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Fecal Incontinence

(Incontinence, Fecal; Bowel Incontinence; Incontinence, Bowel)

Definition

Fecal incontinence is the loss of control over the bowels. Some people may have uncontrolled release of just gas and liquid stool. Others have no control over the release of solid waste.

Causes    TOP

Women are more likely to suffer from this condition than men. Many cases are a result of an injury to the pelvic floor. The pelvic floor is a group of muscles that support pelvic organs. Injury can happen through complications from childbirth . Other causes include:

  • Constipation
  • Rectal prolapse
  • A condition that is present from birth
  • Trauma or injury to anal sphincter or its nerves—the healthy sphincter opens and closes to control the release of fecal material
  • Diarrhea
  • Scarring of the rectum from radiation therapy or surgery

Rectal Prolapse

Rectal prolapse
The rectum falls through the anal opening.
Copyright © Nucleus Medical Media, Inc.

Risk Factors    TOP

This condition is more common in older adults.

Risk factors include:

  • History of episiotomy
  • Diseases of the nervous system such as stroke
  • Damage to the spinal cord such ascauda equina syndrome
  • Other risk factors thought to contribute to fecal incontinence include:
    • Diabetes
    • Lack of physical activity
    • Being overweight

Symptoms    TOP

The main symptom is the inability to control bowel movements, which leads to leakage of solid or liquid stool.

When Should I Call My Doctor?

Call your doctor if you have fecal incontinence. Your doctor can help find the underlying cause.

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may send you to a specialist, such as a:

  • Gastroenterologist
  • Colorectal surgeon
  • Proctologist

Your bodily structures may need to be viewed. This can be done with:

The pressure of your anal canal may need to be checked. This can be done with anorectal manometry.

Treatment    TOP

Talk with your doctor about the best plan for you. Options include:

Diet

Your doctor may suggest changes to your diet. You may be referred to a nutritionist for diet ideas. Examples of dietary changes include:

  • Eating smaller meals more frequently
  • Avoiding foods that may trigger diarrhea such as spicy foods or foods with caffeine
  • Eating more fiber and drinking more fluids—if incontinence is due to constipation

Bowel Training    TOP

A bowel movement schedule can also train your bowels. For example, you can pick several times throughout the day to try to go to the bathroom such as after meals.

Exercise    TOP

Learn how to do Kegel exercises. These exercises help strengthen the pelvic floor muscles.

Surgery    TOP

Surgical procedures may be used to treat this condition when other treatments have failed. Examples include:

  • Surgical repair of the anal sphincter
  • Inserting an artificial bowel sphincter that you can open and close as needed
  • Colostomy for severe cases—disconnects the colon and brings the end through an opening in the abdomen

Prevention    TOP

To help reduce your chance of getting fecal incontinence, take the following steps:

  • Prevent constipation by eating a high-fiber diet and drinking plenty of fluids.
  • Pay attention to your diet and avoid foods that trigger diarrhea.
  • Try to maintain a regular bowel movement schedule.
  • Talk to your doctor if you are having trouble with diarrhea or constipation.

RESOURCES:

International Foundation for Functional Gastrointestinal Disorders
http://www.iffgd.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Digestive Health Foundation
http://www.cdhf.ca
Canadian Society of Intestinal Research
http://www.badgut.org

References:

Fecal incontinence. National Digestive Diseases Information Clearinghouse website. Available at:
...(Click grey area to select URL)
Updated November 25, 2013. Accessed December 18, 2014.
Fecal incontinence: treatment. American Academy of Family Physicians website. Available at:
...(Click grey area to select URL)
Updated April 2014. Accessed December 18, 2014.
Garg, P, Song J, Bhatia A, Kalia H, Menon G. The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Colorectal Diseases. 2010;12:965-970.
Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health State-of-the-Science Conference Statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449-458.
Rectal prolapse. American Society of Colon & Rectal Surgeons website. Available at:
...(Click grey area to select URL)
Updated October 2012. Accessed December 18, 2014.
12/4/2009 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Deutekom M, Dobben A. Plugs for containing fecal incontinence. Cochrane Database Syst Rev. 2009;(4):CD005086.
11/5/2014 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Pannu HK, Glanc P, et al. ACR Appropriateness Criteria® pelvic floor dysfunction [online publication]. Reston (VA): American College of Radiology (ACR); 2014. 20 p. Available at: http://www.guideline.gov/content.aspx?id=48295#Section420. Accessed November 5, 2014.
Last reviewed December 2014 by Peter Lucas, MD
Last Updated: 11/5/2014