Incontinencia Fecal

La incontinencia fecal (también llamada incontinencia anal o intestinal) es la capacidad deteriorada para controlar el paso del gas o de las heces. Este es un problema común, pero a menudo no se discute debido a la vergüenza. Si el paciente no se busca tratamiento puede resultar en aislamiento social y un impacto negativo en la calidad de vida.

CAUSAS

Hay muchas causas de la incontinencia fecal tales como lesión, enfermedad y edad.

  • Lesiones relacionadas con el parto: Esta es la causa más común, como resultado de un desgarro en los músculos anales. Los nervios que controlan los músculos anales también pueden ser lesionados, lo que puede llevar a la incontinencia. Algunas lesiones pueden detectarse inmediatamente después del parto; Sin embargo, muchos pasan desapercibidos hasta que causan problemas más adelante en vida. Puesto que puede ser años después de dar a luz, el parto no es a menudo reconocido como la causa del problema.
  • Trauma a los músculos anales: Las operaciones anales o lesiones traumáticas en los tejidos cercanos a la región anal pueden dañar los músculos anales y disminuir el control intestinal.
  • Pérdida de la fuerza muscular anal relacionada con la edad: Algunas personas pierden gradualmente la fuerza muscular anal a medida que envejecen. Un problema leve de control puede haber existido cuando eran más jóvenes, pero esto empeora más tarde en la vida.
  • Enfermedades neurológicas: El accidente cerebrovascular grave, demencia avanzada o lesión de la médula espinal puede causar falta de control de los músculos anales, lo que resulta en incontinencia.

SÍNTOMAS

Los síntomas pueden variar de leves a severos. Los casos leves sólo pueden implicar dificultad para controlar el gas. Los casos graves pueden conducir a una incapacidad para controlar las heces líquidas y formadas. Un paciente puede tener una sensación de urgencia o experimentar fuga de heces debido a frecuentes heces líquidas o diarrea.

Si hay sangrado con falta de control intestinal, consulte a su médico tan pronto como sea posible. Esto puede indicar una inflamación en el colon y el recto, como la colitis ulcerosa, la enfermedad de Crohn, un tumor rectal o un prolapso rectal. Todas estas condiciones requieren una pronta evaluación por un médico.

DIAGNÓSTICO

Una discusión inicial de los síntomas con su médico ayudará a determinar el grado de incontinencia y el efecto en su vida. Los posibles factores subyacentes a menudo se encuentran durante una revisión de su historial médico, tales como:

  • Embarazos múltiples, bebés de gran peso, partos con fórceps o episiotomías (incisiones quirúrgicas para ayudar al parto).
  • Antecedentes de cirugías anal o rectales anteriores.
  • Enfermedades o condiciones médicas.
  • Efectos secundarios de la medicación.

Se debe realizar un examen físico de la región anal. Un examen puede identificar fácilmente una lesión obvia a los músculos anales. Su médico decidirá si se necesitan pruebas para confirmar el diagnóstico. Se puede usar una sonda de ultrasonido en el área anal, que proporciona fotografías de los músculos anales potencialmente lesionados. Otras pruebas pueden ser necesarias para evaluar la función de los músculos y los nervios que ayudan a controlar los movimientos intestinales.

TRATAMIENTO

Existen opciones de tratamiento quirúrgico y no quirúrgico que varían según la causa y la gravedad del problema. Su cirujano de colon y recto discutirá diferentes métodos de tratamiento y le ayudará a decidir qué enfoque es mejor para usted.

OPCIONES NO QUIRÚRGICAS

Cambios en la dieta: Los problemas leves pueden ser tratados simplemente cambiando la dieta.

Medicamentos que constipen: Los medicamentos específicos pueden dar lugar a heces más firmes, lo que permite un mayor control intestinal.

Medicamentos: Las enfermedades inflamatorias intestinales (como la colitis ulcerosa o la enfermedad de Crohn) pueden causar diarrea y contribuir a los problemas de control intestinal. El tratamiento de estas enfermedades subyacentes puede eliminar o mejorar los síntomas de la incontinencia.

Ejercicios de fortalecimiento muscular: Los ejercicios caseros simples para fortalecer los músculos anales pueden ayudar en casos leves.

Biorretroalimentación: Un tipo de terapia física para ayudar a los pacientes a fortalecer los músculos anales y detectar cuando las heces están listas para ser evacuadas.

OPCIONES QUIRÚRGICAS

Existen varias opciones quirúrgicas para el tratamiento de la incontinencia fecal. Tenga en cuenta que la cirugía no es la elección correcta para cada paciente.

Reparación del músculo quirúrgica: Las lesiones de los músculos anales pueden ser reparadas quirúrgicamente.

Estimulación de los nervios: La inserción de un estimulador nervioso puede ayudar a los nervios que controlan los músculos y la piel del ano a trabajar más eficientemente.

Inyecciones de agente acumulador: Inyectar una sustancia en el canal anal puede agrandar y fortalecer el mecanismo de "compresión" de los músculos anales utilizados durante los movimientos intestinales.

Colostomía quirúrgica: En los casos graves, una colostomía puede ser la mejor opción para mejorar la calidad de vida. Durante este procedimiento, parte del colon (intestino grueso) se lleva a cabo a través de la pared abdominal para drenar en una bolsa.

¿QUÉ ES UN CIRUJANO DE COLON Y RECTO?

Cirujanos de colon y recto son expertos en el tratamiento quirúrgico y no quirúrgico de las enfermedades del colon, recto y ano. Han completado el entrenamiento quirúrgico avanzado en el tratamiento de estas enfermedades, así como la formación en cirugía general completa. Cirujanos certificados por la junta de colon y recto completan residencias en cirugía general y cirugía de colon y recto, y pasan los exámenes intensivos llevados a cabo por la Junta Americana de Cirugía y la Junta Americana de Cirugía de Colon y Recto. Ellos están bien versados en el tratamiento de enfermedades tanto benignas como malignas del colon, recto y ano. Ellos son capaces de realizar exámenes de detección rutinas y de tratar quirúrgicamente condiciones, si está indicado para hacerlo.

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.



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