Bowel movements might be something you’d rather not think about. Yet when you lose control over them, they become front and center in your mind. Fecal incontinence can range from minor—accidentally passing gas or a little bit of liquid stool, to major—involuntarily passing solid stools. Either way, the condition can be embarrassing to discuss and lead to poor self-esteem and social isolation.
Fecal incontinence is a common condition affecting more than 5.5 million Americans. It is most prevalent in adults over age 65 and in women. It can almost always be managed, and sometimes can be cured, but self-treatment is rarely successful.
Have a frank discussion with your doctor about your symptoms so you can work together to find the most effective treatment for you.
Causes of fecal incontinence
Controlling bowel movements requires coordination between the smooth muscles of your rectum and internal sphincter, and the striated muscles of your pelvic floor and the external anal sphincter at the end of your digestive tract.
Your nervous system controls the actions of maintaining the barriers that hold waste inside and releasing those barriers when you’re ready to defecate.
Fecal incontinence isn’t a disease; it’s a symptom of other problems that comprise this barrier function. For example, childbirth or anal surgery can damage the sphincter muscles. More serious conditions that damage nerves, such as diabetes, multiple sclerosis, and spinal injuries, can compromise muscle function or lead to a loss of sensation so you no longer feel the presence of stool.
Inflammatory bowel diseases and inflammation from radiation can cause a loss of elasticity and storage capacity in the rectum, leading to accidents. Constipation can lead to fecal impaction—a buildup of hardened stools in the rectum—with “overflow incontinence,” and diarrhea makes it more difficult to retain stools.
Watch your diet
You may be able to reduce minor leakage by changing your diet in the following ways:
• Add more fiber, which adds bulk to your stool, from fruits, vegetables, and whole grains. The recommended daily amount of fiber is 25 to 30 grams. Add fiber to your diet slowly to avoid discomfort from bloating and gas.
• Eat smaller meals throughout the day. You’re more likely to feel an urgent need to go, and have diarrhea, after large meals.
• Treat constipation—if present—to avoid fecal impaction.
• Keep a food and symptom journal to log the types and amount of food eaten and when fecal incontinence occurs. If you see a pattern of incontinence several hours after you consume certain foods, try cutting back on them. Alcohol and caffeine may cause diarrhea.
• Avoid sweeteners like xylitol and sorbitol, which can contribute to diarrhea.
Depending on the cause and severity of the problem, one or more of the following treatment options may be indicated:
• Bowel training. Some people with fecal incontinence need to relearn how to control their bowels. One way to retrain the bowels is through biofeedback, which uses a computer to monitor muscle contractions as you learn exercises to strengthen the rectum and pelvic muscles. Stronger muscles can help retain stool. If fecal incontinence is caused by constipation, your doctor may recommend starting a routine of having a bowel movement at the same time daily.
• Medication. Drugs may be used if fecal incontinence is caused by diarrhea. Imodium A-D is an anti-diarrheal medication that thickens the stool and also increases the strength of the rectal muscles. Other medications help treat fecal incontinence in other ways, for example, by decreasing intestinal secretions, contracting the muscle that closes the rectum, or slowing the movement of stool through the bowel.
• Anal bulking agents. Your doctor can inject a gel that can build up tissue around the anus, thereby narrowing the opening and allowing better control.
• Disimpaction. Your doctor can remove a fecal impaction, if present, and place you on a program to prevent recurrence.
• External incontinence devices. If you’re unable to regain fecal continence, you can wear an external device to collect any leaking stool. These prescription devices, available at medical supply stores and some pharmacies, typically consist of a drainable pouch attached to an adhesive wafer. The hole in the center of the wafer is placed over the rectum to allow stool to pass through. These devices can remain in place for 24 hours, but they must be changed if any stool leakage occurs.
• Sacral nerve stimulation. A thin wire, inserted alongside the sacral nerves in the lower back, uses electricity to contract the sphincter muscles. If this helps, a permanent device can be placed. This method is typically reserved for patients after simpler treatments have failed.
• Surgical repair. If fecal incontinence is caused by injury to the pelvic floor, anal canal, or anal sphincter, surgery may be performed to repair the problem. For example, damaged muscles in the anus may be replaced with muscle from the leg or arm.
• Artificial sphincter. If your anal sphincter muscles are not capable of holding in stool, an artificial anal sphincter can be surgically implanted. This sphincter consists of a fluid-filled cuff that surrounds the anal canal, a pressure-regulating balloon in the anal canal, and a control pump located just under the skin. Normally, the cuff is full of fluid, which squeezes the anal canal closed. When you need to have a bowel movement, you squeeze the pump several times; the fluid then drains from the cuff into the balloon, and stool can pass through the open anal canal. After the bowel movement, the cuff automatically refills with fluid from the balloon.
• Colostomy. Severe fecal incontinence that doesn’t respond to treatment may require a colostomy, in which the large intestine is connected to the abdominal wall. Instead of entering the rectum, stool goes directly from the intestine into a special bag on the outside of the body.
• Wear disposable underwear that’s made for fecal incontinence or place absorbent pads in your underwear.
• Always pack wipes and extra underwear when you go out.
• Keep the area around your anus clean and dry. After a bowel movement, wash with plain water or an alcohol-free wipe; let your skin air dry. Then apply a barrier cream to prevent skin irritation.
• Go to the toilet before you leave home.
• If you plan to eat out, take an antidiarrheal medicine before you go.
• Ask your doctor about fecal deodorants—pills that reduce odor in your stool and gas.