What is fecal incontinence?
Fecal incontinence also called anal incontinence is the term used when bowel movements cannot be controlled. Stool (feces/waste/poop) leaks out of the rectum when you don’t want it too, which means not during planned bathroom breaks. This leakage occurs with or without your knowledge. Fecal incontinence happens more often in women than in men and also happens more often among older people.
The term fecal incontinence is used if any of these situations occur:
Stool leaks out when passing gas.
Stool leaks out due to physical activity/daily life exertions.
Feeling like you have to go and not being able to make it to the bathroom in time.
Stool is seen in the underwear after a normal bowel movement.
There is complete loss of bowel control.
Reasons people have bowel incontinence include:
Ongoing (chronic) constipation. This causes the anus muscles and intestines to stretch and weaken, leading to diarrhea and stool leakage.
Fecal impaction. It is most often caused by chronic constipation. This leads to a lump of stool that partly blocks the large intestine.
Long-term laxative use.
Colectomy or bowel surgery.
Not sensing that it’s time to have a bowel movement.
Gynecological, prostate, or rectal surgery.
Injury to the anal muscles due to childbirth (in women).
Nerve or muscle damage (from injury, tumor, or radiation).
Severe diarrhea that causes leakage.
Severe hemorrhoids or rectal prolapse.
Stress of being in an unfamiliar environment.
What are possible 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. You may start to skip 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 advise nutritional supplements.
Diagnosis of Bowel Incontinence
Discussing bowel incontinence can provide clues for a doctor to help make the diagnosis. During a physical examination, a doctor may check the strength of the anal sphincter muscle using a gloved finger inserted into the rectum.
Other tests may be helpful in identifying the cause of bowel incontinence, such as:
Stool testing. If diarrhea is present, stool testing may identify an infection or other cause.
Endoscopy. A tube with a camera on its tip is inserted into the anus. This identifies any potential problems in the anal canal or colon. A short, rigid tube (anoscopy) or a longer, flexible tube (sigmoidoscopy or colonoscopy) may be used.
Anorectal manometry. A pressure monitor is inserted into the anus and rectum. This allows measurement of the strength of the sphincter muscles.
Endosonography. An ultrasound probe is inserted into the anus. This produces images that can help identify problems in the anal and rectal walls.
Nerve tests. These tests measure the responsiveness of the nerves controlling the sphincter muscles. They can detect nerve damage that can cause bowel incontinence.
MRI defecography. Magnetic resonance imaging of the pelvis can be performed, potentially while a person moves their bowels on a special commode. This can provide information about the muscles and supporting structures in the anus, rectum, and pelvis.
Balloon expulsion test. This is where your health care provider inserts a small balloon filled with water into your rectum. You’ll then go to the bathroom and push out the balloon. If it takes longer than 3 minutes, you may have trouble passing stools.
Colonoscopy. Your health care provider will insert a flexible tube into your rectum to closely examine your colon.
Depending on the cause of fecal incontinence, options include:
Anti-diarrheal drugs such as loperamide hydrochloride (Imodium A-D) and diphenoxylate and atropine sulfate (Lomotil)
Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil), if chronic constipation is causing your incontinence
Exercise and other therapies
If muscle damage is causing fecal incontinence, your doctor may recommend a program of exercise and other therapies to restore muscle strength. These treatments can improve anal sphincter control and the awareness of the urge to defecate.
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.
Biofeedback. Specially trained physical therapists teach simple exercises that can increase anal muscle strength. People learn how to strengthen pelvic floor muscles, sense when stool is ready to be released and contract the muscles if having a bowel movement at a certain time is inconvenient. Sometimes the training is done with the help of anal manometry and a rectal balloon.
Bowel training. Your doctor may recommend making a conscious effort to have a bowel movement at a specific time of day: for example, after eating. Establishing when you need to use the toilet can help you gain greater control.
Bulking agents. Injections of nonabsorbable bulking agents can thicken the walls of your anus. This helps prevent leakage.
Sacral nerve stimulation (SNS). The sacral nerves run from your spinal cord to muscles in your pelvis, and regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can strengthen muscles in the bowel.
Posterior tibial nerve stimulation (PTNS/TENS). This minimally invasive treatment stimulates the posterior tibial nerve at the ankle. In a large study, however, this therapy didn’t prove to be significantly better than a placebo.
Vaginal balloon (Eclipse System). This is a pump-type device inserted in the vagina. The inflated balloon results in pressure on the rectal area, leading to a decrease in the number of episodes of fecal incontinence.
Radiofrequency therapy. Known as the Secca procedure, this involves delivering temperature-controlled radiofrequency energy to the wall of the anal canal to help improve muscle tone. Radiofrequency therapy is minimally invasive and is generally performed under local anesthesia and sedation. However, this procedure isn’t always covered by insurance.
Treating fecal incontinence may require surgery to correct an underlying problem, such as rectal prolapse or sphincter damage caused by childbirth. The options include:
Sphincteroplasty. This procedure repairs a damaged or weakened anal sphincter that occurred during childbirth. Doctors identify an injured area of muscle and free its edges from the surrounding tissue. They then bring the muscle edges back together and sew them in an overlapping fashion, strengthening the muscle and tightening the sphincter. Sphincteroplasty may be an option for patients trying to avoid colostomy.
Treating rectal prolapse, a rectocele or hemorrhoids. Surgical correction of these problems will likely reduce or eliminate fecal incontinence. Over time, the prolapse of the rectum through the rectal sphincter damages the nerves and muscles of the sphincter. The longer the prolapse goes untreated, the higher will be the risk of fecal incontinence not resolving after surgery.
Colostomy (bowel diversion). This surgery diverts stool through an opening in the abdomen. Doctors attach a special bag to this opening to collect the stool. Colostomy is generally considered only after other treatments haven’t been successful.