What is Fecal Incontinence?

Fecal incontinence refers to the inability to control your bowel movements, causing involuntary leakage of stool. The severity may range from passage of a small amount of stool while passing gas, to complete loss of bowel control. Normally, the ability to hold or control the passage of stool requires the nerves and muscles of the rectum as well as the anal sphincter muscles to be working normally.

Causes

Fecal incontinence is caused by an alteration of bowel habits and conditions that affect the normal function of the nerves and muscles of the rectum, anus, and pelvic floor. The anal sphincter muscles or pelvic floor can weaken with age, or as a result of childbirth, trauma, or surgery involving the anus or pelvis. The rectum can be affected by radiation treatment or bowel conditions such as Crohn’s disease. Damage to the nerves of the rectum and anus leading to incontinence may be caused by stroke, spinal cord injury, or other neurologic conditions.

Symptoms

Normally, adults should not experience involuntary leakage of stool. Adults with fecal incontinence experience spontaneous leakage of stool during daily activities or with exertion. Patients may experience occasional or frequent “accidents”, often with soiling of undergarments. Symptoms may be worse in patients with chronic diarrhea.

Tests & Diagnosis

Your doctor can diagnose fecal incontinence based on clinical history and by performing a physical examination, including anorectal exam. Additional tests may be used including anorectal manometry, endoscopic exam, or radiology tests.

Treatment

Effective treatments are available for fecal incontinence. For mild symptoms, a combination of dietary changes, medications, fiber supplementation, and pelvic floor exercises may improve bowel control. Patients often benefit by working with a physical therapist to perform exercises that strengthen the pelvic floor muscles. When conservative measures are ineffective, a novel procedure called sacral nerve stimulation (SNS) can be considered to stimulate contraction of the anal sphincter muscles, resulting in better bowel control.