FECAL INCONTINENCE

Fecal incontinence is a dreaded symptom.

The main causes are:

1. Diarrhea

2. Impacted feces

3. Rectal carcinoma

4. Recto-vaginal fistula

5. Malignant spinal cord compression

1. Acute diarrhea can cause incontinence in the elderly, or if disability and weakness prevent quick access to the toilet. Exclude possible fecal impaction and treat with loperamide 2mg to 4mg 4 times a day. (see Diarrhea)

2. Impacted feces results in small amounts of liquid feces, often with loss of control, after a period of constipation. (see Constipation)

3. Rectal carcinoma (either untreatable primary carcinoma or anastomotic recurrence) can cause fecal incontinence due to sphincter damage, together with blood, discharge and smell. Palliative colostomy can divert feces but will not reduce blood and discharge. Local treatments such as transanal laser therapy can be helpful. Smell is reduced by metronidazole 250mg to 500mg 3 times a day, and regular changes of pads. (see Lasers)

4. Recto-vaginal fistula occurs as a complication of pelvic malignancies, or following radiation damage. The patient may be too embarrassed to describe the true situation. A palliative colostomy should be performed whenever possible.

5. Loss of anal sphincter tone is a late complication of malignant spinal cord compression. It is usually best managed by inducing constipation with codeine phosphate 30mg to 60mg every 4 hours (or simply by stopping laxatives if the patient is already taking morphine), and clearing the rectum with enemas or manually every third day. (see Spinal Cord Compression)

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.