DR. HOOK- No leaks: Wipe out bowel seepage

"Let Go and Let God" is an expression I've heard for a couple of decades. I still haven't mastered it. Actually, I can't really say I'm trying to master it. Well, really... oh, never mind. The point is that some things are just out of our control, like the weather, traffic, and Lindsay Lohan. 

Over Thanksgiving, we were going to deep fry our organic turkey, but there was rain. (Is it sacrilegious to deep fry something organic? I feel we should be roasting it over a campfire while singing folk songs.) I could shake my fists to the cloudy skies and yell, "Don't rain on my parade!" but I don't think it would be good for my singing voice. So what happens when you let go?

 Fecal incontinence is something you really don't want to let go if possible. Unfortunately, this "taboo" topic is not discussed much– even in the doctor's office. No one has ever volunteered this information to me, and so I find out only by asking during my review of systems. 

"Do you have diarrhea, constipation, bowel movement accidents..." The response usually is, "Ah, no, no, no... and well, hmm, now that you mention it..."

 Fecal incontinence means after the age of four, a person accidentally poops at least once a month. Minor fecal incontinence occurs when passing gas or some diarrhea. Major fecal incontinence means stool comes out without planning. 

How many people have fecal incontinence? We really aren't sure because people don't admit to it. It is thought about 11-15 percent of adults have fecal incontinence, and it's the #2 cause of nursing home placement. In 1988, $400 million adult diapers were sold, some of which probably were for fecal incontinence. Holy cr... well, you know.

 Who says getting older is great? Age is a risk factor for fecal incontinence, in particular those with dementia. Men and women have it equally, but women are twice as likely to admit it. Other risk factors include COPD (chronic obstructive pulmonary disease, like emphysema), irritable bowel syndrome (IBS), inflamatory bowel disease (IBD), urinary incontinence, and brain injury. 

 Women who have vaginal childbirth might have damage to the anal sphincter or pudendal nerve, which can lead to fecal incontinence for years. Hemorrhoid and anal fistula surgery can lead to fecal incontinence as well, due to the trauma. 

 Diabetics are more at risk because of neurological damage, which makes it hard to sense there is stool in the rectum. When poop is in the rectum, the internal anal sphincter relaxes, and it's up the external sphincter (which you control) to stay shut or open up. 

But as in multiple sclerosis, dementia, and spinal cord injuries, if the person can't sense it, the person can't control it.

 Also in diabetics with diarrhea due to bacterial overgrowth syndrome or autonomic neuropathy, diarrhea can be hard to hold back and so leaks through like top secret information in the White House. IBS, IBD, and even fecal impaction can cause diarrhea that might cause unwanted, embarrassing leakage. 

 What to do? Talk to your doctor. This is a medical issue, and no embarrassment is necessary. Studies can be done to determine the underlying problem and that can help lead to management. Endoscopy, anorectal manometry, defecography, and nerve testing are some studies that might be needed.

 As for this Thanksgiving, we had to stand over our turkey fryer with an umbrella because we didn't want a grease fire to burn down the house. As noted above, leakage can be a bad thing.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.