Case history
Case history #1
A healthy 63-year-old woman presents with a history of over 7 years of fecal and urinary incontinence. The fecal incontinence is in the form of urgency, being unable to defer defecation for more than 1 to 2 minutes after the desire to evacuate. She also leaks without being aware and has to wear pads constantly. Despite pelvic floor exercises she has seen a gradual deterioration in her symptoms such that she is virtually house bound. Occasional trips out are dominated by easy access to toilets. Her past obstetric history consists of two vaginal deliveries, the first requiring forceps and resulting in a tear that was repaired at the time of delivery.
Case history #2
An 85-year-old female nursing home resident who has severe dementia is brought in by her caregiver. The caregiver describes the patient as having constant perianal soiling and liquid diarrhea. Examination reveals marked perianal excoriation, a patulous anus, and a large hard fecal bolus filling the rectum.
Other presentations
The complex interplay of different underlying contributing factors result in a variety of presentations. These may include urgency and the inability to postpone defecation until a socially acceptable time; passive leakage or the passage of flatus or feces without being aware; or the seepage or undesired leakage of stool with otherwise normal continence and evacuation. Intestinal disease resulting in rapid fecal transit (e.g., functional bowel disease, gastroenteritis, inflammatory bowel disease, bowel cancer) may overcome an otherwise normal pelvic floor. The sudden and persistent onset of incontinence in a patient with otherwise no precipitating factors should alert the physician to exclude such underlying disease processes.
Use of this content is subject to our disclaimer