Fecal incontinence, also called bowel incontinence or accidental bowel leakage, refers to accidentally leaking stool (poop). This can happen if you suddenly feel the need to go but can’t reach the bathroom in time, or when stool leaks without you feeling the urge to go.
In the United States, about 18 million adults, roughly 1 in 12 people, experience fecal incontinence. According to the National Institutes of Health, it is more common in older adults and women.
Fecal incontinence can disrupt your life and cause embarrassment, but help is available. At Charleston GI, we’re committed to helping you choose the most effective course of treatment.
Loose, watery stools are harder to control and fill the rectum quickly.
Large, hard stools can block the rectum, which causes softer stool to leak around them.
Straining with constipation can damage nerves and muscles, which may cause liquid stool to leak past hardened stool.
Muscle damage or weakening
Muscles in the anus, rectum, and pelvic floor control stool. When these muscles are damaged or weakened, fecal incontinence can occur.
Damage or weakness can occur due to:
Injury during vaginal delivery, especially with forceps use.
Surgical cuts during delivery, such as episiotomy.
Surgery, radiation therapy, or accidents involving the pelvic area.
Natural weakening with age.
Nervous system disorders
Nerve damage can affect your muscle control and ability to feel sensation, leading to loss of bowel awareness or control.
Conditions that may cause this include:
Brain diseases like Parkinson's, Alzheimer's, and cerebral palsy.
Long-term nerve diseases like diabetes and multiple sclerosis.
Stroke
Spinal cord injury or tumors.
Nerve injury during surgery.
Laxative overuse which can damage nerves.
Physical problems of the anus or rectum
Scarring or inflammation that reduces the rectum’s ability to hold stool.
Rectal prolapse, when the rectum falls through the anus.
Hemorrhoids that interfere with muscle closure.
Rectocele, or bulging of the rectum into the vagina.
Reduced rectal elasticity
The rectum needs to stretch to hold stool.
If you have a disease like Crohn’s disease or have undergone treatment such as radiation, scar tissue may develop, making the rectum less stretchy. This can lead to leakage.
Pelvic organ prolapse (POP)
Weak pelvic muscles can cause organs such as the rectum, vagina, uterus, or bladder to sag or slip out of position.
Rectal prolapse and rectocele are forms of pelvic organ prolapse (POP) that can cause fecal incontinence.
RISK FACTORS
Age
Fecal incontinence is more common in adults over 65 due to natural muscle weakening. Even so, it is not a normal part of aging and should be evaluated by a healthcare provider.
Sex
Fecal incontinence is more common in women due to vaginal childbirth injuries and hormone treatments during menopause.
Digestive system diseases
Long-term intestinal conditions that increase risk include:
Conditions causing muscle, nerve damage, or tissue scarring
Alzheimer’s disease
Dementia
Parkinson’s disease
Type 2 diabetes
Multiple sclerosis
Proctitis
Stroke
SYMPTOMS
The primary symptom of fecal incontinence is the inability to control the passage of stool. This may occur during a short-term illness that causes diarrhea, but for some individuals, fecal incontinence is a chronic condition.
There are two types of fecal incontinence:
Urge incontinence
Urge incontinence is the sudden urge to pass stool, but not being able to control the urge. The need to pass stool may come on so suddenly that it's not possible to get to the restroom in time.
Passive incontinence
Passive incontinence occurs when a person passes stool without being aware of the need to do so. A person may not be able to feel that the rectum is full of stool.
Fecal incontinence may also involve the leakage of stool when a person passes gas.
WHEN TO SEE A DOCTOR
We recommend seeing your healthcare professional if you or your child develops fecal incontinence. This is especially important if fecal incontinence:
Happens often.
Causes emotional distress.
Affects your ability to do daily activities.
Causes you to avoid time with family and friends.
Often, people are embarrassed to talk about fecal incontinence, but the sooner you're evaluated, the sooner you may find some relief.
DIAGNOSTIC TEST
Medical History and Physical Exam
Your provider will ask questions about your symptoms, diet, and medical history.
They will also perform an anal and rectal exam:
Visual inspection of the anus and surrounding area.
Reflex testing of anal muscles.
Digital rectal exam (finger inserted) to assess muscle and tissue condition and detect large, hard stool.
Neurological exam:
Your provider will test your general nervous system health, including sensation, reflexes, coordination, and balance.
Tests of Rectal and Anal Function
Anorectal manometry:
A narrow, flexible device is inserted into the anus and rectum to measure muscle and nerve function, as well as rectal capacity.
Balloon expulsion test:
A small balloon filled with water will be inserted into the rectum, and then you will attempt to expel it to assess rectal emptying ability.
A flexible tube with a camera is used to examine the rectum and colon for inflammation, cancer, or abnormal tissue. Variations allow your gastroenterologist to inspect different sections of your colon.
