instruction: hello doctor my father is 86 years old he is a hypertension patient and on metosartan 25 my ecospirin 75 and nexpro for prostrate he is on maxvoid my for the past 10 days he is complaining that while passing urine there is an urge and sometimes he passes stool on medical advice he took imodium four tablets for two days and ofloxin 200 my for five days but still the problem continues please advice
output: hello welcome you to icliniq com I can understand you must be very concerned about your father health well I have reviewed his medical history which he has been taking for hypertension prostate and recent use of antibiotics and imodium so typical symptom you mention that whenever he urges to pass urine stools passes by itself which is suggestive of stool incontinence means loss of control stools with his age it is possible that he has weak anal sphincter the anal sphincter is a muscle around the anus which contracts and control the stool output in older age it become weak and lack sustained contraction hence get loosened with every attempt to pass urine which increases abdominal pressure would also lead to evacuation of stools this stool incontinence because of loose sphincter at times perceived as diarrhea however it is not actual diarrhea for diarrhea once has to have stool volume more than 200 my 24 hour and significant change in consistency of stools like watery stools or greenish unformed stools containing food particles if none of these signs which are suggestive of diarrhea I suggest you to stop ofloxacin if given for perceived diarrhea the drug he has been taking for prostate also causes external anal sphincter and hence partly contribute to his stool incontinence I want to know if he is feeling mucus thick jelly like material in stools blood in stools or rectal pain or repeated visits to toilet when nothing comes out this information is important to rule out any inflammatory process beside loose anal sphincter I suggest you few investigation for stool studies which will tell if he has active infection of bowel and if present can be treated with antibiotics then for treatment he can take imodium two tablets thrice daily for two more days excessive use of this medication would cause constipation and can worsen patient discomfort I want you to help him learn pelvic muscle strengthening exercises there are many youtube videos available to learn how to do pelvic floor strengthening exercises while sitting on a common chair lastly biofeedback therapy which is a computerized software which help him to control his anal sphincter while passing urine or otherwise this treatment is offered at physiotherapy department of a hospital avoid excessive fibers and modify liquids to 5 liter maximum intake in a day this would reduce the overall bulk of stools formation in the bowel and hence decreased stool output stop or reduce alcohol intake if taking this also causes diarrhea and loose sphincter controls I hope this helps stool incontinence secondary to age with loose sphincter plus drug side effect digital rectal examination performed by gastroenterologist in person norectal manometry not usually required if digital rectal examination is suggestive of the diagnosis stool detail report stool fecal calprotecin and stool for occult blood stool for ova and parasites stool for fat globules and reducing substance complete blood count stool incontinence secondary to older age and drug related follow up to disclose other parts of history as mentioned above otherwise follow above regimen and see me in one week time after investigation