KALA incontinence (syn: encopresis) - a violation of the function of the rectum and sphincter of the anus, manifested by involuntary defecation. Retention of the contents of the rectum is associated with the function of the external sphincter of the anus, providing its arbitrary closure, and the tonic closure of the internal sphincter. The regulation of the function of anal sphincters is carried out by innervation centers located in the brain and spinal cord, as well as in the distal colon. Fecal incontinence is observed in congenital malformations of the anorectal region, inflammatory bowel diseases (for example, some forms of colitis, dysentery, cholera), pelvic tumors, disorders of the central or peripheral innervation of the rectum (for example, with congenital syphilis, spinal malformations, muscle and intestinal mucosa, etc.). Fecal incontinence can occur in patients with mental disorders (for example, with oligophrenia). Its special variety is the so-called bear disease - a violent vegetative reaction to the action of an extreme psychoemotional stimulus, characterized by sudden involuntary loose stools.
The diagnosis is established on the basis of characteristic complaints, medical history and patient examination results, including examination of the anus, digital rectal examination, sigmoidoscopy and other studies.
Conservative treatment is indicated in the absence of gross organic damage to the obturator apparatus of the rectum. In order to regulate the intestinal emptying regimen, it is recommended to consume an adequate amount of liquid and food, the use of suppositories with glycerin or bisacodyl. Exercise is advisable - multiple contractions of the sphincters, muscles of the perineum, buttocks, due to which these structures are strengthened, their muscle mass is increased and thus involuntary defecation is prevented. Strychnine, proserin , ATP, and B vitamins are prescribed. Patients with increased excitability of the nervous system are shown the use of tranquilizers and sedatives. Psychotherapy should be aimed at creating and fixing a conditioned reflex to the place and environment in which the patient can perform an act of defecation. With organic lesions of the obturator apparatus of the rectum, the treatment is surgical. Apply various reconstructive operations aimed at restoring the damaged sphincter of the anus, its plastic replacement with areas of neighboring muscles.