Fecal Incontinence

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What Is Fecal Incontinence

At its most basic, fecal incontinence (FI) or accidental bowel leakage (ABL) is a condition where you’re not able to hold a bowel movement until reaching a bathroom. However, there’s actually a broader range of signs and symptoms that characterize the disorder, including the following:

Having trouble holding a bowel movement
Having solid or liquid stool leak when least expected
Finding streaks of stool in the underwear
Seeking out the restroom when out in public
Avoiding specific types of foods

You may feel like you’re the only one dealing with these issues, but the truth is, you’re one of many. In fact, millions of Americans contend with fecal incontinence every day.

For most, fecal incontinence is characterized by light to moderate leakage, though there are plenty who experience more severe symptoms. Age can be a contributing factor, so it’s not surprising that older people experience it more frequently, but accidental bowel leakage has been reported to affect men and women as early as 40. Considering that the Baby Boomer generation continues to age, more studies and research are being conducted to see what can be done to better manage and reduce or treat ABL.

If you or someone you know experiences any of these symptoms, you can check this list to get a better understanding of what ABL looks like.

Causes Of Fecal Incontinence

Accidental Bowel Leakage may occur from a number of underlying conditions that affect bowel control.

Diarrhea. The increased volume of loose stools can create a sense of urgency to get to the toilet.
Constipation. When large, hard stools get stuck in the rectum, watery stools can leak out around the hard stool. What’s more, constipation causes the muscles of the rectum to stretch, weakening them. When these muscles are compromised, they might not be able to hold stool long enough for the person to get to a bathroom as a result.
Damage to Muscles or Nerves. Any damage to the anus can create incontinence issues as stool can leak out. Weak pelvic floor muscles also make holding stool in the rectum more difficult. Nerve damage can interfere with signals to the brain. When this occurs, the brain is not properly alerted that a stool is in the rectum and ready to be voided. Nerve damage can be caused by a myriad of circumstances including:
- Hemorrhoid surgery
- A history of straining to pass stool
- Childbirth
- Stroke
- Diabetes
- Multiple sclerosis
- Spinal cord injury
Rectal Change. Radiation treatment for rectal cancer or other pelvic cancers can cause scarring of the rectum, reducing its ability to keep stool from leaking. Inflammatory bowel diseases can cause swelling and irritation that make the rectal wall stiff, again compromising its ability to properly function.
Aging. As you age, muscles and tissues lose elasticity. As this ability to stretch becomes more limited, fecal incontinence can occur.
Childbirth. Childbirth puts tremendous stress on your body. If there is damage to the pelvic floor muscles during delivery, bowel control problems can appear immediately. In other cases, fecal incontinence may not emerge until many years later. Childbirth-related bowel control problems may be caused by:
- Injuries to nerves during labor and delivery
- Tearing of muscle during delivery
- Damage to muscles as a result of using forceps during delivery
- Episiotomy (when a doctor makes a cut in the vaginal area to ease delivery)
Gallbladder Removal. Following gallbladder surgery an increased amount of bile in the intestines acts as a laxative. The looser stools are harder to control since the anus is designed to control solid waste.
Medication Side Effects. Certain medications can cause diarrhea, which contributes to leakage.
Pelvic Floor Dysfunction. Pelvic floor strength is critical to digestive (bowel) health for both women and men. Here’s how a poorly functioning pelvic floor can create a situation for ABL:
- Impairs the ability to sense stool in the rectum.
- Decreases the ability to contract muscles used during a bowel movement.
- Rectal prolapse causes the rectum to drop down through the anus—this can lead to stretching of the anus muscles, stretching of the pelvic floor nerves, and mucus discharge from the prolapse segment.
- Rectocele causes the rectum to protrude through the vagina.
- Causes the pelvic floor to become weak and sag.

It goes without saying that if you or someone you know is experiencing any of these conditions, it’s important to share that information, along with the frequency of ABL episodes, with your healthcare provider.

