and chronic straining at stool contribute to the development of symptomatic hemorrhoids 1.
Treatment Options
Treatment options include over-the-counter medications like hydrocortisone creams for symptom relief, increasing fiber intake to 25-30 grams daily, drinking plenty of water, and using stool softeners like docusate sodium (100-300 mg daily) 1. Warm sitz baths for 10-15 minutes several times daily can also provide relief.
Key Considerations
This sensation occurs because hemorrhoids disrupt the sensitive nerve endings in the anal area that help control bowel movements, leading to altered sensations during defecation and sometimes causing mucus discharge that might be mistaken for stool leakage. It is essential to note that the use of topical corticosteroids and analgesics should be limited, as prolonged use of potent corticosteroid preparations may be harmful 1.
Additional Factors
Other factors, such as constipation, diarrhea, pregnancy, and family history, have also been proposed as contributing to the development of symptomatic hemorrhoids, although rigorous proof of such beliefs is lacking 1. Defecatory disorders, including impaired rectal evacuation and increased resistance to evacuation, may also coexist with hemorrhoids and should be addressed in the treatment plan 1.
From the Research
Hemorrhoids and Fecal Incontinence
- Hemorrhoids can cause a sensation of fecal incontinence or incorrect passage of stool, as they can lead to disordered anorectal function 2.
- Increased pressure and shearing force in the anal canal may result in bleeding, itching, pain, and disordered anorectal function, even incontinence 2.
- Hemorrhoids can cause symptoms such as anal pain or discomfort, pruritus ani, and fecal soiling, which can be abolished by successful treatment for rectal bleeding and hemorrhoidal prolapse 3.
Pathophysiology of Hemorrhoids
- Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions 4.
- The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoids 4.
- Dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development 4.
Treatment and Symptoms
- Treatments designed to abolish rectal bleeding and prolapse can also reduce the incidence of symptoms such as anal pain or discomfort, pruritus, and fecal soiling 3.
- Hemorrhoidectomy and rubber band ligation can be effective in controlling these symptoms 3.
- Patients with hemorrhoids may experience functional bowel symptoms, such as bloating, abdominal pain, and excessive straining, which can be associated with irritable bowel syndrome 5.