Differential Diagnosis for Stool Incontinence in Old Age
Single Most Likely Diagnosis
- Fecal impaction: This is a common cause of stool incontinence in the elderly, often due to chronic constipation, which can lead to a buildup of feces in the rectum, causing liquid stool to leak around the impaction.
Other Likely Diagnoses
- Diarrheal illnesses: Conditions such as gastroenteritis, inflammatory bowel disease, or malabsorption can lead to stool incontinence in the elderly due to the increased liquidity and frequency of stools.
- Neurogenic bowel: Conditions affecting the nervous system, such as stroke, spinal cord injury, or dementia, can disrupt normal bowel function, leading to incontinence.
- Rectal prolapse: Weakening of the muscles that hold the rectum in place can cause the rectum to prolapse, leading to stool incontinence.
- Hemorrhoids: Large or prolapsed hemorrhoids can cause stool incontinence, especially if they are bleeding or irritated.
Do Not Miss Diagnoses
- Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis): Although less common, these conditions can cause severe diarrhea and stool incontinence, and missing the diagnosis can lead to significant morbidity and mortality.
- Infectious colitis (e.g., Clostridioides difficile): This condition can cause severe diarrhea, abdominal pain, and stool incontinence, and is particularly dangerous in the elderly due to the risk of dehydration and sepsis.
- Colorectal cancer: Although less common as a cause of stool incontinence, colorectal cancer can cause changes in bowel habits, including incontinence, and missing the diagnosis can be fatal.
Rare Diagnoses
- Rectovaginal fistula: An abnormal connection between the rectum and vagina can cause stool incontinence, although this is a rare condition.
- Anorectal trauma: Trauma to the anus or rectum, such as from a fall or sexual assault, can cause stool incontinence, although this is uncommon in the elderly.
- Congenital anorectal malformations: Rare congenital conditions, such as Hirschsprung's disease, can cause chronic constipation or stool incontinence, although these are typically diagnosed in childhood.