Fecal incontinence, also called bowel incontinence, is a loss of bowel control that results in involuntary bowel movements (fecal elimination). This can range from an infrequent involuntary passage of small amounts of stool to a total loss of bowel control.
Some people with fecal incontinence feel the urge to have bowel movements but are unable to wait to reach a bathroom. Other people don’t feel the sensation of a pending bowel movement, passing stool unknowingly.
Fecal incontinence can be an uncomfortable condition, but it can improve with treatment.
Normal bowel control relies on the proper function of the:
- pelvic muscles
- rectum, part of the lower end of the large intestine
- anal sphincter muscles, the muscles in the anus
- nervous system
Injury to any of these areas can result in fecal incontinence.
Common causes of fecal incontinence include:
Chronic constipation can lead to a fecal impaction. This happens when a hard stool gets stuck in the rectum. The stool can stretch and weaken the sphincter, which makes the muscles incapable of stopping normal passage.
Another complication of fecal impaction is leakage of liquid fecal matter through the anus.
External hemorrhoids can block the sphincter from closing completely. This allows loose stool and mucus to pass involuntarily.
Damage to the anal sphincter will prevent the muscles from keeping the anus tightly closed. Surgery in or near the anorectal region, trauma, and constipation can damage the sphincter muscles.
If the nerves that control sphincter movement are damaged, the sphincter muscles won’t close properly. When this happens, you may also not feel the urge to go to the bathroom.
Some causes of nerve damage include:
Pelvic floor dysfunction
Women can undergo damage to the muscles and nerves in their pelvis while giving birth, but symptoms of pelvic floor dysfunction may not be immediately noticeable. They may occur years later. Complications include:
- weakness of the pelvic muscles that are used during bowel movements
- rectal prolapse, which is when the rectum protrudes through the anus
- rectocele, which is when the rectum bulges down into the vagina
Some men may also develop pelvic floor dysfunction.
Anyone can experience fecal incontinence, but certain people are more likely to get it than others. You may be at risk if:
- you’re over the age of 65
- you’re a woman
- you’re a woman who has given birth
- you have chronic constipation
- you have a disease or injury that caused nerve damage
Your doctor will perform a thorough medical history and physical evaluation to diagnose fecal incontinence. Your doctor will ask you about the frequency of the incontinence and when it occurs, as well as your diet, medications, and health issues.
The following tests may help reach a diagnosis:
- digital examination of the rectal area
- stool culture
- barium enema (fluoroscopic X-ray of the large intestine, including the colon and rectum, with barium contrast)
- blood tests
- electromyography (to test the function of muscles and related nerves)
- anorectal ultrasound
- proctography (X-ray video imaging during a bowel movement)
The treatment for fecal incontinence depends on the cause. Some of the treatment options include:
Foods that cause diarrhea or constipation are identified and eliminated from the diet. This can help normalize and regulate bowel movements. Your doctor many recommend an increase in fluids and certain types of fiber.
For diarrhea, antidiarrheal medications such as loperamide (Imodium), codeine, or diphenoxylate/atropine (Lomotil) may be prescribed to slow down large intestine movement, allowing stool passage to be slower. Your doctor may recommend fiber supplements for constipation.
Following a bowel retraining routine can encourage normal bowel movements. Aspects of this routine may include:
- sitting on the toilet on a regular schedule
- using rectal suppositories to stimulate bowel movements
You can wear specially designed undergarments for added protection. These garments are available in disposable and reusable forms, and some brands use technology that minimizes odors.
Kegel exercises strengthen the pelvic floor muscles. These exercises involve a routine of repeatedly contracting the muscles that are used when going to the bathroom. You should consult your doctor to learn the correct way to do the exercises.
Biofeedback is an alternative medical technique. With it, you learn to use your mind to control your bodily functions with the help of sensors.
If you have fecal incontinence, biofeedback will help you learn how to control and strengthen your sphincter muscles. Sometimes medical equipment used for training is placed in your anus and rectum. Your doctor will then test your rectum and anal sphincter muscle function.
The muscle tone measured is visually displayed on a computer screen so you can observe the strength of the muscle movements. By watching the information (the “feedback”), you learn how to improve rectal muscle control (the “bio”).
Surgical treatment is generally reserved for severe cases of fecal incontinence. There are several surgical options available:
- Sphincteroplasty. The torn ends of the anal sphincter are brought back together so that the muscle is strengthened and anal sphincter is tightened.
- Gracilis muscle transplant. The gracilis muscle is transferred from the inner thigh and placed around the anal sphincter muscle to add strength and support.
- Artificial sphincter. An artificial sphincter is a silicone ring that is implanted around the anus. You manually deflate the artificial sphincter to allow for defecation and inflate it to close the anus, which prevents leakage.
- Colostomy. Some people who have severe fecal incontinence choose to undergo surgery for a colostomy. During a colostomy surgery, your surgeon redirects the end of the large intestine to pass through the abdominal wall. A disposable bag is attached to the abdomen around the stoma, which is the portion of the intestine that is attached to the opening made through the abdomen. After the surgery is complete, stools no longer pass through the anus but instead empty from the stoma into a disposable bag.
Solesta is an injectable gel that was approved by the Food and Drug Administration (FDA) in 2011 for the treatment of fecal incontinence. The goal of Solesta therapy is to increase the amount of rectal tissue.
The gel is injected into the wall of the anus and effectively reduces or completely treats fecal incontinence in some people. It works by causing increased bulk and thickness of the anal tissue, which narrows the anal opening and helps it stay more tightly closed.
Solesta must be administered by a healthcare professional.
Aging, past trauma, and certain medical conditions can lead to fecal incontinence. The condition isn’t always preventable. The risk, however, can be reduced by maintaining regular bowel movements and by keeping the pelvic muscles strong.