Fecal incontinence

Fecal incontinence is the inability to control bowel movements, causing leakage of stool (feces).  This can include the inability to hold a bowel movement until reaching a toilet (urge incontinence) or passing stool without being aware of it (passive incontinence).

If you suspect you have fecal incontinence, it’s important to discuss your condition with your doctor. While you may feel embarrassed or reluctant, there are many treatment options available to improve your symptoms and quality of life.

Your risk for fecal incontinence increases if you have:

• Diarrhea three or more times a day
• Chronic constipation
• Muscle damage or weakness to the rings at the end of the rectum (anal sphincter)
• Damage to the nerves that senses stool in the rectum or that control the anal sphincter
• Loss of storage capacity or stretch in the rectum
• Surgery in the rectum or anus
• Childbirth by vaginal delivery
• Rectal prolapse (dropping of the rectum down into the anus)
• Rectocele (the rectum protruding through the vagina)
• Large hemorrhoids
• Severe dementia
• Tumors

Nearly 18 million adults in the U.S., or about one in 12, have fecal incontinence.  Although people of any age can have a bowel control problem, fecal incontinence is more common in older adults. It is also slightly more common among women.

Your doctor will ask for your medical history and perform a physical exam. Additional tests may include:

• Anal manometry: Using a thin, flexible tube, your doctor will check how well the muscles and nerves around your anus and rectum are working.
• Magnetic resonance imaging: MRI imaging may help determine problems with the structure of your anus and rectum.
• Anorectal ultrasound: Sound waves make images of the structures in your anus and rectum.
• Proctography: An X-ray that helps your doctor find out how much stool you can store in your rectum and how your body handles stool.
• Proctosigmoidoscopy: Using a flexible tube, your doctor will look inside your rectum and lower intestine for evidence of scars and/or inflammation.
• Anal electromyography: Looks for signs of nerve damage in the pelvic floor and rectum.

There are many effective treatments that may improve your quality of life, and they vary depending on the type of incontinence you have and what is causing it.

• If you have constipation or diarrhea: Dietary changes may be recommended to improve the consistency of your stools. Medications, such as anti-diarrheal drugs, laxatives and injectable bulking agents, may also be recommended.
• If muscle damage is causing fecal incontinence: An exercise program or other therapies, including biofeedback, bowel training and sacral nerve stimulation, to restore muscle strength may be recommended.
• If you have an underlying problem, such as sphincter muscle damage or rectal prolapse, surgery may be considered. 

Your treatment plan will be customized to your needs based on a conversation with your doctor.