Fecal Incontinence

Fecal Incontinence Treatment

Similar to urinary incontinence when you cannot control when your bladder voids, fecal incontinence refers to the inability to hold in a bowel movement. Fecal incontinence can be mild or severe—it can be so much as a “leak” while passing gas, or there may be full fecal incontinence, where a patient cannot hold in their bowel movements at all. Fecal incontinence isn’t often serious and there are few complications, but it can be very embarrassing to a patient. Fecal incontinence treatment can help with quality of life, and treating fecal incontinence is important for patients to begin to live normal lives again.

What Is Fecal Incontinence?

Fecal (anal) incontinence is the medical term for when bowel movements can’t be controlled. In other words, a patient has some kind of leak from the anus and rectum, whether it’s mild or severe. Women are much more likely to experience fecal incontinence than men, and it is more common in older people. Here are some examples of what bowel leakage may look like:

• Stool leaks out during physical exertion or exercise 
• Stool leaks out while passing gas
• Feeling the urge to go but being unable to make it to the bathroom in time
• Stool in the underwear after a bowel movement
• Complete loss of bowel control

Fecal incontinence may present with other symptoms, such as diarrhea, which can cause discomfort.

What Are the Symptoms of Fecal Incontinence?

The primary symptom of fecal incontinence is the inability to hold in stool, which should be noticeable in most patients. Fecal incontinence can be accompanied by other disorders, such as:

• Gas and bloating
• Diarrhea
• Constipation
• Abdominal pain 

If you’re experiencing these symptoms along with an inability to hold in stool, you should contact your gastroenterologist for fecal incontinence treatment.

What Are the Causes of Fecal Incontinence?

There are several causes of fecal incontinence. Most of them are related to changes in how the body functions, particularly muscle and nerve damage. Some of the more common causes of fecal incontinence are:

• Older age. Anal and rectal muscles weaken as we age, as well as nearby areas in the pelvis.
• Frequent constipation or diarrhea. Both of these conditions affect the rectal and anal muscles and can cause them to weaken over time.
• Muscle damage. Muscle damage to the anal muscle or pelvic floor muscles can occur for a variety of reasons, such as a difficult childbirth.
• Damage to nerves. It is the nerves that send signals to the muscles, so if the nerves are damaged, this can lead to fecal incontinence. This could occur because of a difficult vaginal delivery, spinal cord injury, diabetes, multiple sclerosis (MS), and other reasons.
• Inability of the rectum to stretch. Other comorbid conditions, such as inflammatory bowel disease (IBD), such as ulcerative colitis, and Crohn’s disease, can make the rectum difficult to stretch.
• Rectal prolapse. During a rectal prolapse, the rectum falls into the anus.
• Overuse of laxatives. Using too many stimulant laxatives can lead to fecal incontinence.

When Should You Speak to a Doctor About Fecal Incontinence?

Many patients don’t consult primary care or their gastroenterologist because of embarrassment over fecal incontinence. However, there are many fecal incontinence treatment options, and your physician needs to assess you properly for the proper diagnosis or to rule out any causes. You should speak to a doctor if fecal incontinence persists or if it is accompanied by other symptoms. Some diagnostic tests your physician may run include:

• Anal manometry. This test sees how strong your anal sphincter muscles are. A thin, flexible tube is inserted into the rectum to determine sphincter tightness.
• Endoluminal ultrasound or anal ultrasound. A probe is inserted into the anus to see the shape and structure of the rectum and sphincter.
• Flexible sigmoidoscopy. This diagnostic is similar to a colonoscopy, and the prep is the same, but the flexible tube only examines the sigmoid (lower) version of the colon, the rectum, and the anus.
• Magnetic resonance imaging (MRI). This can sometimes be used to examine the organs around the pelvis.

Fecal incontinence treatment is often managed with dietary changes and bowel training (also known as biofeedback), but medications or surgery may also be used.

Your doctor may recommend that you avoid any foods that cause loose stool, such as caffeine, alcohol, prunes, fruit juice, spicy foods, and dairy products. Things that can help thicken stool include applesauce, peanut butter, bananas, pasta, and potatoes. Your physician may also recommend a fiber supplement.

Bowel training is typically done in two stages: you’ll take an enema at consistent times throughout the day to help your bowel movements become more consistent. Secondly, your gastroenterologist may recommend exercising certain muscles, such as Kegel exercises. A therapist trained in pelvic floor therapy can help with the second half of bowel training.

Your doctor will make specific suggestions for medications, and some may be over-the-counter. Do not take any over-the-counter supplements or medications first without consulting your physician. Some treatments may include loperamide imodium for diarrhea and other treatments as directed by your doctor. They may also suggest creams (such as diaper cream) to help ease the irritation around the anal areas.

Surgery is only used in the most severe cases to treat fecal incontinence. Several options include:

• Sphincteroplasty. During this procedure, damaged sphincter muscles are sewn back together for a tighter anal opening.
• Sacral nerve stimulation. A small device is implanted right under the skin in the upper buttocks. It sends impulses through the body that help control the bladder, bowel movements, and pelvic floor muscles.
• Colostomy. An incision is made in the abdomen, the colon is brought to the surface, and stool is received through a special pouch attached to the abdomen. This is the last-line fecal incontinence treatment when all other treatments have failed.