Risk Factors

Not everyone has the same likelihood of developing ABL. There are certain factors associated with the development of the condition, including:

Aging
Neurological disorders (multiple sclerosis, Parkinson’s disease, etc.)
Physical injury to the rectal area (childbirth, radiation or surgical damage from prostate cancer treatment)
Various diseases (diabetes, obesity, celiac disease)
Inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
Functional gastrointestinal disorders (irritable bowel syndrome)
Reduced physical mobility

Diagnosis And Tests

In the process of evaluating your fecal incontinence symptoms, your physician may order one or more of the following diagnostic procedures:

Endosonography (rectal ultrasound). Placement of a small, balloon-tipped ultrasound probe into the rectum to view the anal sphincter muscles.
Magnetic resonance imaging (MRI). Creation of images of the anal sphincter muscles.
Flexible sigmoidoscopy (proctosigmoidoscopy). Use of a small flexible camera to inspect the intestinal tract. This can be helpful to determine inflammation, tumors or scar tissue.
Anal Manometry. Use of a pressure-sensitive tube to check the sensitivity and function of the rectum. This also checks the tightness of the anal sphincter muscles and their ability to respond to nerve signals.
Anal Electromyography (EMG). Testing for pelvic floor and rectal muscle nerve damage.
Defecography (proctography). An X-ray test that shows how much stool the rectum can hold, how well the rectum can hold stool and how well the rectum can eliminate stool.

Treatment Options

For the tens of millions with fecal incontinence, there are a number of things that can be done to improve bowel function. Before anything, though, successful treatment requires correctly diagnosing the underlying problem. There are lots of things that could be going on, and finding the best approach for you calls for professional help.

Fortunately many lifestyle changes are effective for managing light to moderate fecal incontinence. Sometimes even small adjustments to your diet or medication are all it takes to regain normal bowel function.

But don’t give up hope if you have more severe ABL. There are plenty of treatment options for you, too, including everything from active management to surgery. However, these measures do not always guarantee a return to complete bowel control.

That’s why it’s so important to talk to your doctor about the issues you’re experiencing. Check out our tips for talking with your doctor about accidental bowel leakage here, then explore the treatment options below. And if you need help finding a specialist near you, click here to try our doctor finder.

Behavioral Modifications

Healthy Bowel Habits – Increased fluid intake, regular exercise, and regular bowel habits can all help reduce or eliminate ABL. Fiber and sufficient fluid intake helps create a softer stool that is well formed.
Bowel Retraining – This is a do-it-yourself program to re-teach your bowel how to have regular, controlled movements.
Diet Modification – Add high-fiber foods to your diet, including whole grains, fresh vegetables and beans. Products containing psyllium, such as Metamucil, can also be helpful because they add bulk to your stool. And as you’ve heard a million times, try to drink between 8 and 12 cups of water a day.

Products

For 90% of those with ABL, leakage is light to moderate. Many people are able to manage their condition with lifestyle and behavior changes. Those who require additional help managing their condition may want to try:

Butterfly® – A body liner specifically designed for women and men with light to moderate ABL. Butterfly fits comfortably and invisibly on the buttocks, providing secure protection.
Absorbents and Protective Wear – There’s a wide variety of disposable or reusable absorbent products that may be used for the management of bowel leakage.
Collection System – For those with heavier leakage, there are multiple collection options, ranging from bags adhered directly to the skin to catheters and tubes attached to a collection bag.

Medications

For diarrhea, there are many over-the-counter medications including Imodium® as well as prescription medication such as Lomotil®, Nulev® and Lotronex®.

Non-Invasive Treatment

Pelvic Muscle Exercises (Kegels) – You may have thought they’re only useful for bladder issues, but they’re actually very effective for gaining strength in the muscles used for bowel function, too.
Biofeedback – By learning to pay close attention to your body, you can identify and train the muscles associated with bowel function. There are a number of devices and methods available to help you do so.
Neuromodulation – This a frequently performed outpatient procedure implants a small device to gently stimulate the nerves that are involved with the brain-bowel connection.
SECCA® – A physician delivers precisely controlled radiofrequency energy to the anal canal to thicken the tissue, a process which can improve the function of the sphincter muscle.
Fenix® – A small, flexible band of titanium beads with magnetic cores is used to create a barrier to involuntary bowel leakage. The magnetic bond is temporarily broken to allow the voluntary passage of stool and then restored immediately after.

Surgical Treatment

Sphincteroplasty – This is a form of surgery to correct defects in the anal sphincter.
Artificial Anal Sphincter – Patients receive a small implant that imitates the natural function of the anal sphincter muscle. It’s manually controlled by the patient with a bulb pump placed discretely in the body.
Colostomy – This process involves the surgical creation of an opening in the abdominal wall through which the colon passes and where a disposable bag is fitted to collect stool.

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