Brief Answer:
Please provide further information.

Detailed Answer:
Hello, Sir.

I can certainly understand your concerns.

I worked through your query in detail.

You possibly seem to have mild to moderate fecal incontinence. This could indicate the weakness in anal sphincters.

Before guiding you further, I would like to know the following from you.

1 .When did the symptoms first begin.
2. Was there any history of injury to spinal cord in the past?
3.Any history of coexisting medical disorders?
4.Any past history of surgery ?

Once I receive your answers, I shall guide you through.

Thank you

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Brief Answer:
Possible functional fecal incontinence.Require further work up.

Detailed Answer:
Hello, Sir.

I have worked through your query and provided answers again.

I apologize for the delayed response considering my hectic work schedule.

In the absence of relevant history, the possibility of idiopathic functional anorectal incontinence is high.

This requires a baseline evaluation at the earliest to design appropriate management and to prevent further worsening of the condition.

Fecal continence is maintained by the structural and functional integrity of the anorectal unit. Normal anal sphincter function is a critical part of continence.

The anal sphincter is comprised of 2 components: the internal anal sphincter (IAS) and the external anal sphincter (EAS). The IAS is chiefly responsible for maintaining continence at rest and contributes approximately 70-80% of the resting sphincter tone.

Hence, in your case an assessment of the function of above two structures is mandatory, since you are a young man who has a lot of life ahead.Hence I d not want to leave any stone untouched.

I can understand that you are not quite comfortable with anal examination.
But it is now mandatory that you some degree of compliance with anorectal examination to plan appropriate treatment by the concerned doctors.

In your case, I would like to advise you those investigations which will cause relatively very less embarrassment and discomfort simultaneously yielding accurate results in very less time.

I recommend the following.

1. Anorectal pressure monitoring(manometry studies).

2. Endoanal ultrasonography.

As a short term alternative, I advise medical therapy to control your symptoms.Check for 2 weeks(to make up your mind) if there is any symptomatic improvement before taking up any investigations I suggested.(In case if you are really distressed about anal examination)

Meanwhile medical therapy can be instituted to improve the consistency of stool and prevent the seepage/soilage.For this, I generally recommend my patients with Psyllium/Ispaghula husk powder 2 spoons in 250 ml of water at bedtime daily.This acts like a bulking agent.

Additionally, I prescribe oral pills of LOPERAMIDE(IMODIUM) 2 mg once a day on SOS basis.

Loperamide hydrochloride increases gut transit time, allowing for increased absorption of water from the volume of stool. This results in a firmer, more easily controlled stool.An additional benefit of loperamide (Imodium) is that it increases internal anal sphincter tone and may improve rectal compliance.

Please check with your physician if he shares my view and if can prescribe these medications to you.

Further specific management if any is largely based on test results.

Post your further queries if any.
Thank you.

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Brief Answer:
Continue using medications for at least 3 months.

Detailed Answer:
Hello, Sir.

I can certainly understand your concerns.

Few lifestyle measures can help you.

Avoid putting on weight.

Avoid fried , fatty and junk food.

Drink Good amounts of water.

Try to schedule bowel habits at a fixed time.

Make sure you have one bowel movement at bedtime , since this will prevent fecal incontinence symptoms in the day time, especially while at work.

Continue the prescribed medications for 3 months at least.

In case you respond, it's fine.

In case if you don't respond even after 3 months, It would be wise to get the tests I prescribed and look for a permanent solution.

Post your further queries if any.
Thank you

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