Talk with your doctor about any changes in your usual bowel habits. Be honest and open about all of your symptoms. If you are having periods of looser stool or frequent constipation, ask your doctor about the need for further evaluation.
For a thorough evaluation of your symptoms, seek the care of a specialist such as a urogyn, colorectal surgeon, or gastroenterologist. Sometimes you need a team of doctors to help manage several aspects of these conditions. The evaluation should always begin with discussion of the symptoms and physical examination.
In addition to a review of your medical history and a physical exam, the doctor may recommend tests such as:
Depending upon your symptoms and evaluation findings, other tests that are sometimes necessary include:
- Colonoscopy / Sigmoidoscopy: Colonoscopy is a procedure done with anesthesia using a flexible camera to examine the colon. This test helps your doctor investigate possible blockage of the intestines from cancer or other masses. The colonoscopy, for example, may identify a mass that is making it harder for you to move your bowels. Or, it may locate a fistula or gastrointestinal disorder such as colitis of Crohn’s disease, which is causing your FI symptoms.
- Nerve Testing / Anal Manometry: Nerve testing evaluates possible injury to the nerves, which can cause decreased strength and sensation. Anal manometry is one type of nerve testing. It checks for normal or abnormal sense of bowel filling. It helps your doctor evaluate contraction and relaxation of the pelvic floor muscles. It also examines the sphincter muscle that surrounds the anus and identifies defects in that muscle which might be a part of your problem.
- MRI or Defecography: These tests evaluate the surrounding tissues for possible anatomic problems such as pelvic organ prolapse or problems with the pelvic floor muscles. This is the best study for the muscles near the bowels in the pelvis. It can help your doctor see how the bowels move when you strain.
- Ultrasound: Evaluates the anal sphincter muscles.
- Barium enema: X-ray study used to look for masses that block the intestines. Doctors look to see how long the contrast stays in your bowels, and sometimes are able to identify a concern for pelvic floor prolapse using this study.
- CT scan: X-ray study that can be used to look at the intestines or surrounding tissues for causes of constipation such as masses within or around the intestines.
- Sitz study: Evaluates the time it takes food to move through your bowels. For this study, you swallow a capsule and then several images are taken in the days afterward to see how far some markers have moved through your bowels.