Instruct: Given a question, retrieve relevant passages that can help answer the question.
Query: What is the number one cause of fecal incontinence?
Fecal incontinence (FI), also known as anal incontinence, or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents—including flatus (gas), liquid stool elements and mucus, or solid feces. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and usually there is more than one deficiency of these mechanisms for incontinence to develop. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery (especially involving the anal sphincters or hemorrhoidal vascular cushions), altered bowel habits (e.g., caused by irritable bowel syndrome, Crohn's disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence), and receptive anal sex. An estimated 2.2% of community dwelling adults are affected.
There are many causes of infectious diarrhea, which include viruses, bacteria and parasites. Infectious diarrhea is frequently referred to as gastroenteritis. Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections. Shiga-toxin producing Escherichia coli, such as , are the most common cause of infectious bloody diarrhea in the United States.
Constipation is the most common chronic gastrointestinal disorder in adults. Depending on the definition employed, it occurs in 2% to 20% of the population. It is more common in women, the elderly and children. Specifically constipation with no known cause affects females more often affected than males. The reasons it occurs more frequently in the elderly is felt to be due to an increasing number of health problems as humans age and decreased physical activity.Since ancient times different societies have published medical opinions about how health care providers should respond to constipation in patients. In various times and places, doctors have made claims that constipation has all sorts of medical or social causes. Doctors in history have treated constipation in reasonable and unreasonable ways, including use of a spatula mundani.
Functional gastrointestinal disorders are very common. Globally, irritable bowel syndrome and functional dyspepsia alone may affect 16–26% of the population.
During the third stage of labor, while the infant is being born, the vagina undergoes significant changes. A gush of blood from the vagina may be seen right before the baby is born. Lacerations to the vagina that can occur during birth vary in depth, severity and the amount of adjacent tissue involvement. The laceration can be so extensive as to involve the rectum and anus. This event can be especially distressing to a new mother. When this occurs, fecal incontinence develops and stool can leave through the vagina. Close to 85% of spontaneous vaginal births develop some form of tearing. Out of these, 60–70% require suturing. Lacerations from labor do not always occur.
In 1980, gastroenteritis from all causes caused 4.6 million deaths in children, with the majority occurring in the developing world. Death rates were reduced significantly (to approximately 1.5 million deaths annually) by the year 2000, largely due to the introduction and widespread use of oral rehydration therapy. In the US, infections causing gastroenteritis are the second most common infection (after the common cold), and they result in between 200 and 375 million cases of acute diarrhea and approximately ten thousand deaths annually, with 150 to 300 of these deaths in children less than five years of age.
Irritable bowel syndrome (IBS) is the most common of the functional gastrointestinal disorders. These are idiopathic disorders that the Rome process has helped to define.
A pit latrine, also known as pit toilet or long drop, is a type of toilet that collects human feces in a hole in the ground. Urine and feces enter the pit through a drop hole in the floor, which might be connected to a toilet seat or squatting pan for user comfort. Pit latrines can be built to function without water (dry toilet) or they can have a water seal (pour-flush pit latrine). When properly built and maintained, pit latrines can decrease the spread of disease by reducing the amount of human feces in the environment from open defecation. This decreases the transfer of pathogens between feces and food by flies. These pathogens are major causes of infectious diarrhea and intestinal worm infections. Infectious diarrhea resulted in about 700,000 deaths in children under five years old in 2011 and 250 million lost school days. Pit latrines are a low cost method of separating feces from people.
