排便失禁

定义

Fecal incontinence is when a person is not able to control bowel movements.

Types of fecal incontinence are:

Urge incontinence—Being unable to delay having a bowel movement
Passive incontinence—Passing stool without feeling the need to get to a bathroom
Anal incontinence—Passing stool or gas due to problems with the muscles of the anus
Overflow incontinence—Leaking liquid stool when there is a large mass of stool blocking the rectum

原因

The rectum is the last part of the large intestine. It holds onto stool until it is ready to pass through the anal canal. Nerves in the rectum send signals to the brain when it is full. This creates the urge to pass stool. Stool moves into the anal canal to the anal sphincter. The muscles of the sphincter control the passage of stool out of the body. Fecal incontinence happens when there is a problem with this process.

原因可能是:

Problems that disturb the bowels 和 result in changes in stool, such as 腹泻或便秘
Structural problems of the pelvic floor that make it hard for the rectum to work as it should
Damage that causes weakness of the anal sphincter, such as from trauma or surgery
Intestinal diseases that cause swelling of the anus 和 rectum, such as 炎症性肠病
Problems with the way the nervous system works that make it hard for the rectum to signal the brain when it is full

风险因素

This problem is more common in older adults. 它在女性中也更为常见. Other things that may raise the risk are:

Problems that disturb the bowels, especially 腹泻
Problems with the structure or function of the anus or rectum, such as 炎症性肠病和直肠脱垂
Spinal cord or nervous system conditions or injuries, such as 多发性硬化症
Problems that affect stool characteristics, such as infection or a blockage of stool
服用某些药物, such as those that weaken the sphincter, 引起便秘或腹泻, 或者降低警觉性

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Rectal Prolapse—The rectum falls through the anal opening.

症状

The main symptom is not being able to control the passage of solid or liquid stool.

诊断

The doctor will ask about your symptoms 和 health history. 会做一次身体检查. This is often enough to make the diagnosis.

Images may be taken to look for an underlying cause. 这可以用:

Anorectal manometry may be done to check the pressure of the anal canal.

治疗

Underlying causes will be treated. The goal of treatment is to manage symptoms. More than one treatment may be needed. 的选择是:

Dietary changes, such as avoiding foods 和 supplements that may trigger 腹泻
Lifestyle changes, such as exercising regularly 和 going to the bathroom on a regular schedule
Biofeedback to learn how to control the passage of stool
治疗药物:
- 便秘
- 腹泻
- Poor anal sphincter muscle tone

程序和手术

People who are not helped by other methods may need procedures or surgery. 的选择是:

Injecting a bulking agent into the walls of the anus to narrow the opening
Repairing damage to the anal sphincter
Radiofrequency energy delivery to change the muscular structure of the anal canal
Vaginally-inserted balloon to increase pressure on the rectum
An artificial bowel sphincter that a person can open 和 close as needed
结肠造口术 to disconnect the colon 和 bring the end through an opening in the abdomen called a 气孔

预防

There are no known guidelines to prevent this health problem.

参考文献

Bharucha AE, dunvan G，等. 流行病学, 病理生理学, 和 Classification of Fecal Incontinence: State of the Science Summary for the National Institute of Diabetes 和 Digestive 和 Kidney Diseases (NIDDK) Workshop. 我是胃肠醇吗. 2015年1月,110 (1):127 - 136.
Bowel control problems (fecal incontinence). National Institute of Diabetes 和 Digestive 和 Kidney Diseases website. 可以在: http://www.的趋势.国家卫生研究院.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence. 2017年11月28日发布.
成人大便失禁. EBSCO DynaMed网站. 可以在: http://www.力学.com/condition/fecal-incontinence-in-adults. 于2021年2月11日发布.