What Can Cause Anal Leakage or Leaky Anus & How is it Treated?

About Anal Leakage or Leaky Anus

The medical term used for anal leakage is fecal incontinence, also sometimes referred to as leaky anus. It is the condition where the patient suffers from uncontrollable leakage of feces from the anus, which in severe cases lead to complete loss of bowel movement. The illness is seen in 2% of population.1 The symptoms are more frequent in elderly individual. More common in female than male. There are several symptoms, causes, diagnosis, treatment process and preventive measures for this problem of anal leakage or leaky anus which are summarized here under.

Symptoms of Anal Leakage or Leaky Anus

The signs or symptoms of anal leakage vary from person to person. However, some of the common symptoms associated with leaky anus include:

  • Itchy buttocks.
  • Itchy anus.
  • Pain and discomfort in the anal area.
  • Burning Anus.
  • Feeling like passing bowel even after bowel movement.
  • Altered bowel movement like diarrhea and constipation.

What Can Cause Anal Leakage or Leaky Anus?

What Can Cause Anal Leakage or Leaky Anus?

  • Colitis and diarrhea,
  • Anal sphincter damage,
  • Autonomic neuropathy
  • Constipation
  • Rectal prolapse
  • Anal cancer
  • Rectal stiffening
  • Hemorrhoids or piles
  • Prolapse rectum
  • Anal fissure surgery2
  • Radiation therapy of for rectal and prostate cancer3
  • Pelvic radiotherapy for cancer of vagina, uterus and sigmoid colon4

Anal leakage is also known as anal incontinence. The leakage of content of large intestine through anus is a serious condition that causes concern regarding soiling of underwear and cloths. Most infection or inflammatory diseases of colon involves rectum, sigmoid colon and large intestine. Thus, anal leakage is a leaking of fecal materials from large intestine, sigmoid colon and rectum. The fecal content leaks through the anus. The rectal content is semisolid or watery in consistency, may or may not be associated with mucus. Following causes are associated with anal leakage problem.

Colitis and Diarrhea- Bacterial diarrhea causes inflammation of large intestine, sigmoid colon and rectum. The liquid fecal content is mixed with mucus and discharged through the anus resulting in leaky anus. The frequency at times is several episodes or leaks of feces in one hour. The condition is known as enteritis with anal leakage or leaky anus.

Damage to the Sphincter: Anal sphincter tightly closes anus all the time and prevents fecal leaks. The sphincter is a circular smooth muscle that stays contracted until one tries to pass the stool and then sphincter relaxes to let the fecal material pass outside anus. In certain condition sphincter is damaged or becomes weak that results in fecal incontinence or leaky anus. The sphincter muscles are damaged during prostrate or rectal surgery. The other causes of relaxed sphincter muscles are trauma to the anal region, damage caused during child birth and adverse effects from radiation treatment. Damaged or weak sphincter muscles is unable to hold the fecal substances in rectum and anus. The pressure caused by increased volume of fecal substances in rectum and anus causes fecal leak.

Autonomic Neuropathy- Autonomic nervous system contains sympathetic and parasympathetic nerve fibers. Sympathetic nerve fibers send signals to keep internal anal sphincter continuously contracted. Increases signals from parasympathetic nerves to internal sphincter causes relaxation of muscles so fecal material can be discharged out. The sphincter become weak and cannot maintain continuous contraction when sympathetic nerve do not send signals. The conditions that causes sympathetic nerve fiber damage resulting in malfunction are : Diabetic neuropathy, multiple sclerosis, spinal cord injury and stroke. Such condition thus often are associated with leaky anus or anal leakage.

Constipation- Infrequent and smaller quantity of discharge of stool or feces is known as constipation.5 Constipation is observed in individual suffering with dehydration that causes solid and hard stools. The weak smooth muscles of sigmoid colon and rectum also causes constipation. The solid large size of stool causes distension of anus at the time of defecation. The anal sphincter is stretched and often unable to remain in contraction that results in leaky anus or anal incontinence.

Rectal Prolapse as a Cause of Leaky Anus: Rectum continues as anus. The rectal prolapse is caused during chronic illness because of generalized weakness or trying to force feces by vigorous contraction of abdominal muscle as well as intestinal muscles. The prolapse of rectum when forced through anus causes anal dilatation, that follows leaky anus and anal incontinence.

Other Less Common Causes of Anal Leakage or Leaky Anus:

  • Anal cancer
  • Rectal stiffening
  • Hemorrhoids or piles
  • Prolapse rectum
  • Anal fissure surgery2
  • Radiation therapy of for rectal and prostate cancer3
  • Pelvic radiotherapy for cancer of vagina, uterus and sigmoid colon 4

Diagnosis of Anal Leakage or Leaky Anus

The tests performed in case of anal leakage depends on the circumstances of the case. The physician will require a list of the medical history of the patient, such as diet and exercise routine and cases of digestive disorders. Several tests also need to be conducted. Treating physician wants to know several questions that is described below-

  • Frequency of incontinence
  • When did such complication start?
  • Is there any warning or urge?

Diagnostic Test To Evaluate Anal Leakage Or Leaky Anus

  • Balloon expansion test
  • Anal Manometry
  • Proctography
  • Proctosigmoidoscopy
  • Anorectal ultrasonography
  • Magnetic resonance imaging.

How is Anal Leakage or Leaky Anus Treated?