A pit latrine generally consists of three major parts: a hole in the ground, a concrete slab or floor with a small hole, and a shelter. The shelter is also called an outhouse. The pit is typically at least three meters (10 feet) deep and one meter (3.2 feet) across. The hole in the slab should not be larger than 25 centimeters (9.8 inches) to prevent children falling in. Light should be prevented from entering the pit to reduce access by flies. This may require the use of a lid to cover the hole in the floor when not in use. The World Health Organization recommends the pits are built a reasonable distance from the house, balancing issues of easy access versus that of smell. The distance from water wells and surface water should be at least 10 meters (32 feet) to decrease the risk of groundwater pollution. When the pit fills to within 0.5 meters (1.6 feet) of the top, it should be either emptied or a new pit constructed and the shelter moved or re-built at the new location. Fecal sludge management involves emptying pits as well as transporting, treating and using the collected fecal sludge. If this is not carried out properly, water pollution and public health risks can occur.
A basic pit latrine can be improved in a number of ways. One includes adding a ventilation pipe from the pit to above the structure. This improves airflow and decreases the smell of the toilet. It also can reduce flies when the top of the pipe is covered with mesh (usually made out of fiberglass). In these types of toilets a lid need not be used to cover the hole in the floor. Other possible improvements include a floor constructed so fluid drains into the hole and a reinforcement of the upper part of the pit with bricks, blocks, or cement rings to improve stability. In developing countries the cost of a simple pit toilet is typically between US$25 and $60. Recurring expenditure costs are between US$1.5 and $4 per person per year for a traditional pit latrine, and up to three times higher for a pour flush pit latrine (without the costs of emptying). 
As of 2013 pit latrines are used by an estimated 1.77 billion people, mostly in developing countries. About 892 million people (12 percent of the global population), practiced open defecation in 2016, mostly because they have no toilets. Southern Asia and Sub-Saharan Africa have the lowest access to toilets. The Indian government has been running a campaign called "Swachh Bharat Abhiyan" (Clean India Mission in English) since 2014 in order to eliminate open defecation by convincing people in rural areas to purchase, construct and use toilets, mainly pit latrines. It is estimated that 85 million pit latrines have been built due to that campaign as of 2018. Another example from India is the "No Toilet, No Bride" campaign which promotes toilet uptake by encouraging women to refuse to marry men who do not own a toilet.
In a pour-flush pit latrine, a squatting or pedestal toilet with a water seal (U-trap or siphon) is used over one or two offset pits. Therefore, these types of toilets do require water for flushing but otherwise have many of the same characteristics as simple pit latrines. About one to three liters of water is used per flush in that case, and they often have two pits that are used one after the other ("twin pit pour flush pit latrine"). For this reason they are subsumed under the term "pit latrine". The fecal sludge that is removed from the full pits of twin-pit pour-flush pit latrines is somewhat safer to handle and reuse than the fecal sludge from single pit pour-flush latrines. However, significant health risks for the workers who are emptying the pits remain in either case.
An alternative to U-trap or siphon designs is to incorporate a counter-weighted trap door mechanism that provides an air-tight water seal in the closed position. Addition of a small amount of water (generally less than 500 ml) overcomes the counterweight and allows the fecal matter to enter the pit. The devices are sold under the name of "SaTo pan" for as little as US$1.85, and more than 800,000 of them have been installed worldwide since introduction in 2013.
Fifty to seventy percent of cases of gastroenteritis in adults are caused by noroviruses (genus Norovirus, family Caliciviridae). This virus is highly contagious and spreads rapidly. Norovirus is the most common cause of gastroenteritis in the United States.
Unlike pit latrines, composting toilets convert feces into a dry, odorless material, avoiding the issues surrounding liquid fecal sludge management (e.g. odor, insects and disposal). These toilets minimize the risk of water pollution through the safe containment of feces in above-ground vaults, which allows the toilets to be sited in locations where pit-based systems are not appropriate.
Rotavirus, norovirus, adenovirus, and astrovirus are known to cause viral gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children, and produces similar rates in both the developed and developing world. Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group. Rotavirus is a less common cause in adults due to acquired immunity. Norovirus is the cause in about 18% of all cases.
