Anal leakage, fecal incontinence

Small amounts of anal leakage are quite common.  This is the condition in which small amounts of stool or staining is found when wiping an hour after a bowel movement or in the undergarments.  The condition can occur in both men and women.  It is usually the result of either prolapsing internal hemorrhoids that the patient is unaware of, or some inflammatory or irritation problem of the skin within the anal canal or just around the opening of the anus (perianal skin).  An anal fissure can also lead to this type of leakage.  Treatment with simple dietary and hygiene changes is usually effective.

True fecal incontinence, in which the patient can lose a full bowel movement into their undergarments is much less common. It is almost never seen in men unless they have had a traumatic injury to the sphincter.  Except in those rare cases, patients with true fecal incontinence are almost all women in middle age and beyond, they have all had children and often have had a difficult child birthing experience.  Many have also had a history of chronic constipation when they were younger.  These patients usually have an injury to the nerves supplying the sphincter muscle (pudendal nerve).  The injury may have occurred many years earlier during childbirth, but the condition manifests itself in middle age.  Treatment of fecal incontinence is difficult and controversial.  It can involve stool bulking agents, physiotherapy, biofeedback, injection of collagen into the anal canal, surgical repair, and even the implantation of an artificial sphincter device.

© PEZIM CLINIC, Vancouver, British Columbia, Canada