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    Suggest treatment for fecal incontinence and irritable bowel syndrome

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Posted on Sat, 1 Jul 2017 in Digestion and Bowels
Question: for over a year I have had uncontrollable, soft stool. I can't make it 25 feet to the bathroom when I first realize I need to go to the bathroom. No blood noted, not watery, just very loose and total lack of control. Is interfering with daily life.. This happens a minimum of three times a week.
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Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Irritable bowel disease possibly overlapping with fecal incontinence.

Detailed Answer:
Hello Dear patient,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.
Most likely you are suffering from irritable bowel syndrome with overlapping fecal incontinence.
Firstly small briefing for Irritable bowel syndrome and why every patient is a unique case when we deal with IBS.
In IBS there is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome. The structure of the intestines is normal, only functional abnormality occurs in this condition.So frankly speaking (IBS) represents a functional disorder of gastrointestinal tract without the presence of an anatomic defect.

Recent studies by French scientists have indicated that the most important mechanisms include visceral sensitivity, abnormal gut motility and autonomous nervous system dysfunction. The interactions between these three mechanisms make bowel's function susceptible to many exogenous and endogenous factors like gastrointestinal flora, feeding and psychosocial factors.

Further data indicate that according to the above mechanisms, the influence of genetic factors and polymorphisms of human DNA in the development of IBS is equally important.

So in lay mans language till date we are not sure whats the exact cause of this problem.So the million dollar question is how to repair a system when you don't know which part of it is faulty(Some says it can be brain other says it can be hormone anxiety age etc etc).

Some patients have symptoms of unformed stools some have bloating and some may have severe constipation. Some patients have occasional symptoms whereas others may have symptoms for a long period of time.So as seen above every patient is different.Intensity of symptoms in every patient is different as so is the response to medicines and life style change.A patient may respond good to one medication while other patient is totally unresponsive to the same.

Our goal-
Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits best our patient.All the below mentioned drugs slows down motility of intestines hence will decrease both frequency of motions as well as will increase your power to control them.


Dicyclomine is an anticholinergic drug.An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.

Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by patient with minimal side effects. Mebeverine works on certain muscles in the wall of your intestines, causing them to relax.

Clidinium bromide is an anticholinergic (specifically a muscarinic antagonist) drug. It may help symptoms of frequent stools.

Chlordiazepoxide works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain.Can be used in combination with above mentioned medicines.


Ask your Gastroenterologist to start you initially on clidinium bromide and mebeverine combination initially for 21 days.

If still after this treatment you can't control bowel we will further investigate your for fecal incontinence.Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.
Digital rectal exam would be done in which gastroenterologist would inserts a gloved and lubricated finger into your rectum to evaluate the strength of your sphincter muscles and to check for any abnormalities in the rectal area.

However as of now initially get a prescription for medications as suggested and follow up after 21 days.

Hope i provided you with useful information.
Follow ups are welcome.

Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2428 Questions

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