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.
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.
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:
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.
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.
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:
Written by familydoctor.org editorial staff