Understanding Fecal Incontinence

What You Need to Know

  • Fecal incontinence affects about one in 10 people.
  • This condition is more common in women and people over the age of 65.
  • Common symptoms of fecal incontinence are leakage of stool or gas that can’t be controlled, urgency to have a bowel movement, and decreased awareness of the need to have a bowel movement or pass gas.
  • Keeping a food and bowel diary can be an effective way of identifying what worsens the incontinence.
  • Medication, muscle training, biofeedback, anal plugs, nerve stimulation and surgery are possible treatment options.

What is fecal incontinence?

Fecal incontinence means that you are not able to hold your feces, or stool, until you get to a toilet. There are many reasons for this, such as a case of diarrhea that strikes suddenly or damaged muscles or nerves within your rectum. Your rectum is the last section of your intestine. It controls bowel movements and signals when you need to go.

Experts believe that about 1 in 12 adults has fecal incontinence. Although it is not a normal part of getting older, you are more likely to have it as you age. Women are also more at risk for this condition than men are.

What causes fecal incontinence?

Fecal incontinence can be caused by a chronic illness, injury, or surgery, including:

  • Diarrhea or constipation

  • Large hemorrhoids

  • Injuries or diseases of the spinal cord

  • Congenital abnormalities

  • Diabetes

  • Severe dementia

  • Extensive inflammatory processes

  • Tumors

  • Obstetric injuries

  • Operations involving division or dilation of the anal sphincters

What are the symptoms of fecal incontinence?

Symptoms of fecal incontinence include:

  • Leaking stool when you are not using the toilet, such as when you cough or pass gas

  • Passing stool before you can reach the toilet

How is fecal incontinence diagnosed?

To diagnose your problem, your healthcare provider will consider:

  • A physical exam

  • Your overall health and medical history

  • Your description of symptoms

Your descriptions of symptoms should include:

  • Any diet or physical activity that seems to cause your problem

  • How severe are the events

  • Related problems such as pain, constipation, or illness

  • When they occur

Imaging tests may include:

  • Anal manometry. Using a thin, flexible tube, your healthcare provider will check how well the muscles and nerves around your anus and rectum are working.

  • MRI. MRI imaging may help find problems with the structure of your anus and rectum.

  • Anorectal ultrasound. Sound waves make images of the structures in your anus and rectum.

  • Proctography. This is an X-ray that helps your healthcare provider find out how much stool you can store in your rectum and how your body handles stool.

  • Proctosigmoidoscopy. Using a flexible tube, your healthcare provider 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.

Your healthcare provider may also ask about your emotions and quality of life. This is done to find out how the condition is affecting you. Fecal incontinence can threaten self-confidence. And you may worry about everything from odors to your appearance.

How is fecal incontinence treated?

The treatment recommended for your fecal incontinence will depend on its cause. You might need to try more than one, or a combination of treatments, to manage fecal incontinence. Possible treatments include:

  • Medicine. You may be prescribe medicines to help control diarrhea or other illnesses or diseases that contribute to fecal incontinence. A high fiber diet is almost always recommended.

  • Muscle training. Your healthcare provider may recommend certain exercises that could help strengthen the muscles of your pelvic floor.

  • Biofeedback. This is a clinical tool that can help you learn to control your bowel movements.

  • Electrical stimulation. Implants that cause small electronic pulses may be surgically placed near important nerves to help manage bowel movements.

  • Anal plug. This removable device can make it easier for you to control when you go to the toilet. It is helpful for people who don’t mind the slight discomfort.

  • Surgery. In some cases, surgery may improve your bowel function or fix a structural problem.

  • Other methods. You may be given shots or a magnetic bead implant to tighten the sphincter.

What are the complications of fecal incontinence?

Complications are problems caused by your condition. With fecal incontinence, complications may include:

  • Emotional and social distress. Fecal incontinence is embarrassing, and you might start to avoid work and social situations. Some people become depressed because of this problem.

  • Physical irritation. Frequent exposure to feces and wiping can irritate the skin around your anus.

  • Poor nutrition. Over time, severe fecal incontinence may mean that your body isn’t getting enough nutrition from your food. Your healthcare provider may recommend nutritional supplements.

How can I prevent fecal incontinence?

Many causes of fecal incontinence can’t be prevented. However, as you go through the process of diagnosis to find its cause, you might learn ways to prevent episodes of incontinence. For example, if your diet is to blame, avoiding certain foods or beverages, such as alcohol or caffeine, may help. So might a high fiber diet with plenty of fluids. Certain treatments, such as bowel training, may help you develop a schedule for going to the bathroom throughout the day and, in turn, prevent accidents.

Living with fecal incontinence

Living with fecal incontinence may require taking certain steps so that you can keep enjoying your life. These steps include:

  • Work with your healthcare provider. Some treatment approaches may take time to become effective. Follow instructions for any medicines your healthcare provider gives you. Ask your medical team if you don’t understand how to use supplies. Contact your healthcare provider if you don’t see any improvement.

  • Try therapy. If fecal incontinence is damaging your relationships, work life, or your overall quality of life, talking to a psychologist may help.

  • Keep a food diary. Keep track of the foods you eat and the days or times when fecal incontinence strikes. This could help reveal a pattern in your diet that contributes to your problem.

  • Train your bowels. One way to reduce your risk of fecal incontinence is to use the toilet regularly and try to have a bowel movement.

  • Pack a change of clothing. Always be prepared. Carry fresh clothes and shoes, cleansing cloths, and a spare bag to store any dirty items.

  • Wear absorbent pads. While you’re learning to manage fecal incontinence, buy some incontinence products, such as pads, that absorb leaks and odors.

  • Take “fecal deodorant” medicine. Talk with your healthcare provider about medicine that can reduce odors associated with fecal incontinence.

  • Learn to care for delicate skin. Use cleansing and barrier products to prevent skin irritation and pain from fecal incontinence.

When should I call my health care provider?

Call your healthcare provider to schedule an appointment to talk about fecal incontinence that is getting in the way of your quality of life. If your fecal incontinence is due to frequent, ongoing diarrhea and you have signs of dehydration, call your healthcare provider right away.

Key points

  • Fecal incontinence means that you are not able to hold your feces, or stool, until you get to a toilet.

  • Fecal incontinence can be caused by diarrhea, damaged muscles or nerves within your rectum, large hemorrhoids, constipation, or chronic illnesses.

  • The treatment recommended for your fecal incontinence will depend on its cause.

7 Things You Should Always Discuss with Your Gynecologist

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When it comes to sexual and reproductive health, it can be hard to know what’s “normal” and what may be a sign of a potential health problem. Even if you feel embarrassed about certain issues, your gynecologist has seen and heard it all and is there to help you, not to pass judgment.

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