Topic: Fecal Incontinence
Question: What to do for Fecal Incontinence ?
Answer: Dietary changes that may improve fecal incontinence include
                
- Eating the right amount of fiber. Fiber can help with diarrhea and constipation. Fiber is found in fruits, vegetables, whole grains, and beans. Fiber supplements sold in a pharmacy or in a health food store are another common source of fiber to treat fecal incontinence. The Academy of Nutrition and Dietetics recommends consuming 20 to 35 grams of fiber a day for adults and age plus five grams for children. A 7-year-old child, for example, should get 7 plus five, or 12, grams of fiber a day. American adults consume only 15 grams a day on average.2 Fiber should be added to the diet slowly to avoid bloating.  - Getting plenty to drink. Drinking eight 8-ounce glasses of liquid a day may help prevent constipation. Water is a good choice. Drinks with caffeine, alcohol, milk, or carbonation should be avoided if they trigger diarrhea.
                
Keeping a Food Diary   A food diary can help identify foods that cause diarrhea and increase the risk of fecal incontinence. A food diary should list foods eaten, portion size, and when fecal incontinence occurs. After a few days, the diary may show a link between certain foods and fecal incontinence. Eating less of foods linked to fecal incontinence may improve symptoms. A food diary can also be helpful to a health care provider treating a person with fecal incontinence.   Common foods and drinks linked to fecal incontinence include   - dairy products such as milk, cheese, and ice cream   - drinks and foods containing caffeine   - cured or smoked meat such as sausage, ham, and turkey   - spicy foods   - alcoholic beverages   - fruits such as apples, peaches, and pears   - fatty and greasy foods   - sweeteners in diet drinks and sugarless gum and candy, including sorbitol, xylitol, mannitol, and fructose
                

                
Examples of Foods That Have Fiber        Beans, cereals, and breads    Fiber         cup of beans (navy, pinto, kidney, etc.), cooked    6.29.6 grams         cup of shredded wheat, ready-to-eat cereal    2.73.8 grams         cup of 100% bran, ready-to-eat cereal    9.1 grams        1 small oat bran muffin    3.0 grams        1 whole-wheat English muffin    4.4 grams        Fruits        1 small apple, with skin    3.6 grams        1 medium pear, with skin    5.5 grams         cup of raspberries    4.0 grams         cup of stewed prunes    3.8 grams        Vegetables         cup of winter squash, cooked    2.9 grams         1 medium sweet potato, baked in skin    3.8 grams         cup of green peas, cooked    3.54.4 grams        1 small potato, baked, with skin    3.0 grams         cup of mixed vegetables, cooked    4.0 grams         cup of broccoli, cooked    2.62.8 grams          cup of greens (spinach, collards, turnip greens), cooked    2.53.5 grams
                

                
Medications
                
If diarrhea is causing fecal incontinence, medication may help. Health care providers sometimes recommend using bulk laxatives, such as Citrucel and Metamucil, to develop more solid stools that are easier to control. Antidiarrheal medications such as loperamide or diphenoxylate may be recommended to slow down the bowels and help control the problem.
                
Bowel Training
                
Developing a regular bowel movement pattern can improve fecal incontinence, especially fecal incontinence due to constipation. Bowel training involves trying to have bowel movements at specific times of the day, such as after every meal. Over time, the body becomes used to a regular bowel movement pattern, thus reducing constipation and related fecal incontinence. Persistence is key to successful bowel training. Achieving a regular bowel control pattern can take weeks to months.
                
Pelvic Floor Exercises and Biofeedback
                
Exercises that strengthen the pelvic floor muscles may improve bowel control. Pelvic floor exercises involve squeezing and relaxing pelvic floor muscles 50 to 100 times a day. A health care provider can help with proper technique. Biofeedback therapy may also help a person perform the exercises properly. This therapy also improves a persons awareness of sensations in the rectum, teaching how to coordinate squeezing of the external sphincter muscle with the sensation of rectal filling. Biofeedback training uses special sensors to measure bodily functions. Sensors include pressure or EMG sensors in the anus, pressure sensors in the rectum, and a balloon in the rectum to produce graded sensations of rectal fullness. The measurements are displayed on a video screen as sounds or line graphs. The health care provider uses the information to help the person modify or change abnormal function. The person practices the exercises at home. Success with pelvic floor exercises depends on the cause of fecal incontinence, its severity, and the persons motivation and ability to follow the health care providers recommendations.
                
Surgery
                
Surgery may be an option for fecal incontinence that fails to improve with other treatments or for fecal incontinence caused by pelvic floor or anal sphincter muscle injuries.
                
- Sphincteroplasty, the most common fecal incontinence surgery, reconnects the separated ends of a sphincter muscle torn by childbirth or another injury. Sphincteroplasty is performed at a hospital by a colorectal, gynecological, or general surgeon.  - Artificial anal sphincter involves placing an inflatable cuff around the anus and implanting a small pump beneath the skin that the person activates to inflate or deflate the cuff. This surgery is much less common and is performed at a hospital by a specially trained colorectal surgeon.  - Nonabsorbable bulking agents can be injected into the wall of the anus to bulk up the tissue around the anus. The bulkier tissues make the opening of the anus narrower so the sphincters are able to close better. The procedure is performed in a health care providers office; anesthesia is not needed. The person can return to normal physical activities 1 week after the procedure.  - Bowel diversion is an operation that reroutes the normal movement of stool out of the body when part of the bowel is removed. The operation diverts the lower part of the small intestine or colon to an opening in the wall of the abdomenthe area between the chest and hips. An external pouch is attached to the opening to collect stool. The procedure is performed by a surgeon in a hospital and anesthesia is used. More information about these procedures can be found in the Bowel Diversion fact sheet.
                
Electrical Stimulation
                
Electrical stimulation, also called sacral nerve stimulation or neuromodulation, involves placing electrodes in the sacral nerves to the anus and rectum and continuously stimulating the nerves with electrical pulses. The sacral nerves connect to the part of the spine in the hip area. A battery-operated stimulator is placed beneath the skin. Based on the persons response, the health care provider can adjust the amount of stimulation so it works best for that person. The person can turn the stimulator on or off at any time. The procedure is performed in an outpatient center using local anesthesia.
(Source: NIDDK)