Definition

Fecal incontinence is when a person is not able to control bowel movements.

Types of fecal incontinence are:

• Urge incontinence—Being unable to delay having a bowel movement
• Passive incontinence—Passing stool without feeling the need to get to a bathroom
• Anal incontinence—Passing stool or gas due to problems with the muscles of the anus
• Overflow incontinence—Leaking liquid stool when there is a large mass of stool blocking the rectum

Causes

The rectum is the last part of the large intestine. It holds onto stool until it is ready to pass through the anal canal. Nerves in the rectum send signals to the brain when it is full. This creates the urge to pass stool. Stool moves into the anal canal to the anal sphincter. The muscles of the sphincter control the passage of stool out of the body. Fecal incontinence happens when there is a problem with this process.

Causes may be:

• Problems that disturb the bowels and result in changes in stool, such as diarrhea or constipation
• Structural problems of the pelvic floor that make it hard for the rectum to work as it should
• Damage that causes weakness of the anal sphincter, such as from trauma or surgery
• Intestinal diseases that cause swelling of the anus and rectum, such as inflammatory bowel disease
• Problems with the way the nervous system works that make it hard for the rectum to signal the brain when it is full

Risk Factors

This problem is more common in older adults. It is also more common in women. Other things that may raise the risk are:

• Problems that disturb the bowels, especially diarrhea
• Problems with the structure or function of the anus or rectum, such as inflammatory bowel disease and rectal prolapse
• Spinal cord or nervous system conditions or injuries, such as multiple sclerosis
• Problems that affect stool characteristics, such as infection or a blockage of stool
• Taking certain medicines, such as those that weaken the sphincter, cause constipation or diarrhea, or reduce alertness

Rectal Prolapse—The rectum falls through the anal opening.

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Symptoms

The main symptom is not being able to control the passage of solid or liquid stool.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. This is often enough to make the diagnosis.

Images may be taken to look for an underlying cause. This can be done with:

• Ultrasound
• MRI scan

Anorectal manometry may be done to check the pressure of the anal canal.

Treatment

Underlying causes will be treated. The goal of treatment is to manage symptoms. More than one treatment may be needed. Choices are:

• Dietary changes, such as avoiding foods and supplements that may trigger diarrhea
• Lifestyle changes, such as exercising regularly and going to the bathroom on a regular schedule
• Biofeedback to learn how to control the passage of stool
• Medicines to treat:
  • Constipation
  • Diarrhea
  • Poor anal sphincter muscle tone

Prevention

There are no known guidelines to prevent this health problem.