In addition, ischemic colitis is a well-recognized complication of abdominal aortic aneurysm repair, when the origin of the inferior mesenteric artery is covered by the aortic graft. In a 1991 review concerning 2137 patients the accidental inferior mesenteric artery ligation was the most common cause (74%) of ischemic colitis. Thus, patients without adequate collateralization are at risk for ischemia of the descending and sigmoid colon. Bloody diarrhea and leukocytosis in the postoperative period are essentially diagnostic of ischemic colitis. The complication can be prevented through careful selection of subjects that may require replanting inferior mesenteric artery (IMA) and completing the pre surgical procedure information with an instrumental evaluation during surgical treatment.
This is the most common cause of anovulation and is thought to account for about 70% of all cases. About half the women with hormonal imbalances do not produce enough follicles to ensure the development of an ovule, possibly due to poor hormonal secretions from the pituitary gland or the hypothalamus. The pituitary gland controls most other hormonal glands in the human body. Therefore, any pituitary malfunctioning affects other glands under its influence, including the ovaries. This occurs in around 10% of cases. The mammary glands are also controlled by the pituitary gland, so lactation can also be affected. The pituitary gland is controlled by the hypothalamus. In 10% of cases, alterations in the chemical signals from the hypothalamus can easily seriously affect the ovaries.
Adequate footwear is important to prevent trauma. General good health and nutrition also reduce ulcer risk. Adequate and prompt cleansing and treatment of ankle and leg skin breaks is also important. Improving hygiene and nutrition may help to prevent tropical ulcers.Tropical ulcer has been described as a disease of the 'poor and hungry'; it may be that slowly improving socioeconomic conditions and nutrition account for its decline. Urbanization of populations could be another factor, as tropical ulcer is usually a rural problem. More widespread use of shoes and socks also provides protection from initiating trauma. Despite this, susceptible individuals still develop tropical ulcers. Sometimes outbreaks can occur; one was recorded in Tanzania in sugarcane workers cutting the crops while barefoot. Tropical ulcers can also occur to the visitors of tropics. The disease is most common in native laborers and in schoolchildren of the tropics and subtropics during the rainy season and is caused in many instances by the bites of insects, poor hygiene, and pyogenic infections. Males are more commonly infected than females.
In response to the high maternal mortality ratio, in 2013 the Department of State to created the Maternal Mortality and Morbidity Task Force. According to Amnesty International's 2010 report, five medical conditions collectively account for 74% of maternal deaths in the US.Postpartum depression is widely untreated and unrecognized, leading to suicide. Suicide is one of the most significant causes of maternal mortality, and reported to be the number one cause by many studies.
The anal canal is the terminal part of the large intestine. It is situated between the rectum and anus, below the level of the pelvic diaphragm. In humans it is approximately 2.5 to 4 cm (0.98-1.58 in) long. It lies in the anal triangle of perineum in between the right and left ischioanal fossa.
In humans, the large intestine begins in the right iliac region of the pelvis, just at or below the waist, where it is joined to the end of the small intestine at the cecum, via the ileocecal valve. It then continues as the colon ascending the abdomen, across the width of the abdominal cavity as the transverse colon, and then descending to the rectum and its endpoint at the anal canal. Overall, in humans, the large intestine is about long, which is about one-fifth of the whole length of the gastrointestinal tract.
When referring to human feces, blood in stool looks different depending on how early it enters the digestive tract—and thus how much digestive action it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleeding; or to hematochezia, with a red color, typically originating from lower gastrointestinal bleeding. Evaluation of the blood found in stool depends on its characteristics, in terms of color, quantity and other features, which can point to its source, however, more serious conditions can present with a mixed picture, or with the form of bleeding that is found in another section of the tract. The term "blood in stool" is usually only used to describe visible blood, and not fecal occult blood, which is found only after physical examination and chemical laboratory testing.
