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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 35793
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I had a dreadfully embarrassing "accident" in a department

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I had a dreadfully embarrassing "accident" in a department store today. I had an upset stomach a couple of days ago and lots of gas since and went on a liquid diet to settle things down. This afternoon I felt much better and we went out to dinner, a greek chicken salad for me. After we went to a department store in search of a new vacuum. While looking at the machines I felt an urge to go to the bathroom which was at the opposite end of the store. On the way feces began rolling out (the only way I can describe it... like lave slowly rolling out) and I couldn't stop it. By the time I got to the bathroom it was running down my legs and all over my clothing. I completed the bm and cleaned myself up as best I could but I was humiliated with seemingly every eye on me as I made my way back to the front to get out of there.This has happened to me other times (maybe 5 times) with NO warning at all and disastrous results. What would cause such that I couldn't hold it in until I reach the facilities. Certainly it has a foul odor but more medicinal than like a normal bm..
Customer: replied 10 days ago.
I clicked continue before finishing profile. I am a female in my 70's.

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The major factors necessary for fecal continence are;

1) an intestine content (fecal material / stool) that is substantially firm and bulky,

2) a passively distensible, capacious and evacuable rectum and

3) an effective barrier to outflow.

Therefore, changes in the quantity and/or quality of stool, the inability of the rectum to accommodate, damage to the anal sphincter mechanism and/or an impaired sensation can result in fecal incontinence.

As a result, common causes of fecal incontinence are;

a) diarrhea,

b) fecal impaction with overflow,

c) impaired rectal storage,

d) loss of rectal sensation to distension, and

e) isolated or combined weakness/impairment of the sphincter and puborectalis muscle.

Frequently, it is a combination of more than one of these mechanisms (new onset diarrhea with pre-existing anal sphincter dysfunction that was subclinical in its expression).

Normal continence involves the coordinated interaction between multiple different nerve pathways and the pelvic and perineal musculature. Many other factors, like systemic disease, emotional effect, bowel motility, stool consistency, evacuation efficiency, pelvic floor stability, and sphincter integrity, play a role in normal regulation of the anal sphincter. Failure at any level may result in an impaired ability to control gas or stool (especially if the motion is liquid). Following investigations are needed for the identifying the cause, if this has been going on for more than 2-3 weeks;

1) Endoanal ultrasound,

2) MRI,

3) Defecography,

4) Anorectal manometry

5) Anorectal electrophysiology testing

The treatment entails;

1) Biofeedback; Pelvic floor exercises with biofeedback are beneficial when combined with the addition of dietary modifications. Biofeedback educates regarding pelvic floor coordination, recognition of sensory thresholds, and conditioning of the pelvic musculature, and it helps develop improved pelvic floor habits.

2) Dietary modification: a food diary may be useful to detect offensive items, such as citrus or spicy foods, caffeine, and alcohol, that may be associated with incontinence. Avoiding these may decrease the irritant load to the rectum.

3) Medications; The two most commonly used drugs are loperamide and diphenoxylate with atropine. Loperamide is currently the treatment of choice because it not only thickens the stool but also has been shown to increase anal sphincter tone and improve continence mechanisms.

4) Anal sphincteroplasty; it is a surgical procedure and is done when the above medical treatment fails and if the injury of the sphincter of anus is demonstrated.

5) Artificial sphincters

6) Sacral nerve stimulation.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer: replied 10 days ago.
Thank you. As sometimes happens I am unable to rate you. I think you can release this so it is possible. Please do.

You are most welcome.

Thanks for the positive rating.

I really appreciate it.