Bowel incontinence, also called fecal incontinence, is a
loss of bowel control that results in involuntary fecal elimination. Severity
can range from an infrequent involuntary passage of small amounts of stool to a
total loss of bowel control. Some people with bowel 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 and have a complete lack of bowel
control. Bowel incontinence can be an embarrassing condition, but it can
improve with treatment.
What Causes Bowel Incontinence?
Normal bowel control relies on the proper function of the pelvic
muscles, the rectum (the lower end of the large intestine), the sphincter
muscles (the muscles in the anus), and the nervous system. Injury to any of
these areas can result in bowel incontinence. Common causes of bowel
Chronic constipation can lead to a fecal impaction. This happens
when a 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 a fecal impaction is the leakage of liquid fecal matter
through the anus.
Diarrhea is the result of loose or liquid stools. These loose
stools can cause an immediate need for a bowel movement. The need can be so
sudden that you don’t have enough time to reach a bathroom.
Damage to the sphincter will prevent the muscles from keeping
the anus tightly closed. Hemorrhoids, surgery, 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 will not feel the urge to go to the bathroom. Some causes of nerve damage
include trauma from giving birth, frequent constipation, stroke, diabetes, and
External hemorrhoids can block the sphincter from closing
completely. This allows loose stool and mucus to pass involuntarily.
Pelvic Floor Dysfunction
Women can suffer from 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
- rectal prolapse, which is when the rectum protrudes through the
- rectocele, which is when the rectum protrudes through the vagina
Who Is at Risk for Bowel Incontinence?
Anyone can suffer from bowel 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 have given birth
- you have frequent constipation
- you have a disease or injury that caused nerve damage
How Is Bowel Incontinence Diagnosed?
Your doctor will perform a thorough medical
evaluation to diagnose bowel incontinence. Your doctor will ask you
about the frequency of the incontinence, when it occurs, diet, medications, and
health problems. The following tests may help reach a diagnosis:
How Is Bowel Incontinence Treated?
The treatment for bowel 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 fiber.
For diarrhea, antidiarrheal medications such as loperamide, codeine, or diphenoxylate/atropine
(Lomotil) may be prescribed
to thicken stools. 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
- stimulating the sphincter muscles with a lubricated finger
- using suppositories to stimulate bowel movements
You have the option of wearing 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 bowel incontinence, biofeedback will help you learn how to
control and strengthen your sphincter muscles. Sensors are placed in your anus
and on your abdomen. Your doctor will then ask you to contract the sphincter
muscles. The muscle contractions are visually displayed as a graph on a
computer screen so you can observe the strength of the muscle movements. By watching the graph, or the “feedback,” you learn how to improve rectal muscle control,
or the “bio.”
Surgical treatment is generally reserved for severe cases of
bowel incontinence. There are several surgical options available:
- Sphincteroplasty: A defective or scarred portion of the
sphincter is removed, and the healthy part of the muscle is tightened.
- Gracilis muscle transplant: The gracilis muscle is transferred
from the thigh and placed around the sphincter muscles to add strength and
sphincter: An artificial
sphincter is a silicone ring that is implanted in the anus. You manually
deflate the artificial sphincter to allow for defecation and inflate it to
close the anus, which prevents the leakage of feces.
- Colostomy: Some people
who have severe bowel 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 stoma, which is
the portion of the intestine that is visible on the outside of 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 United
States Food and Drug Administration (FDA) in 2011 for the treatment of bowel
incontinence. The goal of Solesta treatment is to increase the amount of rectal
tissue. The gel is injected into the anus and effectively reduces or completely
treats bowel incontinence in some patients. It works by causing the growth of
rectal tissue, which narrows the anal opening and helps it stay tightly closed.
Can Bowel Incontinence Be Prevented?
Age, past trauma,
and certain medical conditions can cause bowel incontinence. Unfortunately, the
condition isn’t always preventable. The risk, however, can be reduced by
maintaining regular bowel movements and by keeping the pelvic muscles strong.