Anal incontinence, an undervalued pathology

Undoubtedly, anal incontinence is one of the digestive pathologies that most alter the patient's quality of life, not because of its severity, but because of the invalidation that may result for the sufferer.. Interestingly doctors have given little importance and many still ignore the diagnostic and therapeutic possibilities that are available today.

We can define it as the repeated loss of voluntary control of anal continence that is not incidental, it can be for gases, liquids or solids and it occurs in individuals over 4 years of age.

It occurs between 3 and 7% of the population although most do not go to the doctor because of embarrassment or ignorance of current techniques. And it is more frequent in: women, over 65 and with difficulties in mobilization.

The causes that cause incontinence can be several:

-Alterations or loss of strength of the muscles or sphincters of the anus: after anorectal interventions (fissures, fistulas, hemorrhoids), multiple or difficult deliveries, trauma and stretching of the pelvic nerves (constipation)

-Decrease in rectal sensitivity: for dementias, advanced age, spinal cord injuries, cerebrovascular accidents and multiple sclerosis

-Decrease in rectal capacity: for infectious proctitis, actinic roctitis (after radiotherapy), inflammatory bowel disease and some rectal tumors.

The diagnostic tests to be performed are the following:

1. Detailed clinical history of the patient.

2. Physical examination that includes a digital rectal examination.

3. Psychological Support.

Four. Endoanal ultrasound to evaluate if there is sphincter injury.

5. Anorectal manometry to assess anorectal function.

Treatment

Depending on the type and severity of incontinence, there are several possibilities that can be applied together or in isolation.

-Diet: fiber supply and mass forming agents.

-drugs: Loperamide

-Anorectal biofeedback

-Repair or prosthetic surgery.

Of all of them perhaps the least known is biofeedback, which is a technique that is not annoying for the patient and is done through a computer and through which they learn to perform a series of exercises to improve the strength of the anal sphincters and subsequently practice them at home.