14 Within gastrointestinal disorders, FI is more common in inflammatory bowel disease (IBD) patients than non-IBD controls (OR 7.73) in a meta-analysis of seventeen studies and 4671 patients, with a likely multifactorial etiology heightened by local inflammation during a flare. Among neurological disorders, diabetes mellitus as well as stroke are correlated with FI in older patients, 13 and FI in patients with multiple sclerosis is common. Several important medical comorbidities are associated with FI. In the elderly, recognition of bowel disturbances driving FI can have tremendous therapeutic implications, as they are relatively easier to correct than neuromuscular injuries to the pelvic floor. 11 Such injuries likely remain an important risk factor in immediate post-partum FI, 12 rather than late-onset FI, though obstetric injuries may nevertheless work synergistically with the aforementioned neuromuscular changes to increase risk of FI with aging. 10 However, more recent data indicate that bowel disturbances such as diarrhea and IBS are the main risk factors for FI in the elderly, rather than obstetric history. 9 It was therefore previously thought that obstetric injury may be major contributing risk factor in FI in older women. Vaginal delivery has been shown to cause anal sphincter injury despite the initial absence of clinical symptoms. There has been much debate over the role of obstetric injury in the development of FI. ( From Rao SS, Bharucha AE, Chiarioni G, et al. These patients may demonstrate dyssynergia with impaired rectal sensation.Īnorectal anatomy relevant to fecal incontinence. These patients may describe constantly being unable to reach the bathroom in time.įecal seepage: The unintentional passage of stool that can follow an otherwise normal defecation, often presenting with fecal staining of undergarments. Urge incontinence: The discharge of fecal matter despite active attempts to retain contents. Passive incontinence: The unintentional passage of stool or gas without awareness of its occurrence. For research purposes, FI is now defined as at least two episodes in a four-week period, whereas previous definitions were less stringent. By Rome IV criteria 1, FI is no longer described as “functional” (as in Rome III criteria) 2, and there is no distinction as to the presumed etiology in making the diagnosis. It can coexist with diarrhea, constipation as well as urinary incontinence. FI is the unintentional passage of solid or liquid stool.
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