Faecal incontinence

Question 1

symptoms of faecal incontinence

Answer 1

DRE - pressence of hard stool in rectum. faecal impaction with overflow

causes- immobility, opiate analgesia, inadequate diet and water intake

Question 2

management of faecal incontinence

Answer 2

disimpact the faecal mass with examining fingers
enemas
suppositries
manual evuation under anaesthesia

once rectum is clear, prescribe laxatives (decussate sodium)

reduce opiate, encourage oral intake, check thyroid test and serum Ca2+

Question 3

causes of faecal incontinence

Answer 3

trauma to internal and external sphincters and/or pudendal nerve

• obstetric trauma
• surgery (haemorrhoids, anal fissures)
• non iatrogenic accidental injury

impaired motor or sensory neurological pathways
stroke, dementia, MS, cauda equina syndrome, alcoholic peripheral neuropathy, diabetic neuropathy, myasthenia gravis

impaired external anal sphincter 
muscular dystrophy
myotonic dystrophy
senile degernation
rectal prolapse

inadequate rectal volume
torrential diarrhoea
rectal fibrosis (UC, radiation, ichaemia)

functional disorders
dyssynergic defaecatin
inadequate cess to toilet