Ask the Expert
Fecal Incontinence in Women: Q&A with an Expert
Like the kids’ book says, everyone poops. And at some point, some of us feel like we’re going to poop in our pants. It might be during the onset of a stomach bug, the weeks you spend recovering from childbirth or when that laxative kicks in while you’re out shopping.
Fecal incontinence is not something anyone wants to talk about, but it’s extremely common, affecting up to one in four women at some point in their lives. Many women who experience occasional or chronic stool leakage may feel embarrassed about it, but they should know that treatment can help.
Grace Chen, M.D., a urogynecologist at the Johns Hopkins Women’s Center for Pelvic Health and Reconstructive Surgery, talks about the causes and treatments of fecal incontinence.
What is fecal incontinence?
Fecal incontinence means your body can’t control its own bowel movements, resulting in leakage of stool. Here’s how that happens: Muscles in your gastrointestinal tract move the contents of your gut (food you’ve eaten that’s being digested) through your body. Once all of the nutrients are absorbed, what’s left is stool, which sits in the colon until you have a bowel movement.
Your anal sphincter is a muscle that holds the anus closed so stool doesn’t leak out until you’re ready to go. When the sphincter doesn’t do its job — or if your stool is too loose or even too hard — leakage can happen.
Fecal incontinence can occur once in a while or it may happen all the time. Symptoms include:
- Inability to resist the urge to defecate
- Not getting to the toilet fast enough
- Being unaware of the need to go
What causes fecal incontinence?
Age is the biggest risk factor for fecal incontinence; it’s a condition that primarily affects older women. But it can also occur in younger women. Other risk factors and causes of fecal incontinence include:
- Constipation: “When you’re constipated, you can have liquid stool around impacted feces in your colon,” says Chen. “Hard stool makes it difficult for one of the anal sphincters to contract, allowing liquid material to seep through.”
- Diarrhea: Loose stool is harder to control, and even the rare bout of diarrhea can cause leakage.
- Childbirth: “Research shows if you have a vaginal delivery, particularly an assisted delivery, you may be at more risk for developing fecal incontinence,” says Chen. Assisted delivery techniques include forceps, vacuum or episiotomy, where the doctor makes a cut in the tissue between the vagina and anus for easier delivery.
- Nerve or muscle damage: Any damage to the nerves that signals the need for a bowel movement or the muscles that control bowel movements can cause fecal incontinence. Causes of nerve damage include surgery, childbirth, spinal cord injury or other chronic health conditions, such as diabetes and multiple sclerosis.
- Rectal conditions: Rectal scarring from surgery or radiation therapy can keep the rectum from stretching. This can allow stool to leak out. Rectal prolapse, where the rectum slips into the anus, can also cause fecal incontinence.
- Bowel problems: Any condition that causes diarrhea raises your risk of fecal incontinence. These conditions may include Crohn’s disease, ulcerative colitis and irritable bowel syndrome.
- Mobility problems: Leakage is more likely to happen to people who have trouble getting to the bathroom fast enough. This can be due to physical disability or age-related mobility problems. Inactivity can also cause constipation that contributes to fecal incontinence.
What are treatments for fecal incontinence?
Because of the wide variety of causes, treating fecal incontinence might involve seeing multiple medical professionals. But the good news is that it isn’t just something you have to live with, and you’ll have many experts in your corner. “You should try to get your bowel symptoms managed as best as possible,” says Chen. “Gynecologists, gastroenterologists, physical therapists and colorectal surgeons all work together to treat fecal incontinence.”
Your medical team will focus on approaches such as:
- Improving stool quality: Regulating your stool consistency can reduce the likelihood of leakage. Medicine can help control chronic diarrhea or constipation, while fiber supplements can help increase the bulk of your stool.
- Physical therapy: Research shows physical therapy can help control fecal incontinence, such as in cases with nerve damage from childbirth.
- Medical devices: Nerve stimulation devices appear to work as well as surgery to improve muscle control in the anus. Other devices to improve bowel control include a vaginal insert designed to prevent stool from leaking out of the anus.
- Surgery: If you have a condition such as rectal prolapse, surgery may be able to help.
So when should you get treatment for fecal incontinence? Chen says women should see a doctor when fecal incontinence bothers them, even if it only happens once in a while.
“If fecal incontinence is lowering your quality of life or causing other problems, such as skin irritation, you may want to see a doctor,” says Chen. If you’re nervous about what the doctor might recommend, Chen says the important thing to know is that talking to a doctor doesn’t mean committing to treatment. “The more informed you are, the more empowered you’ll be to make an educated decision,” she says.