Definition

What is fecal incontinence?

Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

How common is fecal incontinence?

Fecal incontinence is common. It is more common in older people and in women. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of fecal incontinence?

Most adults who experience fecal incontinence do so only during an occasional bout of diarrhea. But some people have recurring or chronic fecal incontinence. They may be unable to resist the urge to defecate, which comes on so suddenly that they don’t make it to the toilet in time. This is called urge incontinence. Another type of fecal incontinence occurs in people are not aware of the need to pass stool. This is called passive incontinence.

Fecal incontinence may be accompanied by other bowel problems, such as:

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes fecal incontinence?

Fecal incontinence is commonly caused by altered bowel habits (generally diarrhea, but also constipation) and conditions that affect the ability of the rectum and anus to hold stool. The sphincter muscles become weaker as you grow older. The sphincters muscles or the nerves supplying them can be damaged during vaginal delivery in women, by trauma, or during anal surgery. Nerve malfunction can also happen in people who strain excessively, in patients with diabetes or after a stroke. The rectal wall can stiffen after radiation treatment or in patients with Crohn’s disease. In these patients, the rectum cannot stretch as much as it needs to, so the excess stool leaks out. Other conditions where the rectum drops down into the anus (rectal prolapse) or when the rectum protrudes into the vagina (rectocele) can also cause fecal incontinence.

Risk factors

What increases my risk for fecal incontinence?

There are many risk factors for fecal incontinence, such as:

  • Although fecal incontinence can occur at any age, it’s more common in middle-aged and older adults.
  • Being female. Fecal incontinence is slightly more common in women. One reason may be that fecal incontinence can be a complication of childbirth. But most women with fecal incontinence develop it after age 40, so the connection with pelvic floor injury during childbirth is unclear. However, it’s possible that the injury doesn’t cause symptoms for many years.
  • Nerve damage. People who have long-standing diabetes or multiple sclerosis — conditions that can damage nerves that help control defecation — may be at risk of fecal incontinence.
  • Fecal incontinence is often present in late-stage Alzheimer’s disease and dementia.

Physical disability. Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage, leading to fecal incontinence. Also, inactivity can lead to constipation, resulting in fecal incontinence.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is fecal incontinence diagnosed?

Doctors understand the emotional and social consequences of fecal incontinence, so don’t be embarrassed about talking to your doctor about this problem. Your primary care physician may be able to assist you, or you may need to see a doctor who specializes in treating conditions that affect the colon, rectum and anus, such as a gastroenterologist, proctologist or colorectal surgeon. Your doctor will talk to you about your symptoms and perform a physical examination, including a rectal examination. Depending on your symptoms, your doctor may perform one or more tests to identify the cause for incontinence. These tests include measuring pressures in the anus and rectum (anal manometry), using an anal ultrasound or MRI scan to look at the anal muscles and surrounding tissues, using barium studies to see how the rectum and anus perform during defecation (defecography) and testing to see if the nerves supplying the anal muscles are functioning normally (anal electromyography or EMG).

Anal manometry is conducted with a short flexible tube in the anus and rectum. This test measures the strength of the anal sphincter, and can also measure rectal sensation.

Anorectal ultrasonography is performed by placing a small, balloon-tipped ultrasound probe into the rectum. Pictures of the anal sphincters are taken as the ultrasound probe is withdrawn.

For defecocraphy liquid barium is placed in the colon and rectum with a small rectal tube while you lie on a table. After the rectal tube is removed, you will be asked to sit on a specially designed toilet. An x-ray video will be made while you are sitting on the toilet. You will be asked to cough, squeeze the “cheeks” of your buttocks together, and expel your rectal contents. After defecating, you will be asked to bear down as if you were having a bowel movement.

Similar to ultrasound, magnetic resonance imaging (MRI) can take pictures of the anal sphincters with a small probe in your rectum. Like barium defecography, MRI can also obtain pictures of the pelvic floor muscles and rectum while you squeeze muscles and expel contents; these pictures are obtained after adding ultrasound gel in your rectum.

Proctosigmoidoscopy – Your doctor will use a long, slender tube with a tiny video camera attached to examine your rectum and sigmoid — approximately the last 2 feet of your colon. This test can identify inflammation, tumors or scar tissue that may cause fecal incontinence.

Anal electromyography (EMG) – Tiny needle electrodes will be inserted into muscles around your anus to identify nerve damage.

How is fecal incontinence treated?

Fortunately, effective treatments are available for fecal incontinence. Treatment for fecal incontinence can help improve or restore bowel control. Depending on the cause of your incontinence, treatment may include dietary changes, medications, special exercises that help you better control your bowels, or surgery.

Foods that can cause diarrhea and worsen fecal incontinence include spicy foods, fatty and greasy foods, cured or smoked meat, and dairy products (especially if you are lactose intolerant). Caffeine-containing beverages can act as laxatives, as can products which contain artificial sweeteners (e.g., sugar-free gum and diet soda). Several anti-diarrheal agents (e.g., loperamide, anticholinergic agents, clonidine, bile salt binding agents, alosetron) that can effectively treat diarrhea are now available. Some of these agents (e.g., loperamide) are available over-the-counter while others are prescription only. Some medications work better for patients than others.

If you have constipation, your doctor may suggest that you eat fiber-rich foods, and prescribe fiber supplements. On the other hand, if you have diarrhea, your doctor may recommend anti-diarrheal medications (e.g., loperamide (Imodium)) or fiber supplements to help bind stool.

