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When you feel the urge to have a bowel movement, you may not be able to hold it until you get to a toilet. Or stool may leak from the rectum unexpectedly, sometimes while passing gas.
More than 5.5 million Americans have fecal incontinence. It affects people of all ages - children and adults. Fecal incontinence is more common in women and older adults, but it is not a normal part of aging.
Loss of bowel control can be devastating. People who have fecal incontinence may feel ashamed, embarrassed, or humiliated. Some don't want to leave the house out of fear they might have an accident in public. Most try to hide the problem as long as possible, so they withdraw from friends and family. The social isolation is unfortunate but may be reduced with treatment that improves bowel control and makes incontinence easier to manage.
What causes fecal incontinence
Fecal incontinence can have several causes:
Constipation is one of the most common causes of fecal incontinence. Constipation causes large, hard stools to become lodged in the rectum. Watery stool can then leak out around the hardened stool. Constipation also causes the muscles of the rectum to stretch, which weakens the muscles so they can't hold stool in the rectum long enough for a person to reach a bathroom. Muscle Damage
Fecal incontinence can be caused by injury to one or both of the ring-like muscles at the end of the rectum called the anal internal and external sphincters. The sphincters keep stool inside. When damaged, the muscles aren't strong enough to do their job and stool can leak out. In women, the damage often happens when giving birth. The risk of injury is greatest if the doctor uses forceps to help deliver the baby or performs an episiotomy, which is a cut in the vaginal area to prevent it from tearing during birth. Hemorrhoid surgery can also damage the sphincters.
Fecal incontinence can be caused by damage to the nerves that control the anal sphincters or the nerves that sense stool in the rectum. If the nerves that control the sphincters are injured, the muscles don't work properly and incontinence can occur. If the sensory nerves are damaged, they don't sense that stool is in the rectum so you won't feel the need to use the bathroom until stool has leaked out. Nerve damage can be caused by childbirth, a long-term habit of straining to pass stool, stroke, physical disability due to injury, and diseases that affect the nerves such as diabetes and multiple sclerosis.
Loss of Storage Capacity:
Normally, the rectum stretches to hold stool until you can get to a bathroom. But rectal surgery, radiation treatment, and inflammatory bowel disease can cause scarring that makes the walls of the rectum stiff and less elastic. The rectum then can't stretch as much to hold stool and fecal incontinence results. Inflammatory bowel disease also can irritate rectal walls, making them unable to contain stool.
Diarrhea, or loose stool, is more difficult to control than solid stool because with diarrhea the rectum fills with stool at a faster rate. Even people who don't have fecal incontinence can leak stool when they have diarrhea.
Pelvic Floor Dysfunction:
Abnormalities of the pelvic floor muscles and nerves can cause fecal incontinence. Examples include:
Childbirth is often the cause of pelvic floor dysfunction, and incontinence usually doesn't appear until the mid-forties or later.
How is fecal incontinence diagnosed
Doctors understand the feelings associated with fecal incontinence, so you can talk freely with your doctor. The doctor will ask some health-related questions, do a physical exam, and possibly run some medical tests. Your doctor may refer you to a specialist, such as a gastroenterologist, proctologist, or colorectal surgeon.
The doctor or specialist may conduct one or more tests:
How is fecal incontinence treated
Effective treatments are available for fecal incontinence and can improve or restore bowel control. The type of treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary for successful control because continence is a complicated chain of events. Dietary Changes
Food affects the consistency of stool and how quickly it passes through the digestive system. If your stools are hard to control because they are watery, you may find that eating high-fiber foods adds bulk and makes stool easier to control. But people with well-formed stools may find that high-fiber foods act as a laxative and contribute to the problem. Foods and drinks that may make the problem worse are those containing caffeine - like coffee, tea, or chocolate - which relaxes the internal anal sphincter muscles.
You can adjust what and how you eat to help manage fecal incontinence.
Keep a food diary. List what you eat, how much you eat, and when you have an incontinent episode. After a few days, you may begin to see a pattern involving certain foods and incontinence. After you identify foods that seem to cause problems, cut back on them and see whether incontinence improves. Foods and drinks that typically cause diarrhea, and so should probably be avoided, include:
What Foods Have Fiber
For examples of foods that have see High Fiber Food Chart - Foods High in Dietary Fiber
If diarrhea is causing your incontinence, medication may help. Sometimes doctors recommend using bulk laxatives to help people develop a more regular bowel pattern. Or the doctor may prescribe anti-diarrheal medicines such as loperamide or diphenoxylate to slow down the bowel and help control the problem. Bowel Training
Bowel training helps some people relearn how to control their bowel movements. In some cases, bowel training involves strengthening muscles; in others, it means training the bowels to empty at a specific time of day.
