Feeling nausea or the feeling that vomiting might occur can be due to gut problems but more commonly is due to other causes...

Incontinence

Loss of control - faecal incontinence



Maintaining bowel control.

  • Accidents or being caught short are fortunately a rare event for most of us - perhaps occurring at the time of a diarrhoeal illness.
    • However more frequent loss of control is another issue.
  • Control is maintained by two sphincters - muscular rings at the anus.
    • The internal sphincter is not under voluntary control. It remains closed without our conscious effort.
    • The outer ring or external sphincter can be closed voluntarily.We use this to provide extra protection in extreme urgency or to maintain control with coughing , sneezing etc.

  • Damage to these sphincters or damage to the nerves that supply the sphincters can cause problems with continence.
  • There are three types of incontinence.
    • Involuntary discharge of stool or gas without awareness.
    • Urge incontinence. This is discharge in spite of attempts to retain bowel contents. i.e unable to hold on!
    • Seepage or leakage of small amounts - staining of underclothes.



What causes loss of control?

  • The most common problems are:
    • Birth defects - born with abnormal sphincters.
    • Following childbirth. This is more likely to have sphincter damage after prolonged labour, difficult forceps, breech delivery and  may be associated with deep vaginal tear but not always.
    • The problems may not be apparent at the time but becomes an issue in later life.This may be because of some gradual loss of tissue "tone" or if a new bowel problem develops than "overwhelms" a weak sphincter.
    • Diarrhoeal diseases leading to urgency and losseness that overwhelms the defences. Obviously the more liquid the worse the problem.
    • Some colonic "irritants" bile salts / excess laxative use - may cause a similar problem.
    • Elderly – gradual loss of tissue strength over time.
    • Impaction with leakage around a full rectum. This mostly occurs in the elderly who may not be aware of developing severe constipation. Then present with leakage / incontinence. Often the diagnosis is delayed.
    • Neurological problems such as multiple sclerosis, stroke, spinal cord injury, diabetes (may lead to nerve damage). Intact sensation is essential to be aware of imminent need to pass a bowel motion and todistinguish between formed stool, liquid and gas.i.e knowing when it is safe pass gas!
    • Small rectum / decreased rectal compliance or accommodation. Less ability to store faeces until "ready" to pass a bowel motion.This may be caused by chronic inflammation - diseases such as colitis / Crohn's disease,post radiotherapy, post-surgical changes.
    • Pelvic floor problems.Nerve damage as the result of long-term straining or from rectal prolapse.
  • Investigation

    • Examination by a specialist can provide a lot of information.
    • Anorectal ultrasound (looking for evidence of an anal sphincter tear may be required).
    • MRI is another way of looking at the integrity of the anal sphincters and pelvic floor.
    • A special X-ray looking for any disorder of defaecation may help. This is called a defaecating proctogram.
    • Specialized testing of the anal sphincters and the pressures in the rectum may be required. This is manometry or pressure studies usually combined with nerve testing - especially the pudendal nerve.


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