Fecal incontinence, the loss of small to large amounts of fecal matter, is embarrassing and common among older people, particularly those residing in nursing homes. According to a Cleveland Clinic Journal of Medicine article by Dr. Tyler K. Stevens and colleagues, up to 7 percent of elderly people in the community experience this problem, and the percentage escalates to 50 percent for older people in nursing homes. Gastroenterologist Arnold Wald indicates that the rate of fecal incontinence may be much higher because many people don't report this problem unless a physician asks them about it directly.
Impacted Feces/Chronic Constipation
Although the connection seems counterintuitive, constipation and fecal impaction---a condition in which feces cannot be passed in a bowel movement---can cause the loss of control of feces. According to Stevens and colleagues, these conditions are the most common causes of fecal incontinence. Immobility and disabilities can further exacerbate constipation and fecal impaction.
In an article on bowel care in the elderly, Italian gastroenterologist G. C. Spinzi notes that up to 28 percent of elderly individuals may have chronic constipation, and the prevalence rises to greater than 80 percent for nursing home residents.
The National Digestive Diseases Information Clearinghouse notes that fecal incontinence is more common among older adults, but it is not a normal aspect of aging.
Retrosphincter Dyfunction
Stevens and colleagues indicate that rectosphinchter dysfunction---either decreased squeeze pressure of the anal sphincter muscle or impaired resting pressure---is another common cause of fecal incontinence in older individuals, especially women. This problem is usually caused by diabetic neuropathy---nerve damage caused by diabetes---or by lax and weak rectal muscles. Biofeedback treatment can often help patients improve their sphincter pressure levels, according to Stevens and colleagues. These exercises can improve fecal incontinence.
The National Digestive Diseases Information Clearinghouse explains that biofeedback bowel training uses a special computer that measures the strength of special muscles contractions that occur during exercises of the pelvic Kegel muscles. Strengthening these muscles also strengthens the rectum and improves the sensation within the rectum. Computer feedback shows an individual whether the muscles are contracting correctly and strengthening.
To use this therapy successfully, an elderly person must be motivated to succeed and capable of following instructions. Thus, biofeedback is unsuitable for patients with dementia.
Dementia
Individuals with dementia may have fecal incontinence because they do not sense the need to use the toilet or, if they do sense it, they ignore it. The result is fecal impaction and leakages, according to Stevens and colleagues. Individuals with dementia may be treated with habit training---for example, caregivers or others taking the patient to the toilet at regular intervals, especially after meals. Increasing the individual's fluid consumption and providing more fiber is also helpful.
Chronic Diarrhea
Some elderly patients with fecal incontinence have chronic diarrhea, according to Stevens and colleagues. Treatment with opiates, which are noted for their constipating side effect, is one option to manage this condition. Other medications may be used as well. Stevens and colleagues caution against using the combination of diphenoxylate and atropine because it may cause urinary retention and affect the mental status of older patients.
Medications
Some drugs can lead to fecal incontinence because of fecal impaction. Stevens and colleagues state that medications such as calcium channel blockers or narcotics are constipating. Thus, if an individual is already constipated, his condition will worsen. Opioids are notorious for causing constipation. In cases in which they are necessary to control severe pain, they should be supplemented with stool softeners and laxatives under the direction of the physician.
Some elderly individuals rely too heavily on laxatives, leading to fecal incontinence. Taking iron pills may also cause fecal impaction. Individuals who need to use these drugs should tell their doctors about their fecal incontinence. A substitute drug may be suggested or a lower dosage of the current drug may be effective.
References
- "Cleveland Clinic Journal of Medicine"; Fecal Incontinence in Elderly Patients: Common, Treatable, Yet Often Undiagnosed; Tyler K. Stevens, M.D., Edy E. Soffer, M.D. and Robert M. Palmer, M.D.; May 2003
- "New England Journal of Medicine"; Fecal Incontinence in Adults; Arnold Wald, M.D.; April, 2007
- "Digestive Diseases"; Bowel Care in the Elderly; G.C. Spinzi; 2007
- National Digestive Diseases Information Clearinghouse: Fecal Incontinence
