What is fecal incontinence?

Fecal incontinence means that you aren't able to hold your bowel movement (feces or stool) until you get to a toilet. There are many reasons for this. It might be a case of diarrhea that strikes suddenly. Or there could be damaged muscles or nerves in your rectum. Your rectum is the last section of your intestine. It controls bowel movements, and signals when you need to go.

Experts believe that about 1 in 12 adults has fecal incontinence. It's not a normal part of getting older. But you are more likely to have it as you age. Women are also more at risk for this condition than men are.

What causes fecal incontinence?

Fecal incontinence can be caused by a long-term (chronic) illness, injury, or surgery. Causes can include:

• Diarrhea or constipation

• Large hemorrhoids

• Injuries or diseases of the spinal cord

• Birth defects

• Diabetes

• Severe dementia

• Severe inflammation in the digestive tract

• Tumors

• Injuries during childbirth

• Surgery that separates or widens the anal sphincters

• Rectal prolapse

What are the symptoms of fecal incontinence?

Symptoms of fecal incontinence include:

• Leaking stool when you aren't using the toilet. This might be when you cough or pass gas.

• Passing stool before you can reach the toilet

How is fecal incontinence diagnosed?

To diagnose your problem, your healthcare provider ask about your health history and will do a physical exam. The provider will also ask about your symptoms.

When you describe the symptoms, include:

• Any diet or physical activity that seems to cause your problem

• How severe the leaking stool is

• Related problems such as pain, constipation, or illness

• When the leaking occurs

You may need imaging tests, such as:

• Anal manometry . Your healthcare provider uses a thin, flexible tube to check how well the muscles and nerves around your anus and rectum are working.

• MRI. MRI imaging may help find problems with the structure of your anus and rectum.

• Anorectal ultrasound.  Sound waves make images of the structures in your anus and rectum.

• Proctography or defecography This is an X-ray that helps your healthcare provider find out how much stool you can store in your rectum and how your body handles stool.

• Proctosigmoidoscopy. Your provider will use a flexible tube to look inside your rectum and lower intestine. They will look for scars, inflammation, or other conditions. In certain cases, you may need a colonoscopy. This test looks at the entire colon.

• Anal electromyography.  This test looks for signs of nerve damage in the pelvic floor and rectum.

Your healthcare provider may also ask about your emotional health and quality of life. This is done to find out how the condition is affecting you. Fecal incontinence can threaten self-confidence. And you may worry about everything from odors to your appearance.

How is fecal incontinence treated?

The treatment advised for your fecal incontinence will depend on its cause. You might need to try more than 1 or a combination to manage fecal incontinence. Possible treatments include:

• Medicine. You may be given medicines to help control diarrhea or other illnesses or diseases that contribute to fecal incontinence. A high-fiber diet is almost always advised.

• Muscle training.  Your healthcare provider may advise certain exercises that could help strengthen the muscles of your pelvic floor.

• Biofeedback. This is a method that helps you learn to control the muscles that help you have a bowel movement.

• Electrical stimulation . Your healthcare provider may implant small devices that cause small electronic pulses. These are put near important nerves to help control bowel movements.

• Anal plug.  This removable device can make it easier for you to control when you go to the toilet. It's helpful for people who don’t mind the slight discomfort.

• Surgery. In some cases, you may need surgery to improve your bowel function or fix a structural problem.

• Other methods. You may be given shots to bulk up the anal sphincter muscle. Or you may get a magnetic bead implant to tighten the sphincter.

What are possible complications of fecal incontinence?

Complications are problems caused by your condition. With fecal incontinence, complications may include:

• Emotional and social distress.  Fecal incontinence is embarrassing. You may start to skip work and social situations. Some people become depressed because of this problem.

• Physical irritation . Frequent exposure to feces and wiping can irritate the skin around your anus.

• Poor nutrition.  Over time, severe fecal incontinence may mean that your body isn’t getting enough nutrition from your food. Your healthcare provider may advise nutritional supplements.

How can I help prevent fecal incontinence?

Many causes of fecal incontinence can’t be prevented. But as you go through the process of diagnosis to find its cause, you might learn ways to prevent episodes of incontinence. For instance, if your diet is to blame, not having certain foods or drinks, such as alcohol or caffeine, may help. So might eating a high-fiber diet with plenty of fluids. Bowel training may help you develop a schedule for going to the bathroom throughout the day. This can help prevent accidents.

Living with fecal incontinence

You may need to take certain steps so that you can keep enjoying your life. These steps include:

• Work with your healthcare provider.  Some treatment approaches may take time to work. Follow directions for any medicines your provider gives you. Ask your healthcare team if you don’t understand how to use supplies. Contact your provider if you don’t see any improvement.

• Try therapy.  If fecal incontinence is damaging your relationships, work life, or your overall quality of life, talking with a mental healthcare provider or therapist may help.

• Keep a food diary.  Keep track of the foods you eat and the days or times when fecal incontinence strikes. This could help show a pattern in your diet that contributes to your problem.

• Train your bowels.  One way to reduce your risk is to use the toilet regularly and try to have a bowel movement.

• Pack a change of clothing. Always be prepared. Carry fresh clothes and shoes, cleansing cloths, and a spare bag to store any dirty items.

• Wear absorbent pads.  While you’re learning to manage this condition, buy some incontinence products. These might be pads that absorb leaks and odors.

• Take “fecal deodorant” medicine.  Talk with your provider about medicine that can reduce odors linked to fecal incontinence.

• Learn to care for delicate skin.  Use cleansing and barrier products to prevent skin irritation and pain from this condition. Zinc oxide paste is an example of a barrier product.

When should I call my healthcare provider?

Call your healthcare provider to schedule an appointment to talk about fecal incontinence that is affecting your quality of life. Call your provider right away if your condition is from frequent, ongoing diarrhea and you have signs of dehydration. If you have rectal bleeding, or black, tarry stool, get medical care right away or go to the nearest emergency room.

Key points about fecal incontinence

• Fecal incontinence means that you aren't able to hold your bowel movement (feces or stool) until you get to a toilet.

• It can be caused by diarrhea, damaged muscles or nerves in your rectum, large hemorrhoids, constipation, or chronic illnesses.

• You may need imaging tests for a diagnosis, such as an MRI, anal manometry, or anorectal ultrasound.

• Possible complications include emotional and social distress, irritation in the skin around your anus, and poor nutrition.

• Treatment may include lifestyle changes, medicine, muscle training, biofeedback, electrical stimulation, or surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.