The treatment for anal leakage varies significantly on the underlying cause. Anal leakage or leaky anus can be treated either through the use of topical applications, oral medication or may even require surgery. Therefore, it requires proper diagnosis by a qualified medical practitioner. Treatment depends on diagnosis of cause of anal leak and severity of symptoms. The urgency of treatment and choice of treatment like conservative treatment, medication or surgery has to be evaluated by experienced primary care physician or specialist. Following are the choices of non-surgical treatments for anal leakage or leaky anus:

Conservative Treatment for Anal Leakage or Leaky Anus –

  • Bed Rest- Bed rest helps in case anal leak is caused by enteritis or severe malnourishment.
  • Rehydration- Solid stool often gets impacted and causes damage to anal sphincter. One must drink lots of water to keep stool soft.
  • Diet to Prevent Constipation- Lentils, bean, pasta, oatmeal, apple and pears.
  • Diet to Prevent Diarrhea- Frequent diarrhea causes leaky anus. In such cases non-infectious diarrhea can be controlled with diet. The diet that helps to prevent diarrhea are oatmeal, wheat or pasta, white rice and boiled potatoes.
  • Fiber Supplements- Fiber supplement helps to prevent constipation. Research study suggests fiber diet that contain gum Arabic, psyllium and CMC fibers helps to treat leak anus.6
  • Exercises- The anal sphincter weakness is treated with sphincter tightening exercises. The research study suggests such exercises works better with biofeedback.7

Medication for Anal Leakage or Leaky Anus –

  • Anti-diarrheal Medications- Kaopectate, Pepto-Bismol and Imodium
  • Enemas for Constipation- Enema helps to soften stool and relieve constipation. Enema is given using mineral oil, saline solution and laxative like bisacodyl enema.
  • Antibiotics- Bacterial infected colitis is treated with antibiotics.
  • Antispasmodic Medications- Abdominal colic associated with leaky anus is treated with antispasmodic medication. Most antispasmodic prescribed are Bentyl, Buscopan and Hyoscyamine.
  • Anti-depressants- Ulcerative colitis and chron’s disease causes leaky anus and depression. In such case patient should be prescribed antidepressant as an adjuvant treatment.
    Hydrocortisone Ointments- Repeated fecal passage causes irritation and ulcer of anal mucosa. Such condition is treated with hydrocortisone ointment.
  • Oral Pain Relievers- The stretching of anal mucosa and sphincter as well as repeated fecal movement causes mucosal ulcer and anal fissure. Such condition is extremely painful and need pain medications. Most such pain is treated with tylenol and rarely opioid is prescribed.

Surgical Treatment for Anal Leakage or Leaky Anus

  • Anal sphincter reconstruction surgery 1, 8
  • Surgical repair of incontinence
  • Prolapsed rectum

Following anal fissure surgery

Radiation Therapy- Rectal cancer often causes anal leakage. In such cases rectal cancer is treated with radiation. Radiation therapy causes severe stricture and atrophy of external and internal anal sphincter. Such damage often causes tight anal opening.

These are some of the treatment options that often advised by treating primary care physician or specialist.

Prevention of Anal Leakage or Leaky Anus

  • There are some natural ways by which such anal leakage problems can be avoided.
  • Performed regular pelvic floor exercise
  • Fiber diet
  • Drink lots of fluid

When To See Your Doctor

Although, it might be embarrassing to discuss problems of anal leakage (leaky anus) with the doctor. But one must also understand soiling cloth is more embarrassing. You must see physician if anal leakage does not stop in 2 to 3 days. Increase daily frequency of defecation, loose stool and presence of mucus in stool suggest possible diarrhea. If you are suffering with diarrhea you must see your primary care physician in 24 to 48 hours to prevent dehydration and acute mineral deficiency. Leaky anus and abdominal pain should be evaluated by physician as soon as possible.

References:  

  1. Modern concepts for the treatment of fecal incontinence. Rosen HR1., Acta Chir Iugosl. 2002;49(2):23-4.

  2. Delayed fecal incontinence following surgery for anal fissure. Levin A1Cohen MJMindrul VLysy J., Int J Colorectal Dis. 2011 Dec;26(12):1595-9.

  3. Faecal incontinence following radiotherapy for prostate cancer: a systematic review. Maeda Y1Høyer MLundby LNorton C., Radiother Oncol. 2011 Feb;98(2):145-53.

  4. Faecal incontinence: A late side-effect of pelvic radiotherapy. Putta S1Andreyev HJ., Clin Oncol (R Coll Radiol). 2005 Sep;17(6):469-77.

  5. The pathophysiology of chronic constipation

    Christopher N Andrews, MD MSc FRCPC1 and Martin Storr, MD1,2,

    Can J Gastroenterol. 2011 Oct; 25(Suppl B): 16B–21B.

  6. Dietary Fiber Supplementation for Fecal Incontinence: A Randomized Clinical Trial

    Donna Z. BlissKay SavikHans-Joachim G. JungRobin WhitebirdAnn Lowry, and Xioayan Sheng, Res Nurs Health. 2014 Oct; 37(5): 367–378.

  7. Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults–a systematic review., Norton C1Kamm MA., Aliment Pharmacol Ther. 2001 Aug;15(8):1147-54.

  8. Anal sphincter reconstruction for incontinence due to non-obstetric sphincter damages. Madiba TE1Moodley MM., East Afr Med J. 2003 Nov;80(11):585-8.

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