A 38-year-old woman G4P4 is undergoing evaluation for fecal incontinence. She has no known medical problems.
Which of the following is the most likely cause of this patient’s condition?A. Rectal prolapse
The most common cause of fecal incontinence is obstetric trauma that causes direct damage to the anal sphincter or to the pudendal nerve. The rectal sphincter can be completely lacerated, but as long as the patient retains a functional puborectalis sling, a high degree of continence will be maintained. Anal sphincter weakness may also be caused by other nontraumatic etiologies, such as spinal cord injury. Other causes of fecal incontinence include conditions that decrease rectal sensation, such as dementia, central nervous system (CNS) disease, diabetes, or multiple sclerosis. Therapy for fecal incontinence includes bulk-forming and antispasmodic agents, especially in those patients presenting with diarrhea. All caffeinated beverages should be stopped. Biofeedback and electrical stimulation of the rectal sphincter are other possible conservative treatments. Surgical repair of a defect is indicated when conservative measures fail, when the defect is large, or when symptoms warrant a more aggressive treatment approach.