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What is Incontinence

Bowel incontinence is when one can't control the release of gas or stool.

It can range from not being able to control gas, to not being able to control liquid stool and even not being able to control formed stool. The incidence of bladder and bowel incontinence increases with age. It is a fairly common problem, but many do not seek treatment for it because of embarrassment.

What causes Incontinence

There are many causes of incontinence and these include

  • Injury to anal muscles during childbirth
  • Injury to nerves of the anal muscles during childbirth
  • Operations involving the anal region
  • Traumatic injury involving the anal region
  • Diseases affecting the nerves that control the anal muscles e.g. Diabetes or stroke
  • Aging
What is involved in maintaining continence

Being continent (able to hold in one's stool and not leak) involves several factors. It requires an intact, strong anal sphincter muscle, functioning nerves that control the anal sphincter muscles. Any process that damages the anal sphincter muscles or the nerves can cause incontinence. Aging can affect continence because as one grows older, the bulk and strength of the anal muscle decreases. 

In addition, stool consistency plays a part as well. Imagine your hand holding onto a tennis ball and your other hand holding onto some water. It is easier to control the tennis ball and not let it slip out of your hands when compared to water. Similarly, it is easier for the anal sphincter muscle hold on to solid stool, rather than liquid stool. The rectum is also involved for continence. When stool presents at the rectum, the rectum then relaxes and then accommodates (stores) the stool until it is time to defecate.

Rectums that are stiff will not be able to do this, and hence the person would have to run to the bathroom urgently every time the stool presents at the rectum.

How does childbirth cause incontinence

Injury during childbirth is one of the most common causes of incontinence.

Sometimes, during vaginal delivery, there might be a tear in the perineum extending into the anal sphincter muscle. With the tear in the anal sphincter, the muscle strength is decreased.

Secondly, the nerves controlling the anal sphincter muscles can also get stretched and damaged during childbirth.

While some injuries may be recognized immediately following childbirth, others can manifest much later in life (when the anal sphincter muscle strength decreases with aging) and hence the link between incontinence and the previous childbirth may not be recognized.

Treatment of Incontinence
  • ​Dietary changes
  • Constipating medications
  • Treating an underlying disorder
  • Muscle strengthening exercises
  • Biofeedback
  • Surgical muscle repair
  • Artificial devices
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