From the Guidelines
Fecal incontinence is primarily caused by a combination of factors including bowel disturbances, particularly diarrhea, anorectal dysfunctions, and chronic illnesses, rather than solely obstetric history or other factors. The most recent and highest quality study 1 highlights that independent risk factors for fecal incontinence (FI) in older women include diarrhea, cholecystectomy, current smoking, history of rectocele, stress urinary incontinence, and higher BMI. Other conditions associated with FI, as noted in the study, include advanced age, disease burden, anal sphincter trauma, and decreased physical activity.
Key Factors Contributing to Fecal Incontinence
- Bowel disturbances, especially diarrhea, play a significant role in the development of fecal incontinence, as indicated by the high odds ratio (OR=53) associated with diarrhea in the study 1.
- Anorectal dysfunctions and chronic illnesses, such as inflammatory bowel disease, diabetes, and neurological disorders, can also lead to fecal incontinence.
- The study 1 emphasizes that the burden of chronic illness rather than obstetric history is a more significant risk factor for FI in older women.
- Other factors such as rectal prolapse, certain medications affecting bowel motility or stool consistency, cognitive impairments like dementia, and radiation therapy to the pelvic area can contribute to the condition.
Importance of Early Evaluation and Management
Understanding the specific cause of fecal incontinence is crucial for effective treatment, which may include dietary modifications, pelvic floor exercises, medications to regulate bowel movements, or surgical interventions depending on the underlying issue. Early evaluation by a healthcare provider is essential as many causes can be effectively treated or managed, improving the patient's quality of life and reducing the morbidity and mortality associated with fecal incontinence. The management of fecal incontinence should be tailored to the individual's needs, as suggested by the N-ECCO statement 1, and may involve formal referral to continence specialists for assessment and investigation.
From the FDA Drug Label
Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency. The cause of fecal incontinence is not directly stated in the drug label. However, it can be inferred that a decrease in the tone of the anal sphincter may contribute to fecal incontinence, as loperamide increases the tone of the anal sphincter to reduce incontinence.
- Key factors that may contribute to fecal incontinence include:
- Decreased tone of the anal sphincter 2
From the Research
Causes of Fecal Incontinence
The causes of fecal incontinence can be categorized into several factors, including:
- Bowel disturbances, such as diarrhea 3, 4
- Anal sphincter trauma, including obstetrical injury or previous surgery 3, 4
- Rectal urgency and burden of chronic illness 3
- Neurological disorders, such as pudendal neuropathy 4 and central neurological diseases 5, 6
- Inflammatory bowel disease 7
- Pelvic floor anatomical disturbances, including sphincter defects and rectal compliance 3, 4
- Faecal impaction causing paradoxal diarrhoea 4
- Diminished rectal compliance in proctitis, low anterior resection or small pouches 4
Risk Factors
Several risk factors have been identified, including:
- Disease activity in inflammatory bowel disease 7
- Loose stool 7
- Female gender 7
- Childbirth 7
- Previous surgery 7
- Anal sphincter weakness or fatigability 7
- Anxiety and depression 7
Underlying Causes
The underlying causes of fecal incontinence can be complex and multifactorial, involving a combination of physiological, psychological, and sociodemographic factors 3, 4, 5, 7, 6.