IF SYMPTOMS PERSIST By DR. JOSE PUJALTE JR.

“The anal canal is always closed, except during the passage of feces or flatus.”-- Anatomy, National Medical Series For Independent Study (NMS),   (1984) p.305

Dr. Jose Pujalte Jr. It was the summer of 1990 and reviewing for the medical boards, I crammed using the NMS. Reading back, I penciled in “Hah!” on reading this about the anal sphincters: “The sphincteric mechanism has a remarkable ability to distinguish between and separate flatus from feces.” How true! How could society progress, social harmony prevail if the anal sphinctersrelaxed? Bowel Incontinence. This brings us to bowel incontinence, a condition where the anal sphincters DO relax and trouble is just a smell away. It is defined as the “loss of bowel control resulting in (the) involuntary passage of stool.” Cases range from an occasional leak of gas and feces to a complete loss of control as seen in paralyzed patients. While the state of the anal sphincters play a key role in bowel incontinence, two other conditions must be normal. These are: rectal sensation or the feeling that alerts you to a toilet visit and rectal accommodation, the normal stretching of the rectum to hold stool until such time it can be expelled. Causes. A common and understandable cause is diarrhea. Everyone knows the feeling because of the sticky sweat and goose bumps. An ironic cause is constipation.Now why will incontinence occur when stools are stuck? The impaction of solid stools expands the walls of the rectum eventually leading to loss of muscle tone. Because of this, soft or watery stools easily leak out.  Muscles and nerves in the rectal area can also be damaged during childbirth, tumors, and stroke. Let’s not forget the effect of stress.Diet-conscious women (and men) who abuse laxatives are at risk. Severe hemmorhoids or rectal prolapse may lead to bowel leakage. Side Effect of Medication.Particularly in the elderly, some of their maintenance medications result in bowel incontinence. These are:

• Sedatives or hypnotics
• Narcotics
• Antacids
• Muscle relaxants
• Laxatives

Signs and Symptoms. Aside from the obvious leakage, bowel incontinence can present with the following: diarrhea, constipation, abdominal cramping and gas or bloating. Self-Care. Stool consistency is a product of what you eat or drink. To improve stool bulk, take fiber. High fiber foods include fruits and vegetables, whole-grain breads and cereals. Psyllium-containing food supplements in powder or capsule form are also convenient. Add fiber slowly (usually 5 to 10 grams initially) to prevent bloating. The goal is to get 20 to 30 grams of fiber in the diet daily. There are foods that cause diarrhea and of course, response to food is individual. In general though, diarrhea results from spicy, fatty or greasy foods. If you are lactose-intolerant, taking milk or dairy products will increase the chances of diarrhea. For well formed stools, drink water up to 8 to 10 glasses a day. Some doctors recommend smaller meals because heavy meals trigger bowel contractions ending in diarrhea. Getting Help. Enough of proctologist jokes – these are the doctors, specifically the colo-rectal surgeons that can cure that posterior leak. But before going to the surgeon, get help from your favorite doctor or family medicine practitioner. Maybe all that needs to be done is to get rid of constipation. Maybe impacted stools need to be manually removed. In this case, the doctor will insert one or two fingers in your rectum and break up the hard fecal matter into smaller pieces. As for surgery, damaged sphincters can be repaired by sphincteroplasty. If bowel incontinence is due rectal prolapse (rectum protrudes through your anus), or hemmorhoids, or rectocele in women (part of the rectum protrudes into the vagina), the colo-rectal surgeon is the specialist to see. There’s hope for this private and embarrassing condition. You will just need the resolve to see the doctor. ­ E-mail: [email protected]