Endoscopic ultrasound:
Combines endoscopy and ultrasound to examine rectal and colon tissues in detail.
Defecography:
X-ray or MRI imaging while passing stool allows your gastroenterology team to assess the physical and functional status of the rectum and anus.
Anorectal MRI:
This MRI imaging focuses on the anus and rectal muscles.
Magnetic resonance proctography (MR proctography):
This real-time MRI is used to visualize pelvic floor motion during defecation and is a standard clinical test at some centers.
Other Diagnostic Devices
Portable anorectal manometer:
This simple, low-cost device measures pressures in the rectum and anal canal.
Anal electromyography (EMG):
Detects nerve injury to the anal sphincter and is particularly useful for women with fecal incontinence. It may be more accurate than some other tests.
TREATMENT
If you’re experiencing fecal incontinence, treatment is available. From lifestyle changes to medication and surgery, your gastroenterologist will work with you to determine the best course of action to alleviate your symptoms.
Lifestyle and Dietary Changes
You may be asked to track foods and drinks that affect your bowel movements.
If you are experiencing diarrhea, it is best to avoid:
Caffeine, alcohol, some fruit juices, and prunes
Beans and cabbage-family vegetables
Spicy foods
Cured or smoked meats
Artificial sweeteners
Dairy products
For constipation, you can improve your diet by:
Eating fiber-rich foods such as whole grains, fruits, vegetables, beans, and nuts.
Drinking 8 to 10 glasses of water per day.
Exercises and Training
Bowel training: You may work with a provider to develop a schedule for bowel movements. If necessary, this may include the use of enemas under medical supervision.
Pelvic exercises: These daily exercises strengthen the pelvic muscles that control bowel and bladder function.
Biofeedback therapy: You can learn to control and strengthen anal muscles using electrodes and computer feedback. This treatment is done with the help of a trained therapist.
Medications
Antidiarrheal drugs such as:
Loperamide (Imodium A-D®)
Diphenoxylate (Lomotil®)
Medicines for constipation or sometimes diarrhea, such as:
Methylcellulose (Citrucel®)
Psyllium (Metamucil®)
Avoid using over-the-counter medicines without consulting a healthcare provider. Prescription options may be necessary if over-the-counter (OTC) medications are insufficient.
InterStim therapy is an FDA-approved treatment that addresses bowel and bladder urgency and incontinence. 84% of patients with InterStim report satisfaction. This is an implantable device that sends mild electrical pulses to the sacral nerves. These pulses are designed to reduce incontinence symptoms, giving you the confidence and freedom you deserve. At Charleston GI, our board-certified gastroenterologists offer this treatment to help you enjoy life more fully.
Sphincteroplasty:
Surgical repair of damaged anal sphincter muscles by sewing and tightening the muscle around the anal opening.
Artificial anal sphincter:
This is an implant that mimics the function of the anal muscle.
Sacral nerve stimulation:
This involves implanting a device under the skin near the upper buttocks that sends electrical impulses to sacral nerves to improve muscle control.
Antegrade colonic enema (ACE) surgery:
This procedure involves creating a pathway from the abdomen to the bowel for daily enemas to clear stool.
Colostomy:
Surgical creation of an opening in the abdomen to divert stool into an external pouch. This is only used when other treatments fail.
PREVENTION
Depending on the cause, it may be possible to improve or prevent fecal incontinence. These actions may help:
Reduce constipation by increasing your exercise, eating more high-fiber foods, and drinking plenty of fluids.
Control diarrhea by avoiding food or drinks that may worsen diarrhea, such as caffeinated drinks, alcohol, dairy products, and fatty foods.
Do not strain. Straining during bowel movements can eventually weaken anal sphincter muscles or damage nerves.
How to Live with Fecal Incontinence
Enjoying a normal, happy life with fecal incontinence is possible. Here are some steps to help you manage daily with this condition:
Work closely with your healthcare provider
Take your medications exactly as prescribed and follow all treatment recommendations.
Remember that many treatments require weeks or months to take full effect.
Don't hesitate to ask your healthcare provider to clarify instructions about medications or medical supplies if anything seems unclear. Contact your doctor if your symptoms persist or worsen despite following the treatment plan.
Be prepared
Always carry a change of clothes, including fresh underwear, socks, and shoes, as well as cleansing wipes and a bag to store soiled items.
Consider therapy
If fecal incontinence affects your relationships, work, or mental health, you may find it beneficial to speak with a mental health professional or therapist who can provide support and coping strategies.
Keep a food diary
Track what you eat and when incontinence episodes occur. This will help identify foods or patterns that trigger symptoms.
Protect your skin
Use cleansing wipes and barrier creams to prevent skin irritation and soreness. Products like zinc oxide paste can protect the delicate skin around the anus.
Talk about odor control
Ask your healthcare provider about medications that can help reduce odor related to fecal incontinence.
Train your bowels
You can reduce the risk of accidents by establishing a routine of using the toilet regularly.
