Fecal Incontinence

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.

Symptoms of fecal incontinence

Fecal incontinence symptoms can be mild (streaks or stains of leaked stool in your underwear) to more severe (not being able to control bowel movements).

What causes fecal incontinence?

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. They 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. For some people, this damage 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. This 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 is fecal incontinence diagnosed?

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

Can fecal incontinence be prevented or avoided?

Even though you may be able to reduce your risk of fecal incontinence, you may not always be able to prevent it. This is because anal muscles can be damaged by no fault of yours. These muscles will also naturally weaken over time, despite your best effort to keep them strong.

Fecal incontinence treatment

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.
• 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. can also include 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.
• Pelvic floor physical therapy. This treatment can also help as it involves training to help strengthen pelvic floor muscles.
• Several different surgical procedures can treat fecal incontinence. Often these surgeries repair or replace sphincter muscles.

Living with fecal incontinence

Living with fecal incontinence can be socially and emotionally challenging, no matter what your age. Do not let it isolate you. Do not be embarrassed to talk to your doctor if you have fecal incontinence. It is a very treatable condition. Your doctor can recommend the best treatment for you.

If a treatment plan doesn’t completely solve your fecal incontinence, there are many products that can help you discreetly hide it. These include disposable undergarments as well as a patch that tucks between your cheeks for minor bowel leakage.

Questions to ask your doctor

• 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?

Resources

National Institutes of Health, MedlinePlus: Bowel Incontinence