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OVERVIEW

What is fecal incontinence?

Fecal incontinence is the inability to control bowel movements. This leads to stool (feces) leaking from the rectum at unexpected times. It is more common in women and in the elderly of both sexes.

Many people who have fecal incontinence are ashamed to talk about this problem with their healthcare provider. They think that nothing can help them. However, many effective treatments for fecal incontinence are available.

SYMPTOMS

Fecal incontinence symptoms can be mild (streaks or stains of leaked stool in your underwear) to more severe (not being able to control bowel movements).

CAUSES & RISK FACTORS

Bowel function is controlled by 3 things: anal sphincter pressure, rectal sensation, and rectal storage capacity. The anal sphincter is a muscle that contracts to prevent stool from leaving the rectum. This muscle is critical in maintaining continence. Rectal sensation tells a person that stool is in the rectum and that it is time to go to the bathroom. The rectum can stretch and hold stool for some time after a person becomes aware that the stool is there. This is the rectal storage capacity.

A person also must be alert enough to notice the rectal sensation and do something about it. They must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur.

Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It’s especially likely to happen in a difficult delivery that uses forceps or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina before delivery. Muscle damage can also occur during rectal surgery, such as surgery for hemorrhoids. It may also occur in people who have inflammatory bowel disease or a perirectal abscess.

People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles weaken and the supporting structures in the pelvis become loose.

Damage to the nerves that control the anal muscle or regulate rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur in the following situations:

• During childbirth.
• With severe and prolonged straining for stool.
• With diseases such as diabetes, spinal cord tumors and multiple sclerosis.

Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel disease can also make the rectum less elastic.

Because diarrhea is more difficult to control than formed stool, it is an added stress that can lead to fecal incontinence.

DIAGNOSIS & TESTS

How is fecal incontinence diagnosed?

Along with a physical exam, your healthcare provider may want to do other tests such as an anorectal manometry, which tests anal pressure, rectal elasticity, and rectal sensation. These tests can pinpoint the cause of your incontinence.

PREVENTION

Even though you may be able to reduce your risk of fecal incontinence, you may not always be able to prevent it. This is because anal muscles can be damaged by no fault of yours. These muscles will also naturally weaken over time, despite your best effort to keep them strong.

TREATMENT

Fortunately, effective treatment for fecal incontinence is available, so it’s important that you contact your healthcare provider about it. Attempts at self-treatment are usually unsuccessful.

The treatment of fecal incontinence varies and depends on the cause of your problem. Your healthcare provider may recommend one or more of the following treatments:

• Dietary changes: Preventing diarrhea and constipation are usually very helpful in controlling incontinence. Changes in your diet such as adjusting the amount of fibre you eat, drinking more fluids, or changing the amount of food you eat can often prevent diarrhea and constipation.
• Medicine: Your healthcare provider may prescribe laxatives, anti-diarrhea drugs or stool softeners to treat incontinence. Contact your healthcare provider before you take any over-the-counter incontinence medicines.
• Bowel training: Developing a regular bowel movement pattern can be very helpful. This may involve going to bathroom at specific times of the day such as after you eat, or a treatment called anorectal biofeedback. This procedure measures your sphincter contractions while you do special exercises called Kegel exercises. Biofeedback training can strengthen your sphincter muscles and give you more control over bowel movements.
• Surgery: Several different surgical procedures can treat fecal incontinence. Often these surgeries repair or replace sphincter muscles.

Living with fecal incontinence

Living with fecal incontinence can be socially and emotionally challenging, no matter what your age. Do not let it isolate you. Do not be embarrassed to talk to your healthcare provider if you have fecal incontinence. It is a very treatable condition. Your healthcare provider can recommend the best treatment for you.

If a treatment plan doesn’t completely solve your fecal incontinence, there are many products that can help you discreetly hide it. These include disposable undergarments as well as a patch that tucks between your cheeks for minor bowel leakage.