Information and Treatment for Fecal Incontinence
What Is Fecal Incontinence?
Fecal incontinence is the inability to hold your stool or gas until you get to a toilet.
How Common Is Fecal Incontinence?
Millions of Americans of all ages experience fecal incontinence; an estimated 1 in 12 adults are affected. It is more common in women and older adults, though it is not a normal part of aging.
What Causes Fecal Incontinence?
There are many causes of fecal incontinence, also called anal or bowel incontinence. Childbirth-related injury to anal muscles or nerves is the most common. Such injuries may not be recognized until they cause problems later in life.
Other causes are trauma to anal muscles related to surgery or injury; age-related weakening of anal muscles; and neurological diseases such as severe stroke, advanced dementia or spinal cord injury.
How Does a Physician Assess Fecal Incontinence?
Your physician will ask you to describe the severity of your symptoms and how your life is being affected. Underlying causes for your incontinence may be identified while discussing your medical history. These causes include:
- multiple pregnancies, bearing heavy babies, forceps deliveries, or incisions to aid childbirth (episiotomies)
- previous anal or rectal surgeries
- medical illnesses or conditions
- medication side effects
A physical examination of the anal region should be performed, and may easily detect an injury to the anal muscles. Your physician will decide if diagnostic tests are needed. For example, an ultrasound probe may be used to take photographs of potentially injured anal muscles. Other tests can assess the function of muscles and nerves that help control bowel movements. These include:
- Anal manometry: Using a thin, flexible tube, your health care provider will test how well the muscles and nerves around your anus and rectum are working.
- MRI: MRI imaging may help find structural problems with your anus and rectum.
- Defecography: With this kind of X-ray, your physician will learn how much stool you can store in your rectum and how your body handles stool.
- Proctosigmoidoscopy: Using a flexible tube, your health care provider will examine your rectum and lower intestine for evidence of scars and/or inflammation.
Your provider may also ask about your feelings, since fecal incontinence can undermine self-confidence and provoke worry about everything from odor to your appearance.
How Can I Cope with Fecal Incontinence?
There are a range of steps you can take, including wearing absorbent pads, recognizing and avoiding problem foods, and taking special care of sensitive skin. If the problem becomes unmanageable on your own, consult with a specialist to investigate further and to learn about bowel retraining, medicines, or other simple treatment approaches, such as exercises to strengthen your pelvic floor muscles.
For some patients, surgery might be considered. There are several options:
- Surgical repair of muscle: Anal muscle injuries may be surgically corrected.
- Insertion of a nerve stimulator: This can help nerves that control muscles and skin of the anus work more efficiently.
- Bulking agent injections: Injecting a substance into the anal canal can bulk it up and strengthen the squeezing function of the anal muscles that facilitates bowel movements.
- Colostomy: In severe cases, a colostomy may be the best option for improving quality of life. During this surgery, part of the colon (large intestine) is brought out through the abdominal wall to drain into a bag.
When Should I Make an Appointment with a Specialist?
Schedule an appointment to talk about fecal incontinence if it is diminishing your quality of life. The Women’s Medicine Collaborative has specialists who can help.