Celiac Disease: Managing Fecal Incontinence

B.S. Dietetics, Dietitian, Health Professional

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Celiac disease (CD) affects roughly 3 million Americans. The condition is caused by an immune response to the ingestion of the protein gluten. This response damages the lining of the gastrointestinal tract and leads to painful symptoms. Ingesting gluten when you have CD can cause symptoms including abdominal pain and bloating, chronic diarrhea, vomiting, constipation, weight loss, fatigue, pale or foul-smelling stools, and other issues when left untreated.

Bowel or fecal incontinence can be a hugely embarrassing aspect of CD for many of these patients. Fecal incontinence in CD is most often caused by the need to defecate that comes on so suddenly that the person doesn’t make it to the toilet in time. This is usually due in part to the intentional or unintentional ingestion of gluten.

If you develop new symptoms of fecal incontinence, it is important to see your doctor because many people have multiple causes contributing to the condition. Some of the other causes of fecal incontinence include muscle damage, nerve damage, constipation, diarrhea, loss of storage capacity in the rectum, surgery, rectal prolapse, and rectocele. It is essential to rule out other sources for the condition in order to get proper treatment and prevent missing a co-morbid condition.

Once your physician has assessed that the issue is with CD, there are several things you can do to help prevent the issue, deal with accidents as they occur, and prevent complications. 

Here are a few tips that might help you negotiate this embarrassing condition:

  • First and foremost, maintain your gluten-free diet. For many people, this can also include avoiding cross contamination, as well as beauty products or other items they come into contact with that may contain gluten.
  • Medications may be used at your physician’s discretion and are often aimed at whatever issue contributed to the fecal incontinence. Bulking laxatives, anti-diarrheal medications, or injectable bulking agents may be needed.

  • If muscle damage is a contributing factor, biofeedback, bowel training, sacral nerve stimulation (SNS), posterior tibial nerve stimulation (PTNS/TENS), or vaginal balloon (Eclipse System) may be deemed appropriate.

  • Should there be rectal prolapse, rectocele, or sphincter damage involved in your fecal incontinence, your doctor may decide that surgery is needed to treat the problem. For additional information on surgical options, check out the information given by Cedars-Sinai.

  • Proper skincare is essential in preventing irritation from fecal incontinence. Wiping after each bowel movement with water or alcohol-free, perfume-free towelettes can keep the area clean. Be sure to dry the area thoroughly and apply a barrier cream to prevent the skin in the area from coming into repeated contact with fecal matter. Wearing loose, breathable undergarments and changing them frequently can also help by allowing the airflow to circulate and keeping the area as clean and free from moisture as possible.

  • Keeping an emergency stash of items like clean undergarments, cleansing towelettes, Depends or other adult diapers, and even an extra set of clothing when you are out and about can prevent an embarrassing situation from being even worse.

If you find that your condition is causing you to isolate, avoid social settings, or become anxious or depressed, please speak with your physician immediately. Your doctor may decide to treat the incontinence more aggressively and monitor how it is affecting your mental and emotional health.

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Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition.She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years.Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER).