Introduction

Besides physiologic investigations and radiology imaging, diagnosis of fecal incontinence requires accurate clinical assessment. By means of a structured scheme, clinical assessment aims to evaluate the whole picture: whether the patient is really incontinent, the etiology of the incontinence, and the nature and severity of the problem. Nevertheless, we must keep in mind that when treating an individual patient, these data may not be enough to define the pathophysiology of the symptom and, therefore, we need the investigations we mentioned initially.

The first goal is to determine whether the patient is incontinent. Many patients will not easily admit the symptom. On the one hand, incontinence represents a social stigma and, on the other hand, patients may feel distressed by realizing their physical deterioration reaches the point of not being able to maintain fecal continence. Avoiding the term itself, patients will frequently use other terms, such as diarrhea, fecal urgency, etc. This was shown in a classical study [1] in which data showed how half of the patients referred with chronic diarrhea actually presented incontinence, and less than half of them provided that information to the doctor.

At the same time, we can find continent patients who seem to be incontinent. Physically handicapped patients may find difficulty in entering the bathroom, sitting on the toilet or device for defecation, or even cleaning themselves properly after defecation. Psychiatric patients may feel an inadequate need to defecate even if they are not incontinent. Lastly, we must differentiate between incontinence and soiling due to inadequate hygiene or hemor-rhoid prolapse.

Once fecal incontinence has been established, the next step to investigate is the nature of the incontinence: passive or stress incontinence. Passive incontinence deals with patients who are not aware of the leak of gases or feces, while stress incontinence means the impossibility of stopping the leak of gases or feces even if attempting to do so. It also must be ascertained what kind of incontinence (gas, liquid, or solid feces) and the frequency of the episodes.

Constipation Prescription

Constipation Prescription

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