Fecal incontinence, also called bowel or anal incontinence, is the inability to control bowel movements. This causes an unintentional passing of solid or liquid stool or mucus from the rectum. The National Digestive Diseases Information Clearinghouse (NDDIC) estimates that 18 million+ people in the US suffer from fecal incontinence. It can occur at any age, but it is more common in those over 50 years old. It is also slightly more prevalent among females.
Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage associated with age or giving birth. Nerve damage can also occur among those with diabetes, multiple sclerosis, or back trauma from surgery or injury. Weak anal sphincter muscles or poor sensation in the rectum can contribute to fecal incontinence.
The following conditions increase the risk of fecal incontinence:
- Muscle damage or weakness
- Inability to hold a bowel movement before reaching the toilet
- Nerve damage
- Inability to control the passing of gas/stools
- Gas or bloating
- Loss of storage capacity in the rectum
- Rectal prolapse
- Pelvic floor dysfunction
In addition to a digital rectal exam, our specialists may use the following tests to determine the cause of fecal incontinence:
- Balloon expulsion test – Measures the time it takes to push out a balloon filled with water from the rectum.
- Anorectal manometry – Measures the tightness of the sphincter and sensitivity and functioning of the rectum.
- Proctography – Takes x-ray images during a bowel movement on a specially designed toilet.
- Colonoscopy – Views the entire colon.
- MRI – Determines if the sphincter muscles are intact and to provide images during defecation (defecography).
Reducing constipation, controlling diarrhea, and avoiding straining are all initial noninvasive methods of treating fecal incontinence. Treatments may include one or more of the following:
- Eating, Diet, Nutrition – Food affects stool consistency and how quickly it passes through the digestive system. Eating the correct amount of fiber is important because fiber adds bulk to stool, making it softer and easier to control. Drinking sufficient fluids may help prevent constipation although beverages containing caffeine may cause diarrhea. A food diary helps determine the best diet.
- Medications – Bulk laxatives (e.g., Citrucel, Metamucil) help develop regular bowel patterns. Antidiarrheal medications (loperamide, diphenoxylate) slow down the bowels for better control.
- Pelvic Floor Exercises – These strengthen the pelvic floor muscles for improved bowel control. Biofeedback therapy that uses sensors to tell if patients are using the correct muscles may prove helpful.
- Bowel Training – Developing a regular bowel movement pattern can help relieve fecal incontinence.
- Surgery – Surgery is particularly helpful if injury has occurred in the pelvic floor or sphincter muscles. Sphincteroplasty is the most common surgery during which the separated ends of the sphincter muscle are reconnected.
- Sacral Neuromodulation (SNM) – This treatment manages symptoms of fecal incontinence for those not having success with more conservative treatments. SNM stimulates the sacral nerves, which control the bladder and bowel and muscles related to urinary and bowel function. If the brain and sacral nerves do not communicate correctly, the nerves will not tell the bladder or bowel to function properly. SNM targets this communication problem by stimulating the nerves with mild electrical impulses.