The Centers for Disease Control and Prevention’s National Center for Health Statistics estimates that incontinence costs close to $20 billion each year, a sum it terms “a significant financial burden to the individual and society.”
That breaks down to a total of $14.2 billion by community residents and $5.3 billion by institutionalized patients. A major part of the costs (estimated as much as 75 percent) are attributed to management materials, like absorbent pads and laundry. Fecal incontinence costs were estimated at $4,110 per person in those who had the condition for more than a year, according to the CDC.
Incontinence affects mostly older Americans, although some younger patients suffer from it as well. How old you are when you first start leaking is usually an indication of which type of incontinence you will get -- bowel or urinary incontinence.
Whether it’s “number one” or “number two,” both stem from the same causes which include stroke, diabetes, cognition problems or mobility issues. There’s also age-related changes in the urinary tract, cancer, and infections. For the young, causes can include issues with chronic diarrhea, dehydration, or chronic constipation.
Obviously, it’s a problem that causes great embarrassment to the sufferer, namely because it’s fairly obvious.
ONE BIG PROBLEM, TWO BIG ISSUES
Let’s break down the two issues.
BOWEL INCONTINENCE: This happens when fecal matter leaks out of the rectum. The condition can range from an occasional problem caused by diarrhea or passing gas to a total inability to control bowel movements.
Fortunately, the condition is relatively rare in most healthy adults, experienced only during an occasional bout with the runs. But others have chronic incontinence, and can’t control any bowel movements, including passing gas or stools. These people find it hard to make it to the toilet in time to prevent an accident. A wide range of conditions, including diarrhea, constipation, bloating and gas, can accompany bowel incontinence.
Here are the issues associated with the condition:
1. Muscle and nerve damage. The rings of nerves at the end of the rectum can tell if there is stool in the rectum. If those are damaged, or the ring of muscles that control the anal sphincter are stretched or damaged, it can lead to bowel incontinence. Diseases like diabetes and multiple sclerosis can affect this group of nerves.
2. Constipation. If someone is chronically constipated, he or she may develop a mass of dry, hard stool in the rectum area. This is called impacted stool, and it becomes too large to pass. The muscles try to stretch to accommodate the stubborn stool but eventually become weakened, allowing stool from further up the intestinal tract to leak out.
3. Diarrhea – Loose stools are harder to keep from leaking, so frequent bouts with diarrhea can cause incontinence issues.
4. Storage loss – If rectal walls are scarred or stiffened from surgery, radiation treatments for cancer, or inflammatory bowel disease, the rectum won’t stretch as much as necessary, causing excess stool leakage.
5. Surgery – Surgery for hemorrhoids and other types of operations on the rectum and anus can lead to muscle and nerve damage.
6. Rectal prolapse – This occurs when the rectum drops down into the anus (rectal prolapse) or if the rectum protrudes through the vagina in women (a condition known as rectocele).
There are several factors that can determine whether a patient will develop fecal incontinence, including age, gender (being female), nerve damage, dementia and a physical disability that slows trips to the toilet or causes a disabling injury to the rectal nerves.
Once someone become incontinent, other issues can arise. Fecal incontinence can cause skin irritations, ulcers to the skin around the anus, and emotional distress that can lead to depression. Stinking up the living area and ruining clothing are just some of the embarrassing byproducts that can arise from the condition, causing untold misery for the sufferer and those in close proximity.
BATTLING INCONTINENCE
Although patients are usually reluctant to talk about the issue out of shame, a medical professional can help. The doctor will perform a physical exam and visually inspect the anus.
A pin test or probe may be used to determine whether the issue is happenings due to nerve damage. This test is used to determine the strength of the sphincter muscles. The doctors may also check for rectal prolapse.
A digital rectal exam may also be used to evaluate muscle strength. With a gloved, lubricated finger, the doctor will check the area for sphincter strength and any abnormalities.
A balloon expulsion test may also be required. In this test, a small balloon is inserted into the rectum and filled with water. The patient is then asked to go the bathroom and expel the balloon. The timing is crucial – a duration of one minute or longer is a sign of a disorder.
There’s also the anal manometry test. In this exam, a flexible, narrow tube is inserted into the anus and rectum, bearing a small balloon at the tube’s tip. This measures tightness of the sphincter and the rectum function.
A similar test is an anorectal ultrasonography, where a wand-like instrument can provide video images to evaluate the internal structure. A proctosigmoidoscopy is a similar test that’s used to examine the colon for inflammation, tumors or scar tissue. A colonoscopy or endorectal ultrasound serve essentially the same purpose.
Once the cause is determined, the doctor has several options, including recommending anti-diarrheal drugs, laxatives, and medications that can increase the spontaneous bowel motions. Dietary changes, including adding more fiber-rich foods, may be recommended to add more bulk to stools.
If muscle damage is found to be the cause of incontinence, the doctor may recommend muscle-strengthening exercises for anal sphincter control.
There are also surgical options, including a sacral nerve stimulator, an implant that can strengthen bowel muscles; a sphincteroplasty, which repairs a damaged sphincter; corrections of rectal prolapse; and sphincter repair or replacement with an artificial anal sphincter, an inflatable cuff which will keep the sphincter shut. In extreme cases, a colostomy may be recommended. This is an external bag that diverts stool through an opening in the abdomen into a bag.
URINARY INCONTINENCE
Loss of bladder control can be occasional or chronic, caused by stress, overflow from a bladder that doesn’t empty, an impairment caused by arthritis, or a combination of symptoms.
Certain drinks, including alcohol, caffeine, carbonated drinks and large doses of vitamins B and C, can increase the urine volume and cause incontinence. The condition can also be caused by a urinary tract infection or constipation, pregnancy, childbirth, age-related changes, menopause, hysterectomy, an enlarged prostate or prostate cancer, a tumor, or a neurological disorder.
Gender, age, obesity and some other diseases can put a patient at risk for urinary incontinence. Urinary incontinence can lead to skin problems and urinary tract infections.
After a physical exam, the doctor will likely do a urinalysis, a cystoscopy, cystogram, pelvic ultrasound and other tests to determine the cause of the problem. Treatments include bladder training, double voiding (waiting a few minutes between urination trips), and fluid and diet management, which include cutting back on certain beverages and losing weight.
Finally, there are medications, including anticholinergics, alpha blockers, and mirabegron that are used to treat incontinence.