If fecal incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel retraining program and exercise therapies that will help you improve muscle strength in the vicinity of your anus. In some cases, bowel training means learning to go to the toilet at a specific time of day. For example, your doctor may recommend that you make a conscious effort to have a bowel movement after eating. This helps you gain greater control by establishing with some predictability when you need to use the toilet. Most agree that use of loperamide comprises a first line treatment for fecal incontinence, before moving to biofeedback. In other cases, bowel training involves an exercise therapy called biofeedback. For fecal incontinence, biofeedback involves inserting a pressure-sensitive probe into your anus. This probe registers the strength of your anal sphincter. You can practice sphincter contractions and learn to strengthen your own muscles by viewing the scale’s readout as a visual aid. These exercises can strengthen your rectal muscles. It is also possible to improve rectal sensation with biofeedback therapy.

If you leak large amounts of stool frequently, consider applying a moisture-barrier cream to prevent direct contact between irritated skin and feces. Ask your doctor to recommend a product. Be sure the area is clean and dry before you apply any cream. Non-medicated talcum powder or cornstarch also may help relieve anal discomfort. Wear cotton underwear and loose clothing and change your soiled underwear quickly. If you use pads or adult diapers, be sure they have an absorbent wicking layer on top; this layer wicks moisture away from your skin.

If a rigorous trial of the conservative measures specified above is not effective, surgery or a less invasive procedure (e.g., sacral nerve stimulation, injection of biomaterials) may be considered.

The sacral nerves travel from the spinal cord to muscles in the pelvis. These nerves regulate rectal sensation and strength of the anal sphincter muscles. Sacral nerve stimulation is carried out in stages. First, small needles are positioned in the sacral nerves traveling from the spinal cord to muscles of your lower bowel, and these muscles are stimulated by an external pulse generator to identify which muscle stimulates anal contractions the most. The muscle response to the stimulation generally isn’t uncomfortable. If this procedure improves symptoms over 2-3 weeks, a permanent pulse generator may be implanted.

Injection of a silicone-based material into the anal sphincter may improve incontinence by narrowing the anal canal.

A sphincteroplasty, which is an operation to repair a damaged anal sphincter, may be beneficial in women who have fecal incontinence due to anal sphincter damage caused by childbirth. Other operations, such as an artificial sphincter or a muscle transplant (graciloplasty) are not done very often because they are often associated with complications. A colostomy is the last resort to treat fecal incontinence. A colostomy is an operation that diverts stool through an opening in the abdomen instead of through the rectum. A special bag is attached to this opening to collect the stool.

There are many options to help patients with fecal incontinence. Make an appointment with a gastroenterologist for an evaluation.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage fecal incontinence?

The following lifestyles and home remedies might help you cope with fecal incontinence:

Kegel exercises

Kegel exercises strengthen the pelvic floor muscles, which support the bladder and bowel and, in women, the uterus, and may help reduce incontinence. To perform Kegel exercises, contract the muscles that you would normally use to stop the flow of urine. Hold the contraction for three seconds, then relax for three seconds. Repeat this pattern 10 times. As your muscles strengthen, hold the contraction longer, gradually working your way up to three sets of 10 contractions every day.

Dietary changes

You may be able to gain better control of your bowel movements by:

  • Keeping track of what you eat. Make a list of what you eat for a week. You may discover a connection between certain foods and your bouts of incontinence. Once you’ve identified problem foods, stop eating them and see if your incontinence improves. Foods that can cause diarrhea or gas and worsen fecal incontinence include spicy foods, fatty and greasy foods, cured or smoked meat, carbonated beverages, and dairy products (if you’re lactose intolerant). Caffeine-containing beverages and alcohol also can act as laxatives, as can products such as sugar-free gum and diet soda, which contain artificial sweeteners.
  • Getting adequate fiber. Fiber helps make stool soft and easier to control. Fiber is predominately present in fruits, vegetables, and whole-grain breads and cereals. Aim for 20 to 30 grams of fiber a day, but don’t add it to your diet all at once. Too much fiber suddenly can cause uncomfortable bloating and gas.
  • Drink more water. To keep stools soft and formed, drink at least eight glasses of liquid, preferably water, a day.

Skin care

You can help avoid further discomfort from fecal incontinence by keeping the skin around your anus as clean and dry as possible. To relieve anal discomfort and eliminate any possible odor associated with fecal incontinence:

  • Wash with water. Gently wash the area with water after each bowel movement. Showering or soaking in a bath also may help. Soap can dry and irritate the skin. So can rubbing with dry toilet paper. Premoistened, alcohol-free, perfume-free towelettes or wipes may be a good alternative for cleaning the area.
  • Dry thoroughly. Allow the area to air-dry, if possible. If you’re short on time, you can gently pat the area dry with toilet paper or a clean washcloth.
  • Apply a cream or powder. Moisture-barrier creams help keep irritated skin from having direct contact with feces. Be sure the area is clean and dry before you apply any cream. Nonmedicated talcum powder or cornstarch also may help relieve anal discomfort.
  • Wear cotton underwear and loose clothing. Tight clothing can restrict airflow, making skin problems worse. Change soiled underwear quickly.

When medical treatments can’t completely eliminate incontinence, products such as absorbent pads and disposable underwear can help you manage the problem. If you use pads or adult diapers, be sure they have an absorbent wicking layer on top, to help keep moisture away from your skin.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: November 10, 2017 | Last Modified: November 10, 2017

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