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. Its 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
—back-up of stool increases rectal volume and decreases rectal sensitivity, causing liquid stool to leak out the anus
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:
Eating smaller meals more frequently
Avoiding foods that may trigger
diarrhea, such as spicy foods or foods with caffeine
and drinking more fluids—if incontinence is due to constipation
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.
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:
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
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.
7/21/2015 DynaMed Plus Systematic Literature Surveillance
: 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 November 2018 by
EBSCO Medical Review Board
James Cornell, MD Last Updated: 9/25/2015