1 How does the defecation process occur?

Before describing the causes leading to the development of the disease, it is necessary to understand the mechanism of the act of defecation. This process is controlled by synchronous operation of muscles and nerve endings in the rectum and anus. Retention of fecal masses is provided by the muscles of the sphincter, which in a healthy person is in tension. Cal when moving to this part of the intestine has a high density. The compressed muscular tissues of the sphincter form a dense ring, which prevents the spontaneous release of stool.

The pressure in the area of ​​the sphincter is about 100 mm Hg, it decreases with age, but this is not the main cause of encopresis. The sphincter muscles are constantly in a tonus, the electrical activity is not observed with the act of defecation. Control over the opening of the sphincter during a visit to the toilet is carried out by the autonomic nervous system. The urge to defecate is a consequence of mechanical irritation of the intestinal wall, which occurs when the stool accumulates in the ampulla of the rectum.

In response to this influence, the person takes the appropriate pose. When the abdominal muscles contract and the glottis closes, intra-abdominal pressure rises. This is facilitated by a slowing down of the contractions of the rectum, due to which the fecal masses move towards the anal opening. The muscles of the pelvic floor relax, revealing the anorectal angle. The irritation of the walls of the ampulla of the rectum leads to the opening of the inner and outer sphincters, so that the feces are excreted from the body.

If it is impossible to perform the defecation act, the external sphincter is arbitrarily shortened, which causes the closure of the anorectal angle, the excretion of stool from the rectum is blocked.

2 What causes stool incontinence?

Fecal incontinence in adults can be caused by: frequent constipation and diarrhea, muscle weakness, failure of nerve endings, decreased elasticity of the rectum walls, hemorrhoids. Constipation is a condition characterized by rare acts of defecation( no more than 3 times a week).The result is encopresis. In some cases, constipation leads to the accumulation of stool in the intestine, if simultaneously with them in the intestine are more liquid stool, they can leak out. Long constipation leads to sphincter stretching and weakening, which causes loss of control over the excretion of stool.

Diarrhea can also lead to the onset of this disease. Liquid chair fills the cavity of the rectum faster, it can be difficult to keep it. With a decrease in the tone of the sphincter muscles, encopresis may also develop. Muscle weakening is facilitated by injuries, surgical interventions. If the signals from the nerve endings responsible for the operation of the sphincter muscles are not properly fed, the order of their compression and relaxation is disturbed. In addition, the nerves may not respond to the filling of the rectum with feces, as a result, the person ceases to feel the urge to defecate. The main causes of the violation of the correct operation of nerve endings are strokes, CNS diseases, the habit of delaying the act of defecation, childbirth for a long time.

The rectum of a healthy person is capable of spontaneous expansion when it is necessary to retain stool. Some causes can lead to the formation of scars on the walls of the intestines, which makes them less elastic. Such factors include surgery in the rectum, ulcerative colitis, irradiation, etc. Incontinence of feces in adults develops and if the muscles and nerve roots of the pelvic floor are not working properly. The following reasons are for this:

• decreased sensitivity of the walls of the rectum to irritating effects of feces;
• weakness of the muscles controlling the course of the act of defecation;
• rectocele, in which the rectum falls into the vagina;
• frequent delivery;
• prolapse of rectum with hemorrhoids.

The risk of developing encopresis in a woman increases significantly when using obstetric forceps during labor. No less dangerous in this respect is the episiotomy - the perineal dissection when the child passes through the birth canal. Stool incontinence can appear both immediately after childbirth, and several years later.

External hemorrhoids may cause incomplete closure of the sphincter muscles, as a result of which some liquid stool or mucus begins to exude.

Depending on the age of the patient, stool incontinence may differ by the mechanism of onset and the type of disorder. Encopresis can be manifested in the form of frequent secretion of feces without the preceding urge to defecate. Spontaneous outlet of the contents of the rectum may be accompanied by urge to visit the toilet. There are also irregular leakage of intestinal contents during physical exertion, coughing, sneezing. Encopresis can develop against the background of age-related changes in the body.

3 Methods of diagnosis of the disease

When diagnosed, the doctor examines the patient's medical history, takes into account the data of the initial examination and the results of the diagnostic procedures. When detecting encopresis, instrumental techniques are used primarily. To measure anorectal pressure, a tube is used, which is sensitive to pressure. Its use makes it possible to determine the nature of the functioning of the rectum. This method is also used to determine the compression force of the muscles of the anal sphincter.

MRI allows you to obtain detailed images of the studied parts of the intestine - the muscles of the external and internal sphincter. Proctology is an x-ray study that determines the maximum amount of feces that the rectum can hold. In addition, the procedure allows you to study the features of the distribution of contents in the cavity and determine the efficiency of emptying. Transrectal ultrasound is performed by inserting a special sensor into the anus. The procedure is absolutely painless and safe, it is used to investigate the functioning of the muscles of the pelvic floor and anal sphincters.

Recto-manoscopy is a procedure consisting in inserting a special tube into the anal opening, through which the rectum is viewed from the inside. This allows you to identify the presence of scars, tumors and inflammatory processes.

4 Treatment measures

This or that treatment for this disease is selected depending on the cause that led to its occurrence. In order to eliminate the patient's symptoms, medical or surgical treatment is performed. In addition, you need to revise your diet, constantly train the muscles of the pelvic floor with the help of special exercises. The operation is done when conservative treatment does not work, and also when encopresis is caused by sphincter or pelvic floor injuries.

Such treatment consists in sphincteroplasty - stitching of muscles that have undergone rupture or stretching. There is another method of surgical intervention - the installation of an artificial sphincter under the skin in the anus. The patient himself controls the work of this device, lowering and inflating the cuff.

Stool incontinence leads to some problems in the patient's life, from a simple sense of shame to deep depression.

Therefore, a person needs to perform some measures, the most important of which are a doctor's visit and timely treatment.

And some of the tips below will help you cope with the problem of spitting out your stool. Leaving the house, be sure to empty the intestines, take care of the availability of removable underwear and special means with which you can eliminate the consequences of spontaneous defecation.

In severe cases it is recommended to wear disposable panties and taking medications that reduce the intensity of odor of feces and intestinal gases. You can buy them without a prescription, but any treatment should be agreed with the doctor. With incontinence in an adult, he should consult a proctologist.