Fecal incontinence is the involuntary loss of bowel control.
Types of fecal incontinence include:
- Anal incontinence—Involuntary passage of stool and/or gas related to anal sphincter dysfunction.
- Overflow incontinence—Liquid stool moving around a mass of stool filling the rectum, which then leaks out of the anus.
- Passive incontinence—Passage of stool without sensation of needing to go to the bathroom.
- Urge incontinence—Inability to delay having a bowel movement.
Normal bowel function is a coordination of involuntary and voluntary muscles, and a complex network of nerves. The rectum is the last part of the large intestine. It's function is to hold stool until it is ready for passage through the anal canal. As the rectum fills and stretches, it sends nerve signals to the brain, creating the urge to have a bowel movement. The stool moves down into the anal canal to the anal sphincter. The anal sphincter it is made up of involuntary and voluntary muscles that control the passage of stool out of the body.
Fecal incontinence may be the result of:
- Structural defects in the anorectal area, which may be present at birth or acquired during life, that reduce bowel function
- Weak muscles in the rectum and pelvic floor, which can occur during aging, that reduce the ability to control bowel movements
- Constipation—back-up of stool increases rectal volume and decreases rectal sensitivity, causing liquid stool to leak out the anus
- Diarrhea—liquid stool is more difficult to hold
- Intestinal disease, such as inflammatory bowel disease can result in liquid stool, poor rectal function, or reduced rectal capacity
- Anorectal disorders, such as rectal prolapse, hemorrhoids, fistula, fissure or cancer, may interfere with bowel function
- Nervous system disorders—affect sensitivity and/or interfere with nerve signals between the anorectal region and the brain
- Trauma or surgery resulting in rectal scarring, which can interfer with anal sphincter tone
Risk Factors ^
Fecal incontinence is more common in adults aged 65 years and older. Other factors that may increase your chance of fecal incontinence include:
- Structural, muscular, or nerve deficits present from birth
- Disorders that affect nerve function, such as stroke or multiple sclerosis
- Taking medications that may affect anal sphincter tone, sensitivity, or cause diarrhea or constipation
- Intestinal diseases that can affect bowel health, bowel function, and bowel habits
- Infections that cause severe diarrhea, such as cholera
- Radiation therapy, which may cause scarring of the rectum
- Complications from medical procedures or anorectal surgery
- Trauma from vaginal childbirth
Rectal Prolapse—The rectum falls through the anal opening.
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The main symptom is the inability to control bowel movements, which leads to leakage of solid or liquid stool, and/or gas.
You will be asked about your symptoms and medical history. A physical exam will be done, which will include an evaluation of the perianal area. Your doctor may refer you to a specialist.
Your bodily structures may need to be viewed. This can be done with:
Anorectal manometry may be done to check the pressure of the anal canal.
Treatment depends on what is causing the incontinence. A combination of different treatments may be necessary. It may take some time to find the right treatment. Each method may not work on everyone. Talk with your doctor about the best plan for you. Options may include one or more of the following:
Your doctor may suggest changes to your diet. You may be referred to a registered dietitian. Examples of dietary changes include:
Biofeedback may help improve awareness of sensation, muscle tone, coordination, and other functional changes. It may be used with electrostimulation of specific nerves to cause sphincter contraction. Currently, evidence is inconclusive regarding biofeedback, but it has shown some success.
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.
Learn how to do Kegel exercises. These exercises help strengthen the pelvic floor muscles.
Medications used depend on the cause. They may be in the form of an oral tablet, liquid, topical cream or ointment, or rectal suppository. If fecal incontinence is caused by medications, your doctor may change or stop them. Do not make changes to your medications on your own.
Constipation may be treated with:
- Fiber supplements
- Stool softeners
Diarrhea may be treated with:
- Bulking agents that absorb water and form stool, such as fiber supplements
- Antidiarrheals, such as loperamide or diphenoxylate
- Medications to treat infection
- Medications to improve anal sphincter muscle tone
- Bile acid sequestrants that absorb excess bile salts before they reach the large intestine to reduce loose stools in people with previous surgery to remove the gallbladder or a section of the small intestine
Surgical procedures may be used to treat this condition when other treatments have failed. Examples include:
- Bulking agents, such as collagen or stablized hyaluronic acid, can be directly injected into perianal area. These generally have short-term results and may need to be repeated.
- 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 called a stoma
Other options to manage fecal incontinence may include:
- Radiofrequency energy delivery—Temperature-controlled radio energy is delivered during anoscopy to change the muscular structure of the anal canal. It is not clear how effective this treatment is over a long period of time.
- Vaginally-inserted balloon—A balloon placed in the vagina can be inflated as needed to increase pressure on the adjacent rectal area.
- Anal plugs—Some find success with this method, but they are generally not well-tolerated.
To help reduce your chance of fecal incontinence:
- Prevent constipation by eating a high-fiber diet and drinking plenty of fluids.
- Pay attention to your diet and avoid foods that trigger diarrhea.
- Treat chronic health conditions as advised.
- Try to maintain a regular bowel movement schedule.
- Talk to your doctor if you are having trouble with diarrhea or constipation.
International Foundation for Functional Gastrointestinal Disorders
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Digestive Health Foundation
Canadian Society of Intestinal Research
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11/5/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pannu HK, Glanc P, Bhosale PR, et al. ACR Appropriateness Criteria pelvic floor dysfunction. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=48295#Section420. Accessed September 25, 2015.
7/21/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. American Society of Colon and Rectal Surgeons (ASCRS) clinical practice guideline on treatment of fecal incontinence. Available at: https://www.fascrs.org/sites/default/files/downloads/publication/clinical_practice_guideline_for_the_treatment_of_fecal_incontinence.pdf. Updated 2015. Accessed September 25, 2015.
Last reviewed December 2015 by Daus Mahnke, MD Last Updated: 9/25/2015