Clinical Features

A detailed history is required on the initial visit or contact with the patient. A list of important information that should be elicited when taking history is outlined in under the previous heading: "Etiology of Fecal Incontinence". The temporal relationship between the onset of fecal incontinence and precipitating events should be established. This includes all prior coexisting conditions (diabetes mellitus, etc.), surgeries, spinal injuries, history of physical or sexual abuse, and exposure to radiation. The duration of symptoms should be determined in terms of acute, subacute, or chronic. Incontinence severity is determined by several grading systems. A modified Cleveland Clinic grading system [50] has been validated by investigators at St. Mark's Hospital in the United Kingdom [51]. It provides an objective method of quantifying the degree of incontinence. It can also be used for assessing the efficacy of therapy. The grading system is based on seven parameters that include whether the anal discharge is either solid, liquid, or flatus and whether the problem causes alterations in lifestyle (scores: Never = 0, Always = 5); the need to wear a pad or the need to take antidiarrheal medication, and the ability to defer defecation (scores: No = 0, Yes = 2). Scores range from 0 (continent) to 24 (severe incontinence).

The timing or circumstances under which incontinence occurs should also be determined. This may facilitate identification of the following possible scenarios:

1. Passive incontinence: the involuntary discharge of fecal matter or flatus without any awareness. This suggests a loss of perception and/or impaired rec-toanal reflexes either with or without sphincter dysfunction.

2. Urge incontinence: the discharge of fecal matter or flatus in spite of active attempts to retain these contents. This is due to sphincter function or rectal capacity to retain stool.

3. Fecal seepage: the undesired leakage of stool, often after a bowel movement, with otherwise normal continence and evacuation. This condition is mostly due to incomplete evacuation of stool and/or impaired rectal sensation. Here, sphincter function and pudendal nerve function are mostly intact.

There can be an overlap between these three groups, but making a clinical distinction is useful in guiding further investigations and management. One cannot rely on these clinical features alone to establish a diagnosis due to lack of specificity and positive predictive values when compared with more standardized testing (anorectal manometry) [22].

The other important aspect of history is to determine dietary habits (use of coffee, fiber in diet, etc.) and determination of the presence of rectoanal agnosia (inability to differentiate between formed and unformed stools). A prospective stool diary provides an objective assessment of stool habit (Fig. 2).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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