Fecal incontinence, also known as bowel incontinence or accidental bowel leakage, is the inability to control bowel movements, and often involves unexpected leakage of stool from the rectum.
Bowel incontinence is different for every patient. Some patients with fecal incontinence may experience what’s called urge incontinence, which is the sudden and urgent need to have a bowel movement. Others may experience what’s called passive incontinence, in which the person may not know they need to pass stool.
Bowel incontinence is more prevalent in women and the elderly. Many people who experience fecal incontinence and other bowel problems often feel embarrassed to discuss the issue with their healthcare provider. However, numerous effective treatments are available to treat and manage fecal incontinence without surgery.
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Fecal incontinence is more common in women and the elderly. Other risk factors for bowel incontinence include childbirth (especially in those who had difficult deliveries which caused muscle damage), rectal surgery, inflammatory bowel disease, irritable bowel syndrome and certain other conditions can increase the risk.
While it might not always be possible to prevent fecal incontinence, certain measures can reduce the risk. These include maintaining a healthy diet to prevent diarrhea and constipation, engaging in regular physical activity, and promptly seeking medical intervention for any digestive or bowel-related issues.
The symptoms of fecal incontinence can range from mild, such as streaks or stains of leaked stool in one’s underwear, to more severe instances where a person cannot control their bowel movements at all.
Accidental bowel leakage and fecal incontinence can be caused by a variety of factors, and may be due to several factors combined. Fecal incontinence causes include:
Muscle Damage: The rings of muscle at the end of the rectum, known as the anal sphincter muscles, are responsible for holding in stool until a person is ready for a voluntary bowel movement. Damage to these anal muscles can result in fecal incontinence. Childbirth, especially when it involves an episiotomy or the use of forceps, is a common cause of damage to the anal muscles, and can result in fecal incontinence.
Nerve Damage: The nerves that sense stool in the rectum or control the colon, rectum and anal sphincter (AKA the sacral nerves) can be injured, which may lead to bowel incontinence. Various factors can damage these nerves, including:
Childbirth
Repeated straining during bowel movements
Chronic constipation
Spinal cord injury
Stroke
Diabetes
Multiple sclerosis
Constipation: Chronic constipation can lead to the formation of a dry, hard mass of stool in the rectum, known as stool impaction. This can stretch and weaken the muscles of the rectum and lower intestine. Watery stool from the upper digestive tract can then move around the impacted stool and leak out.
Diarrhea: Solid stool is easier to retain in the rectum than loose stools or more liquid stool. Therefore, having chronic diarrhea can sometimes result in a loss of bowel control and fecal incontinence, especially in those with a weak anal sphincter or damage to the muscles of the pelvic floor.
Hemorrhoids: Swollen veins in the rectum, known as hemorrhoids, can prevent the anus from closing completely, leading to an reduced ability to control bowel movements, accidental stool leakage and fecal incontinence.
Loss of Capacity in the Rectum: If the rectum becomes scarred or stiff, it may not be able to stretch enough to accommodate a normal amount of stool, causing excess stool to leak out through the anal sphincter. Conditions like surgery, radiation treatment and inflammatory bowel disease can cause scarring of the rectum.
Surgery: Surgeries involving the rectum and anus, such as hemorrhoid removal, can result in muscle and nerve damage that may lead to fecal incontinence.
Rectal Prolapse: This condition, where the rectum drops down into the anus and may begin to protrude through the anal sphincter, can result in fecal incontinence. The stretching of the rectal sphincter by prolapse can also damage the nerves that control the rectum and anus.
Rectocele: In women, the rectum can sometimes cause a bulge in the vaginal wall or can even protrude out of the vagina in severe cases. This condition, known as rectocele, can sometimes contribute to fecal incontinence.
To diagnose fecal incontinence, doctors usually conduct a thorough physical exam, which may include a rectal examination and a discussion of the symptoms the patient has been experiencing.
Based on the results of this exam, your doctor may recommend diagnostic tests to help determine the cause of the symptoms you are experiencing. These tests may include anorectal manometry, which measures anal pressure, rectal elasticity, and rectal sensation, overall function of the anal sphincter muscles and more. This can help identify the root cause of bowel incontinence.
Fecal incontinence can sometimes be a symptom of other underlying medical conditions. For example, muscle damage in the pelvic region is a common cause. This damage often occurs during childbirth, especially during difficult deliveries that require the use of forceps or an episiotomy. Other causes of fecal incontinence may include previous rectal surgery, inflammatory bowel disease or a rectal abscess.
The steps taken to improve fecal incontinence vary based on the symptoms a person is experiencing and what is causing the issue. Some common methods of bowel incontinence treatment include:
Dietary changes: Fiber supplements and adjusting fiber intake, fluid consumption, or overall diet can help control diarrhea and prevent constipation, both of which can exacerbate bowel incontinence and stool leaks. Keeping a “Food Diary” of everything you eat or drink can sometimes help your healthcare provider determine if your diet is contributing to the inability to control bowel movements.
Medications: Doctors might prescribe laxatives, anti-diarrhea drugs or stool softeners to help treat the issues contributing to bowel incontinence.
Bowel training: Bowel training involves establishing a regular bowel movement pattern, which can include visiting the bathroom at specific times, like after meals.
Pelvic floor physical therapy: This therapy, which often includes Kegel exercises, helps strengthen the pelvic floor muscles. That can help prevent or reduce bowel leakage in some cases.
Anal plug: Which is medical device fitted into the anal canal that closes off the end of the rectum and can prevent leaking stool. The approach can be particularly helpful to prevent accidental bowel leakage in those who have lost all bowel control due to damage to the anal sphincter muscles or nerve damage that prevents normal bowel function.
Rectal or Anal Surgery: In some cases, surgical procedures might be necessary, especially if the muscles of the rectum or anal sphincter need repair.
While bowel incontinence can be managed effectively with various treatments, whether it can be fully cured depends on its cause. For many, treating fecal incontinence can significantly reduce or even eliminate symptoms, helping patients regain bowel control while improving bowel function.
Doctors might prescribe medications like laxatives, anti-diarrhea drugs or stool softeners to manage fecal incontinence. Be sure to consult with a healthcare provider before starting any over-the-counter medications or other treatments for bowel incontinence.