Fecal incontinence is the loss of control over bowel movements, which may result in involuntary passage of stool or gas. Fecal incontinence is more common in women over the age of 70 but can also affect men, young people, and children over 4 years of age.
Fecal incontinence can be the result of weakening of the muscles of the rectum and anal sphincter due to childbirth or surgery. It can also be caused by diarrhea, constipation, certain medications, and neurological diseases.
Treatment of fecal intolerance may involve dietary changes, medications, physical therapy, or surgery and is typically managed by a colorectal surgeon or gastroenterologist.
Common symptoms
The main symptoms of fecal incontinence are:
- Involuntary loss of liquid, semi-liquid, or solid stool;
- Leakage of stool when passing gas;
- Passing gas without meaning to;
- Loss of stool during strenuous activity or exercise;
- Stool noted in the underwear after having a bowel movement.
People with fecal incontinence may also experience a sudden urge to defecate (have a bowel movement), a decreased or absent urge to defecate, difficulty controlling when they have a bowel movement, or complete loss of control over bowel movements.
Fecal incontinence may be accompanied by anal itching, perianal skin irritation, urinary tract infections (UTIs), urinary incontinence, rectal prolapse, hemorrhoids, or a rectal fistula, leading to feelings of extreme embarrassment, anxiety, and diminished quality of life.
It is important to consult a colorectal surgeon or gastroenterologist for any of the above symptoms in order to confirm a diagnosis and begin the appropriate treatment.
Confirming a diagnosis
Fecal incontinence is diagnosed by a colorectal surgeon or gastroenterologist based on an evaluation of symptoms (including when they started and how long they have been going on), medical history, past surgeries, and current medications, in addition to an anal and rectal exam.
In addition, a provider may order exams like a rectal ultrasound, proctography (defecography), magnetic resonance imaging (MRI), or colonoscopy.
Possible causes
The main causes of fecal incontinence are:
- Natural aging of the body that weakens the anal and rectal muscles;
- Chronic diarrhea or constipation;
- Surgery or trauma to the area;
- Vaginal birth, episiotomy, or the use of forceps during delivery;
- Diabetic neuropathy, multiple sclerosis, spinal cord injuries, or stroke;
- Rectal prolapse, megacolon, infections, or radiation.
Fecal incontinence can also be caused by Crohn's disease, ulcerative colitis, irritable bowel syndrome, hyperthyroidism, diabetes, or the use of medications like metformin, acarbose, antidepressants, or laxatives.
In children greater than 4 years of age, fecal continence is also called encopresis and may be associated with difficulties with sphincter control due to psychological causes like stress, fear, or emotional distress.
Treatment options
Treatment of fecal incontinence should be managed by a colorectal surgeon and will vary based on the cause and severity of the condition.
The main treatments for fecal incontinence are:
1. Dietary changes
Uncomplicated forms of fecal incontinence may be treated with dietary changes, such as increasing the amount of fiber and fluids in a person's diet to help regulate bowel movements as well as decreasing consumption of alcohol, caffeine, fat, and sugar.
2. Medications
Medications for fecal incontinence, such as loperamide (Immodium) or diphenoxylate hydrochloride and atropine sulfate (Lomotil) may be recommended by a healthcare provider to improve consistency of the stool and decrease episodes of involuntary bowel movements.
In the case of fecal incontinence caused by other health conditions, a provider will need to recommend specific treatments to alleviate symptoms and treat the underlying cause.
3. Kegel exercises
Kegel exercises are indicated for the treatment of fecal incontinence because they help strengthen the muscles of the pelvic floor that support the intestines and bladder as well as the uterus in women and people assigned female at birth (AFAB).
To perform Kegel exercises correctly, first try interrupting the flow of urine while emptying the bladder, holding the contraction for close to 3 seconds and repeating the exercise a minimum of 10 times. Once you are able to identify and isolate these muscles, avoid performing Kegel exercises while urinating in order to prevent complications like incomplete bladder emptying and UTIs.
4. Biofeedback
Biofeedback exercises may be recommended by a colorectal surgeon in cases of anal muscle weakness and loss of rectal muscle elasticity. These exercises are performed under the guidance of a physical therapist to strengthen the anal muscles in addition to the abs and pelvic floor.
Biofeedback exercises are important for reconditioning the pelvic muscles because they strengthen the muscles, stimulate blood flow to the area, boost nerve function, and increase body awareness.
Treatment with biofeedback typically involves 6 to 8 sessions with a physical therapist.
5. Surgery
Surgery for fecal incontinence may be recommended by a doctor if other treatments fail to improve symptoms or in cases in which fecal incontinence was caused by obstetric trauma during childbirth, rectal prolapse, or damage to the anal sphincter.
A colorectal surgeon may recommend surgery to correct the muscles that have been damaged, reinforce the anal canal, place an artificial anal sphincter, or even perform a colostomy.