Investigations into the prevalence of these practices have been conducted by the World Health Organization. Their studies demonstrate that this is a global problem. Women experience disrespectful, abusive or neglectful treatment during their childbirth when the birth occurs in medical and health facilities. The abusive relationship and trust between women and health providers can create a great reluctance to obtain medical assistance during birth. Disrespectful and abusive treatment can be experienced during pregnancy. During childbirth, a woman is very vulnerable and cannot protect herself. The results of this abuse can have very negative consequences for the infant and the mother.
A perforated ulcer is a condition in which an untreated ulcer can burn through the wall of the stomach (or other areas of the gastrointestinal tract), allowing digestive juices and food to leak into the abdominal cavity. Treatment generally requires immediate surgery. The ulcer is known initially as a peptic ulcer before the ulcer burns through the full thickness of the stomach or duodenal wall. A diagnosis is made by taking an erect abdominal/chest X-ray (seeking air under the diaphragm). This is in fact one of the very few occasions in modern times where surgery is undertaken to treat an ulcer. Many perforated ulcers have been attributed to the bacterium "Helicobacter pylori". The incidence of perforated ulcer is steadily declining, though there are still incidents where it occurs. Causes include smoking and nonsteroidal anti-inflammatory drugs (NSAIDs). A perforated ulcer can be grouped into a stercoral perforation which involves a number of different things that causes perforation of the intestine wall. The first symptom of a perforated peptic ulcer is usually sudden, severe, sharp pain in the abdomen. The experience is typically so intense that most people precisely recall the exact moment the pain began. The pain is typically at its maximum immediately and persists. It is characteristically made worse by any movement, and greatly intensifies with coughing or sneezing.
Risk factors include age, female gender, urinary incontinence, history of vaginal delivery (non-Caesarean section childbirth), obesity, prior anorectal surgery, poor general health and physical limitations. Combined urinary and fecal incontinence is sometimes termed double incontinence, and it is more likely to be present in those with urinary incontinence.
Symptoms include tenesmus (the sensation of incomplete emptying of the rectum after defecation has occurred) and constipation. Retention of stool may result in fecal loading (retention of a mass of stool of any consistency) or fecal impaction (retention of a mass of hard stool). This mass may stretch the walls of the rectum and colon, causing megarectum and/or megacolon, respectively. Liquid stool may leak around a fecal impaction, possibly causing degrees of liquid fecal incontinence. This is usually termed encopresis or soiling in children, and fecal leakage, soiling or liquid fecal incontinence in adults.
Symptoms can be directly or indirectly related to the loss of bowel control. The direct (primary) symptom is a lack of control over bowel contents which tends to worsen without treatment. Indirect (secondary) symptoms, which are the result of leakage, include pruritus ani (an intense itching sensation from the anus), perianal dermatitis (irritation and inflammation of the skin around the anus), and urinary tract infections. Due to embarrassment, people may only mention secondary symptoms rather than acknowledge incontinence. Any major underlying cause will produce additional signs and symptoms, such as protrusion of mucosa in external rectal prolapse. Symptoms of fecal leakage (FL) are similar, and may occur after defecation. There may be loss of small amounts of brown fluid and staining of the underwear.
Functional FI is common. The Rome process published diagnostic criteria for functional FI, which they defined as "recurrent uncontrolled passage of fecal material in an individual with a developmental age of at least 4 years". The diagnostic criteria are, one or more of the following factors present for the last 3 months: abnormal functioning of normally innervated and structurally intact muscles, minor abnormalities of sphincter structure/innervation (nerve supply), normal or disordered bowel habits, (i.e., fecal retention or diarrhea), and psychological causes. Furthermore, exclusion criteria are given. These are factors which all must be excluded for a diagnosis of functional FI, and are abnormal innervation caused by lesion(s) within the brain (e.g., dementia), spinal cord (at or below T12), or sacral nerve roots, or mixed lesions (e.g., multiple sclerosis), or as part of a generalized peripheral or autonomic neuropathy (e.g., due to diabetes), anal sphincter abnormalities associated with a multisystem disease (e.g., scleroderma), and structural or neurogenic abnormalities that are the major cause.