Fecal incontinence is the inability to control of the bowel movements. This leads to stool (feces) leaking from the rectum (the last part of the large intestine) at unexpected times. This problem affects as many as more than 5.5 million Americans. It is more common in women and in the elderly of both sexes.
Many people with fecal incontinence are ashamed to talk about this problem with their doctor. They think that nothing can help them. However, many effective treatments for fecal incontinence are available.
Fecal Incontinence
Fecal Incontinence
What is fecal incontinence?
Why does fecal incontinence occur?
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. This is the rectal storage capacity. 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.
A person also must be alert enough to notice the rectal sensation and do something about it. He or she must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur.
A person also must be alert enough to notice the rectal sensation and do something about it. He or she must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur.
What causes fecal incontinence?
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 with inflammatory bowel disease or a perirectal abscess.
People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles are growing weaker and the supporting structures in the pelvis are becoming 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:
People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles are growing weaker and the supporting structures in the pelvis are becoming 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.
Because diarrhea is more difficult to control than formed stool, it is an added stress that can lead to fecal incontinence.
If I have fecal incontinence, what can be done?
Fortunately, effective treatment for fecal incontinence is available, so it's important that you talk to your doctor about it. Attempts at self-treatment are usually unsuccessful. Along with a physical exam, your doctor 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.
The treatment of fecal incontinence varies and depends on the cause of your problem. Your doctor may recommend one or more of the following treatments:
The treatment of fecal incontinence varies and depends on the cause of your problem. Your doctor 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 fiber you eat, drinking more fluids, or changing the amount of food you eat can often prevent diarrhea and constipation.
- Medicine: Your doctor may prescribe laxatives, anti-diarrhea drugs or stool softeners to treat incontinence. Talk to your doctor 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.
Source
Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Reviewed/Updated: 12/06
Created: 09/00