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Bowel incontinence


  I have been diagnosed with IBS and diverticulosis and several years ago had polys The kind that doesn't result in cancer) removed.  I have a history associated with IBS, alternating diarreha and constipation, stomach cramps , mucous, etc. etc. But I have recently within the past six weeks to two months started having bowel leaks with of course loose stool. My diet has not changed.  I did experiment with goldenseal root and noticed a definite quickening of my stools and so have discontinued using it about three weeks ago. The bowel incontinence is still occurring and I have never had a problem with it before.  I am only 52 years old and afraid to go out because I am afraid that I will not make it home without soiling my pants. The stools range from liquid to loose and the incontinence is continuous.  I can be just walking and tell there has been release, but I have had no urgency to go.  Any ideas?
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Dear Ms. Weber,
I am sorry to read of your problem. Fecal incontinence can be a devastating occurrence, causing fear and anxiety, and transforming an active person into a recluse.
Fecal incontinence can be caused by a large number of reasons. To be able to make a diagnosis you need to have a detailed clinical evaluation especially a directed exam of the rectum and the surrounding area.  
Had your chronic bowel symptoms been fully investigated? Weakness of the anal sphincters along with loose stools can cause incontinence. Problems with sphincters can occur due to old age, prior surgery, trauma during child-birth ( a frequent cause of problems for women) and nerve damage due to diseases like diabetes mellitus. Sphincter function can be assessed by a test called anorectal manometry. This painless test measures the pressures in the internal and external sphincters and assess whether there is appropriate sensation of and response to rectal contents.
Therapy will depend on the cause of the incontinence.  Patients are given exercises to strengthen the external sphincter and thereby to reduce  the frequency of incontinence.  Sometimes biofeedback is used.  Medical therapies are initially directed to bulk up the stool by using commercial fiber preparations.  If the response to this approach is inadequate, Lomotil can be added.  The dose is titrated to control the incontinence.  Sometimes codeine is used to control symptoms.  If medical treatment fails, surgical options can be explored.  
You have mentioned that polyps were found on a colonoscopy "many" years ago. If your polyps were hyperplastic, further colonscopies are not warranted and you can be screened for colon cancer by annual testing of stool for blood and sigmoidoscopy every 3 years.  If adenomas were seen, then you should have acolonscopy.  These polyps have the potential for malignant degeneration.
I recommend that you see a physician who will be able to diagnose and treat the incontinence. If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of diarrhea/incontinence, by calling the Henry Ford Physician Referral Line at (800)653-6568.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical issues.
HFHSM.D.-sg
*keywords: incontinence
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