I am a 74 year man with diabetes since 25 years and it is under control by medicines and insulin injections. If I make long travels by car, I want to urgently use toilets on the way for passing stools. If I could not see a toilet I usually passes in my underwear and pants while in the car itself. It has become a regular habit now resulting in difficult situations. Kindly advise whether it is due to irritable bowel syndrome and what is the remedial measure I can follow before or in a journey. When the urge comes I cannot control it.

Dr. Surbhi AgrawalGeneral Physician12yrs exp

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There are many potential causes of fecal incontinence, including: diarrhea (possibly due to an infection or ibs) impacted stool (due to severe constipation, often seen in people of your age group) inflammatory bowel disease (crohn's disease or ulcerative colitis) nerve damage (due to diabetes or spinal cord injury) more than one cause for fecal incontinence is a strong possibility. Alot of cases of bowel incontinence, occur without a clear cause. First things first is to figure out the cause, if at all possible. This is a process, no single simple test will be able to figure it out. You will need to see a gastroenterologist and discuss your entire medical history. During a physical examination, a the gi may check the strength of the anal sphincter muscle using a gloved finger inserted into the rectum. Some of the tests that may be needed for figuring this out are: stool testing endoscopy anorectal manometry. A pressure monitor is inserted into the anus and rectum. This allows measurement of the strength of the sphincter muscles. Endosonography. An ultrasound probe is inserted into the anus. This produces images that can help identify problems in the anal and rectal walls. Nerve tests. These tests measure the responsiveness of the nerves controlling the sphincter muscles. They can detect nerve damage that can cause bowel incontinence. Let me try and give you an overview of what kind of treatment options you have. Recommended treatments vary according to the cause of course. Often, more than one treatment method may be required to control symptoms. Diet changes may be helpful: eat 20 to 30 grams of fiber per day. This can make stool more bulky and easier to control. Avoid caffeine. This may help prevent diarrhea. Drink several glasses of water each day. This can prevent constipation. Medications. Try these medicines to reduce the number of bowel movements and the urge to move the bowels: imodium lomotil hyoscyamine methylcellulose can help make liquid stool more solid and easier to control. For people with a specific cause of diarrhea, such as inflammatory bowel syndrome, other medications may also help. Exercises. Begin a program of regularly contracting the muscles used to control urinary flow (kegel exercises). This builds strength in the pelvic muscles and may help reduce bowel incontinence. Bowel training. Schedule bowel movements at the same times each day. This can help prevent accidents in between. Surgery may be recommended for people whose bowel incontinence is not helped by noninvasive treatments. There are many different surgeries that can be done. But I don; t want to get into this unless we know its really necessary. I strongly suggest you look into instituting the dietary changes mentioned above, after that medication may be needed. But above all, you need to be in touch with a good gi. I hope this helps. Feel free to follow-up and I will do my best to talk you through all this. 

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