Surgery to repair the anal sphincter may be an option for people who have not responded to dietary treatment and biofeedback and for those whose fecal incontinence is caused by injury to the pelvic floor, anal canal, or anal sphincter. People who have severe fecal incontinence that doesn't respond to other treatments may benefit from injection of bulking agents in the anus or nerve stimulation in the lower pelvic area. A colostomy may be indicated for people with severe fecal incontinence who haven't been helped by other procedures. This procedure involves disconnecting the colon and bringing one end through an opening in the abdomen - called a stoma - through which stool leaves the body and is collected in a pouch. The colostomy may be temporary or permanent.
There is a growing body of evidence for the treatment modality, and trans-anal irrigation is therefore regarded the logical next step, when medicine is not sufficient. Trans-anal irrigation is typically based on tap water, and allows for higher level of predictable bowel management. Clinical studies have shown significant reduction in time consumption, improvement in quality of life etc. Trans-anal irrigation (TAI) of the rectum and colon is designed to assist the evacuation of feces from the bowel by introducing water into these compartments via the anus. Trans-anal irrigation for treatment of disordered defecation has been widely used among caregivers.
Conducting TAI on a regular basis can be used to help prevent accidents in patients with fecal incontinence; clinical studies observe fewer urinary tract infections (UTIs) than conservative bowel management strategies. In addition, regular evacuation of the recto-sigmoid area promotes transport through the entire colon, therefore helping to prevent blockages in patients with constipation.
TAI should always be started under medical supervision. However, after an initial period of training, many individuals can successfully take control of their own bowel management by conducting TAI, without the help of a carer. Unique in its simplicity, reversible and minimally invasive, trans-anal irrigation has begun to find its place in the treatment hierarchy.
Consensus review of best practice of trans-anal irrigation in adults - This expert review provides a practical adjunct to training for the emerging therapeutic area of TAI. Careful patient selection, directly supervised training and sustained follow-up are key to optimize outcomes with the technique. Adopting a tailored, stepped approach to care is important in the heterogeneous patient groups to whom TAI may be applied.
What to Do About Anal Discomfort
The skin around the anus is delicate and sensitive. Constipation and diarrhea or contact between skin and stool can cause pain or itching. Here's what you can do to relieve discomfort:
How can I cope with my feelings about fecal incontinence
Because fecal incontinence can cause distress in the form of embarrassment, fear, and loneliness, taking steps to deal with it is important. Treatment can improve your life and help you feel better about yourself. If you haven't been to a doctor yet, make an appointment. Also, consider contacting the organizations listed at the end of this fact sheet. Such groups can help you find information and support and, in some cases, referrals to doctors who specialize in treating fecal incontinence.
Everyday Practical Tips:
What if my child has fecal incontinence
If your child has fecal incontinence, he or she needs to see a doctor to determine the cause and treatment. Fecal incontinence can occur in children because of a birth defect or disease, but in most cases it's because of chronic constipation.
Potty-trained children often get constipated simply because they refuse to go to the bathroom. The problem might stem from embarrassment over using a public toilet or unwillingness to stop playing and go to the bathroom. But if the child continues to hold in stool, the feces will accumulate and harden in the rectum. The child might have a stomachache and not eat much, despite being hungry. And it can be painful when he or she eventually does pass the stool, which can lead to fear of having another bowel movement.
Children who are constipated may soil their underpants. Soiling happens when liquid stool from farther up in the bowel seeps past the hard stool in the rectum and leaks out. Soiling is a sign of fecal incontinence. Try to remember that your child cannot control the liquid stool and may not even know it has passed.
The first step in treating the problem is passing the built-up stool. The doctor may prescribe one or more enemas or a drink that helps clean out the bowel, such as magnesium citrate, mineral oil, or polyethylene glycol.
The next step is preventing future constipation. You will play a big role in this part of your child's treatment. You may need to teach your child bowel habits, which means training your child to have regular bowel movements. Experts recommend that parents of children with poor bowel habits encourage them to sit on the toilet four times each day - after meals and at bedtime - for 5 minutes. Give rewards for bowel movements and do not punish children for incontinent episodes.
Some changes in eating habits may also be necessary. Your child should eat more high-fiber foods to soften stool, avoid dairy products if they cause constipation, and drink plenty of fluids every day, including water and juices such as prune, grape, or apricot, which help prevent constipation. If necessary, the doctor may prescribe laxatives.
It may take several months to break the pattern of withholding stool and constipation, and episodes may occur again in the future. The key is to pay close attention to your child's bowel habits. Some warning signs to watch for include
Why Children Get Constipated:
Hope through Research:
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports research into many kinds of digestive disorders, including fecal incontinence. In addition, researchers throughout the country are working to find possible solutions to the problem of fecal incontinence. Some studies address fecal incontinence due to anal sphincter damage and combine surgical procedures with electrical stimulation.