Use absorbent pads Incontinence products can help absorb leaks and control odors while you work on managing your symptoms.
Fecal incontinence can be caused by several conditions, such as weakened or damaged muscles around the rectum, nerve problems that affect bowel control, or other health conditions.
It’s essential to see a healthcare provider or a gastroenterologist for an accurate diagnosis and appropriate treatment, as some underlying causes require medical care to be addressed effectively.
Why do I get skid marks no matter how much I wipe?
Staining on underwear despite cleaning can result from various factors, including incomplete bowel evacuation, weak pelvic floor muscles, hygiene issues, or underlying health conditions.
You can adjust your diet by adding more fiber-rich foods and drinking plenty of water to help create softer, more formed stools. This makes it easier to eliminate completely, which reduces the need for prolonged wiping.
What exactly causes sticky stool?
Several things can cause sticky stool, including:
A high-fat, low-fiber diet. Fat slows digestion and can cause stool to stick together, making it difficult to pass.
Certain medications, including opioids and iron supplements, can cause constipation and sticky stool.
Dehydration causes the body to pull water from the stool, making it denser and stickier. This is why staying hydrated is important when dealing with constipation.
Inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis, often causes inflammation in the digestive tract.
To improve, you should try:
Increasing the amount of fiber in your diet. Fruits, vegetables, beans, and whole grains will help soften stool and make it easier to pass.
Staying hydrated by drinking plenty of water.
Is fecal incontinence permanent?
No, fecal incontinence is not always a permanent condition. Many patients can improve their bowel control with various treatments, including diet changes, bowel training, and exercises. For more severe cases, surgery is available.
How common is fecal incontinence?
This condition is very common. Researchers estimate it affects approximately ⅓ of people.
What complications does fecal incontinence cause?
While fecal incontinence does not cause serious complications, it can have an impact on your mental health and the skin around the anus.
Most patients feel embarrassed about their fecal incontinence, leading them to avoid social situations and potentially develop anxiety or depression.
As for skin irritation, patients may experience pain, itching, sores, or even ulcers in the area around the anus.
What are the signs and symptoms of fecal incontinence?
Some people experience leakage only during episodes of diarrhea, while others deal with ongoing or chronic fecal incontinence. Signs and symptoms include:
Stool leakage when passing gas.
Bowel leakage during physical activity or exercise.
Experiencing sudden, urgent bowel sensations without enough time to reach a restroom.
Discovering stool in underwear following what seemed like a complete bowel movement.
Complete loss of voluntary control over bowel movements.
How is fecal incontinence treated or managed?
Depending on the underlying cause and severity of your fecal incontinence, treatment may involve lifestyle changes, medications, therapy, or even surgery. Treatment options include:
Dietary modifications, such as increasing fiber intake and reducing foods that trigger symptoms.
Physical exercises, including bowel retraining programs, Kegel exercises to strengthen pelvic floor muscles, and biofeedback therapy to improve muscle control.
Medications, including antidiarrheal drugs and constipation treatments like bulk-forming laxatives, suppositories, or medically supervised enemas.
Surgical interventions are typically considered as a final option when other treatments have not provided adequate relief and are recommended by a medical specialist.
How can I lower my risk of fecal incontinence?
While not all causes of fecal incontinence can be prevented, you can reduce your risk of developing two major contributing factors: diarrhea and constipation.
Make dietary adjustments that promote regular bowel movements and help prevent constipation and diarrhea. When experiencing constipation, avoid straining, as this can damage the nerves and muscles responsible for maintaining bowel control.
How long does fecal incontinence last?
The duration of fecal incontinence depends on what is causing it. Chronic conditions like IBS may mean that you experience fecal incontinence periodically for the rest of your life.
What stage of dementia is bowel incontinence?
Bowel incontinence commonly develops during the middle to later phases of dementia progression.
This symptom frequently emerges as cognitive abilities deteriorate, leading patients to lose awareness of the need to go to the restroom, struggle to express when they need to use the bathroom, or face physical limitations that make it difficult to reach restroom facilities promptly.
Explore Axonics Therapy: A Path to Bowel Incontinence Relief
SCHEDULE YOUR GI APPOINTMENT TODAY, NO REFERRAL NEEDED
To learn more about treatment for fecal incontinence in Charleston, SC, get in touch today! Charleston Gastroenterology is committed to a higher standard of care, and we provide a range of medical treatments to help address your concerns.
Disclaimer: This website provides general health information only and is not medical advice. No physician-patient relationship is created and results are not guaranteed.
HIPAA privacy standards apply. Do not submit sensitive medical information. For urgent concerns, contact your physician or seek emergency care.
To learn more about treatment for fecal incontinence in Charleston, SC, get in touch today! Charleston Gastroenterology is committed to a higher standard of care, and we provide a range of medical treatments to help address your concerns.
