About Fecal Incontinence

Fecal incontinence, or bowel incontinence is much less common than urinary incontinence, but its impact on well-being and quality of life can be just as devastating. The good news is you don’t have to suffer in silence. Talk to your doctor about your symptoms and bowel health and get help today. To get you started, here is some basic information about fecal incontinence and the treatments available to help you regain control of your life.

What is fecal incontinence? 

Fecal incontinence (also called bowel or stool or anal incontinence) is the involuntary loss of stool from the bowel. It can range in severity from occasional leakage when you pass gas to the complete loss of bowel control.

Who can get it? 

Occasional soiling is reported by up to 20% of people, whereas complete loss of control is much less common. About 1% of people under the age of 65 and 4%–7% of people over 65 have fecal ncontinence. It is three times more likely to occur in younger women than in men, until the age of 65 when things balance out and roughly the same number of men and women are affected.

How does the bowel work? 

Three things are necessary to maintain normal bowel health and function. If something is wrong with any of these functions, fecal incontinence can occur.

Anal sphincter muscles: Both the external and internal sphincters contract to prevent stool from leaving the rectum.

Rectal sensation: When your bowel is full, nerves send a signal to the brain warning you that it’s time to go to the bathroom.

Rectal accommodation: The muscular wall of the rectum stretches to allow you to hold stool until you reach the toilet.

Causes of Fecal/Bowel Incontinence and Constipation

A broad range of conditions and disorders can lead to fecal or bowel incontinence. Here are some of the most common ones.

  • It may seem contradictory, but in fact, chronic constipation can lead to incontinence. Impacted stool — a mass of hard, dry feces that’s too large to pass — can weaken the walls of the rectum and/or damage the nerves that control defecation. In addition, looser, more watery stool can leak out around the blockage.

  • Loose stool is much harder to control than solid stool, so patients who suffer frequent bouts of diarrhea are more likely to have incontinence. Certain foods or infections can cause diarrhea and aggravate symptoms.

  • Damage to the external or internal sphincter is a frequent cause of fecal incontinence. Like urinary incontinence, this can occur during vaginal childbirth, especially if the doctor must use forceps or perform an episiotomy. Symptoms sometimes don’t show up until years later. The weakness of pelvic floor muscles or the anal sphincter as you age can also cause incontinence.

  • If the nerves that sense when it’s time to go to the bathroom or the ones that control the anal sphincter are damaged, incontinence can occur. This can also happen during childbirth, in people who have suffered a stroke or spinal cord injury, or in those with diabetes, multiple sclerosis or any other disease that attacks the nerves.

  • Inflammatory bowel diseases like Crohn’s disease can irritate the lining of the rectal wall, interfering with its ability to hold stool. Previous surgery or radiation (such as for rectal cancer) can also scar or damage the rectum.

  • Rectal prolapse (a condition where the rectum drops and protrudes into the anus) or rectocele, when the rectum protrudes through the vagina, can lead to incontinence. Hemorrhoids that prevent the anal sphincter from closing properly can also cause leakage.

Treatment of Fecal Incontinence and Constipation

Luckily, treatments are available that can help you regain bowel control or at least minimize/manage your symptoms. The right treatment will depend on the cause of your incontinence. Your doctor may suggest you make changes to your diet or take medication or try special exercises and behavioural training. Surgery may be an option if other treatments fail.

Dietary Changes

Dietary changes centre around improving the consistency of your stool to prevent episodes of incontinence. If you suffer from constipation, you’ll want to drink plenty of liquids and foods that are rich in fibre. Getting lots of fibre in your diet will also help bulk up the stools if diarrhea is contributing to your incontinence. See our list of Diet do’s and don’ts (right) for more helpful tips.

Medications

Medications work by improving the consistency of stool or slowing down the movement of food through your intestine. This will allow water to be fully absorbed in the colon (to prevent diarrhea) and give you enough time to get to the bathroom when you feel the urge to defecate. Some of the most commonly recommended medications are available at your local pharmacy without a prescription.

Fiber supplements: There are all sorts of products available to give you an extra dose of fibre. Some come in chewable form, while the powdered versions can be mixed with water or sprinkled on your food. Try different things until you find one you like.

Antidiarrheal drugs: Loperamide (Imodium®) slows down he movement of food and waste through your intestine and helps treat diarrhea. It can be safely combined with other medications.

Laxatives and stool softeners: If you suffer from constipation, temporary use of a mild laxative to make you go to the bathroom may provide relief, but using them continuously can make fecal incontinence worse. As the name implies, stool softeners will soften your stool to prevent impaction and make it easier to pass. Some products contain both a laxative and a stool softener in the same pill.

Bowel Training

Diet Do's and Don'ts

If you suffer from constipation...

  • Drink at least 8 glasses of water a day

  • Eat high-fibre foods such as fruits, vegetables, whole grains and cereals

  • Eat smaller meals, more frequently

  • Be as active as possible

If you suffer from diarrhea...

  • Avoid spicy or greasy foods, cured or smoked meat, dairy products, caffeine, alcohol and artificial sweeteners

  • Eat plenty of fibre

Bowel training is geared towards restoring lost muscle strength in your bowel wall or anal spincter and teaching you healthy behaviours that can put you back in control. Following an established bathroom routine is one way to make your bowel movements more predictable and reduce the risk of accidents. You can also practice contracting your anal sphincter to strengthen those muscles and prevent leakage. As with urinary incontinence, biofeedback may be helpful in making sure you’re doing these exercises correctly.

Surgery

Surgery can be an option for some causes of fecal incontinence, most often to repair a prolapse or a damaged anal sphincter.

Sphincter repair/replacement: In a procedure called a sphincteroplasty, the damaged area of the sphincter is detached and the edges are sown back together. If necessary, a piece of muscle can be taken from the thigh and wrapped around the sphincter to reinforce it. If the damage is more extensive, an artificial anal sphincter (essentially an inflatable ring) can be implanted, which you can deflate with a pump inserted under the skin of the scrotum (in men) or major labia (in women) when you need to go to the bathroom.

Surgery for rectal prolapse/rectocele: The fallen rectum is lifted back to the correct position and stitched in place. At the same time, the surgeon can repair any damaged muscles that caused the prolapse in the first place.

Hemorrhoidectomy: Internal hemorrhoids can prevent the anal sphincter from closing properly. They can be removed with a scalpel (a surgical knife), a laser or electricity (cautery pencil).

Colostomy: This is a more drastic procedure reserved for people with severe incontinence and for whom other treatments have failed. The rectum is closed off and stool is diverted to an opening in the abdominal wall, to which a special bag is attached to collect the stool.

Sacral Nerve Stimulation

Sacral nerve stimulation The sacral nerve controls the sensation and strength of the anal muscles as well as the bladder. The same procedure described to treat urinary incontinence can be used for fecal incontinence as well.

Bulking Agents

Bulking agents similar to those used to treat urinary incontinence have recently been developed for fecal incontinence. They’ve only been tried in a limited number of people, though, and larger and more rigorous studies are needed. However, they may soon become an option in people with severe incontinence that hasn’t responded to other treatments.

Additional Information