What Is Fecal Incontinence?

Fecal incontinence is involuntary fecal elimination due to an inability to control bowel movements. It is also often referred to as bowel incontinence or accidental bowel leakage. People who develop fecal incontinence cannot control passing solid or liquid stool or mucus.

This article discusses the types, symptoms, causes, and treatments available for fecal incontinence.

Types of Fecal Incontinence

There are three types of fecal incontinence:

• Urge: Characterized by how quickly a person defecates following the urge to use the washroom. In this type, people cannot control their stools and pass them before reaching a bathroom.
• Passive: Occurs when stool or mucus passes from the anus, but the person experiencing it is unaware it’s happening.
• Combined: A combination of both.
  

What Are the Symptoms of Fecal Incontinence?

The main symptom of fecal incontinence is the inability to control bowel movements. This leads to stool leakage that can occur anytime outside the bathroom. For example, a person with fecal incontinence may cough or pass gas, and at the same time, excrete stool beyond their control.

Sometimes, a person is aware that it’s happening and cannot control it, but others do not know that it’s happening. The only other symptom associated with fecal incontinence is soiling, which involves fecal matter staining underwear and clothing.

What Causes Fecal Incontinence?

There are several causes associated with fecal incontinence, and they fall into one of three categories:

• Underlying health conditions
• Trauma caused by injuries or surgeries
• Lifestyle

Some underlying health disorders that can lead to fecal incontinence include:

• Neurological conditions such as dementia, multiple sclerosis, Parkinson’s disease, stroke, spinal cord injury, or type 2 diabetes
• Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
• Irritable bowel syndrome
• Chronic constipation or diarrhea
• Hemorrhoids
• Rectal prolapse
• Proctitis
• Rectocele
• Pelvic floor dyssynergia

Trauma to the area can also lead to the development of fecal incontinence. In some cases, traumas can damage nerves that play a role in controlling bowel movements.

Other injuries cause fecal incontinence because they can weaken pelvic floor muscles and muscles in the sphincter and the pelvic floor muscles. Some possible traumas include:

• Brain injuries
• Vaginal delivery during childbirth
• Spinal cord injuries
• Surgeries to remove rectal or anal cancer, anal abscesses and fistulas, or hemorrhoids
• Obstetric surgeries

Lifestyle can also increase the risk of fecal incontinence, specifically, how much movement a person gets throughout their day. A lack of physical activity, especially for people primarily sedentary in everyday life, can cause the rectum to hold a great deal of stool. Liquid stool passes by solid stool and leaks through the anus.

Children who develop fecal incontinence do so because of congenital disabilities that affect how the anus, rectum, or colon work, as is the case with Hirschsprung's disease.

How Is Fecal Incontinence Diagnosed?

The diagnostic process for fecal incontinence can be extensive. Several tests and exams are available, but your healthcare provider will first gather a health history and collection of your symptoms. They will ask you:

• When it started
• Whether an underlying health disorder or injury could be playing a role
• How often you pass stool involuntarily and how much stool you excrete when it happens
• If the stool is liquid or solid
• Whether or not you are aware you need to use the bathroom but can’t make it in time or if you’re unaware when it happens
• What your diet is like and any possible connection between the food you eat and incontinence

You will also take tests that check for conditions and diseases that can cause fecal incontinence, such as:

• A digital rectal exam
• A pelvic exam
• Blood and stool tests to check for inflammation and infection
• Urine tests to check for disease

To investigate how well the bowel is functioning, healthcare providers will conduct imaging and other tests as well, including:

• Anorectal manometry: Looks at how well the rectum and anal sphincters work
• Defecography: An X-ray that checks to check on the function of the rectum holding and releasing stool
• Electromyography: Examines the function of the nerves and muscles in the anus and pelvic floor

How Is Fecal Incontinence Treated?

Several treatment options are available for fecal incontinence. Healthcare providers will likely start with the simplest treatments because they effectively improve symptoms by roughly 60% in as many as 20% of people who have it. Simple treatments include:

• Keeping a food diary and changing what you eat or drink based on what foods worsen or improve the fecal incontinence
• Taking medications that help address diarrhea or constipation, such as Imodium (loperamide), Pepto Bismol (bismuth subsalicylate), laxatives, and stool softeners
• Adding fiber to your diet
• Training your bowel to have a set schedule for your bowel movements
• Frequently engaging in Kegel exercises to strengthen the pelvic floor, anus, and rectum

If these treatments don’t eliminate or relieve symptoms, medical providers will opt for different types of treatment. Therapies that may help fecal incontinence include:

• Biofeedback therapy, which utilizes devices to learn how to control the bowel better
• Sacral nerve stimulation stimulates the nerves that control bowel functions to reset them so they work better
• Prescription medications to treat the underlying cause
• Vaginal balloons, which inflate inside the vagina to put pressure on the rectal wall to keep stool from passing through
• Non-absorbable bulking agents are injected into the anal wall to increase tissue volume and narrow the anus so the sphincters close better

Coping With Fecal Incontinence

Fecal incontinence can go hand in hand with embarrassment, but it is no reason to feel ashamed. There are ways to cope well with fecal incontinence to help improve your overall quality of life. They include:

• Planning ahead when leaving the house by bringing a bag with cleanup supplies and a change of clothes
• Ensuring you will be near restrooms before you get there
• Going to the bathroom before leaving the house
• Wearing absorbent pads to avoid leakage in your underwear
• Wear disposable underwear
• Take over-the-counter medications to prevent diarrhea or the frequent need to defecate before going to a social event or eating out.
  

Summary

Fecal incontinence is a lack of bowel control. Sometimes, people with the disorder know it's happening but cannot reach the bathroom in time, whereas others are unaware they are experiencing bowel leakage.

To diagnose and treat fecal incontinence, your medical provider must conduct various tests and exams to confirm the cause and start the proper therapies. Though fecal incontinence isn't easy to cope with, managing it effectively can reduce anal leakage. If you're experiencing fecal incontinence, contact your healthcare provider. They will help diagnose and treat the disorder to improve your quality of life.