What is fecal incontinence?

Fecal incontinence is the inability to control bowel movements. This leads to stool (feces) leaking from the rectum at unexpected times. It is more common in women and in the elderly of both sexes.

Many people who have fecal incontinence are ashamed to talk about this problem with their doctor. They think that nothing can help them. However, many effective treatments for fecal incontinence are available.

Why does fecal incontinence occur?

Bowel function is controlled by 3 things: anal sphincter pressure, rectal sensation and rectal storage capacity. The anal sphincter is a muscle that contracts to prevent stool from leaving the rectum. This muscle is critical in maintaining continence. Rectal sensation tells a person that stool is in the rectum and that it is time to go to the bathroom. The rectum can stretch and hold stool for some time after a person becomes aware that the stool is there. This is the rectal storage capacity.

A person also must be alert enough to notice the rectal sensation and do something about it. He or she must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur.

What causes fecal incontinence?

Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It's especially likely to happen in a difficult delivery that uses forceps or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina before delivery. Muscle damage can also occur during rectal surgery, such as surgery for hemorrhoids. It may also occur in people who have inflammatory bowel disease or a perirectal abscess.

People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles weaken and the supporting structures in the pelvis become loose.

Damage to the nerves that control the anal muscle or regulate rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur in the following situations:

• During childbirth.
• With severe and prolonged straining for stool.
• With diseases such as diabetes, spinal cord tumors and multiple sclerosis.

Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel disease can also make the rectum less elastic.

Because diarrhea is more difficult to control than formed stool, it is an added stress that can lead to fecal incontinence.

How will my doctor diagnose the cause of fecal incontinence?

Along with a physical exam, your doctor may want to do other tests such as an anorectal manometry, which tests anal pressure, rectal elasticity and rectal sensation. These tests can pinpoint the cause of your incontinence.

If I have fecal incontinence, what can be done?

Fortunately, effective treatment for fecal incontinence is available, so it's important that you talk to your doctor about it. Attempts at self-treatment are usually unsuccessful.

The treatment of fecal incontinence varies and depends on the cause of your problem. Your doctor may recommend one or more of the following treatments:

• Dietary changes: Preventing diarrhea and constipation are usually very helpful in controlling incontinence. Changes in your diet such as adjusting the amount of fiber you eat, drinking more fluids, or changing the amount of food you eat can often prevent diarrhea and constipation.
• Medicine: Your doctor may prescribe laxatives, anti-diarrhea drugs or stool softeners to treat incontinence. Talk to your doctor before you take any over-the-counter incontinence medicines.
• Bowel training: Developing a regular bowel movement pattern can be very helpful. This may involve going to bathroom at specific times of the day such as after you eat, or a treatment called anorectal biofeedback. This procedure measures your sphincter contractions while you do special exercises called Kegel exercises. Biofeedback training can strengthen your sphincter muscles and give you more control over bowel movements.
• Surgery: Several different surgical procedures can treat fecal incontinence. Often these surgeries repair or replace sphincter muscles.

• What is the best treatment for me?
• How long will my treatment last?
• Is there anything I can do at home that will help?
• Are there any medicines I can take?
• Will exercises help?
• How long will my recovery be after surgery?
• Will I have to have any physical therapy after surgery?
• Should I eat more fiber?