Fecal Incontinence

Understanding Fecal Incontinence

Fecal incontinence means that you are not able to hold your feces, or stool, within your rectum until you get to a toilet. There are many causes of fecal incontinence including cases of diarrhea that strike suddenly, soft stool or damaged muscles or nerves within your anus, the last section of your intestine, which controls bowel movements and signals when you need to go.

Experts believe that about 1 in every 12 adults has fecal incontinence. Although it is not a normal part of getting older, you are more likely to experience fecal incontinence as you age. Women are also more at risk for this condition than men.

Symptoms of fecal incontinence include:

• Leaking stool when you are not using the toilet when you cough or pass gas
• Passing stool before you can reach the toilet

Who's at risk?

Anyone can experience fecal incontinence. However, people most at risk are those with:

• An illness causing diarrhea
• Food sensitivities that cause diarrhea
• Damage to nerves that help control bowel movements
• Damage to pelvic floor muscles (muscles that help with elimination)
• Poor health, such as multiple chronic illnesses
• Large hemorrhoids
• Constipation
• Physical abnormalities that affect bowel control

Diagnosis

To diagnose your condition, your physician will consider:

• Your overall health and medical history
• Your description of symptoms, including:
  • When they occur
  • Any diet or physical activity that seems to cause your fecal incontinence
  • Related concerns, such as pain, constipation, or illness
  • How severe the events are
• A physical exam
• The results of imaging tests that might include:
  • Anal manometry: Using a thin, flexible tube, your physician will check how well the muscles and nerves around your anus and rectum are working.
  • Magnetic resonance imaging: MRI imaging may help determine problems with the structure of your anus and rectum.
  • Anorectal ultrasonography: Sound waves make images of the structures in your anus and rectum.
  • Defecography: This is an X-ray that helps your physician find out how much stool you can store in your rectum and how your body handles stool. It can also be performed with MRI technology
  • Proctosigmoidoscopy and Colonoscopy: Using a flexible tube, your doctor will look inside your rectum and lower intestine for evidence of scars and/or inflammation.
  • Anal electromyography: Looks for signs of nerve damage in the pelvic floor and rectum.

Your doctor may also ask about your emotions and quality of life, to find out how the condition is affecting you. Fecal incontinence can threaten self-confidence, and you may worry about everything from odors to your appearance.

Treatment

The treatment recommended for your fecal incontinence will depend on its cause. You might need to try more than one, or a combination of treatments, to manage fecal incontinence. Possible treatments include:

• Medication: Your doctor may prescribe medication to help control diarrhea, bulk your stool, other illnesses or diseases that contribute to fecal incontinence.
• Muscle training: Your doctor may recommend certain exercises that could help strengthen the muscles of your pelvic floor.
• Biofeedback: This is a clinical tool that can help you learn to control your bowel movements.
• Neuromodulation: Implants that cause small electronic pulses may be surgically placed near important nerves to help manage bowel movements.
• Anal plug. This removable device can make it easier for you to control when you go to the toilet. It is helpful for people who do not mind the slight discomfort.
• Surgery: In some cases, surgery may improve your bowel function or fix a structural problem.

Complications

Complications are problems caused by your condition. With fecal incontinence, complications may include:

• Emotional and social distress: Fecal incontinence is embarrassing, and you might start to avoid work and social situations. Some people become depressed because of fecal incontinence.
• Physical irritation: Frequent exposure to feces and wiping can irritate the skin around your anus.
• Poor nutrition: Over time, severe fecal incontinence may mean that your body isn't getting enough nutrition from your food. Your doctor may recommend nutritional supplements.

Prevention

Many causes of fecal incontinence can't be prevented. However, as you go through the process of diagnosis to find its cause, you might learn ways to prevent episodes of incontinence. For example, if your diet is to blame, avoiding certain foods or beverages, such as alcohol or caffeine, may help. A high fiber diet with plenty of fluids might also work. Certain treatments, such as bowel training, may help you develop a schedule for going to the bathroom throughout the day and, in turn, prevent accidents.

When to call the doctor

Call your doctor to schedule an appointment to talk about fecal incontinence that is interfering with your quality of life. If your fecal incontinence is due to frequent, ongoing diarrhea and you have signs of dehydration, contact your doctor immediately.

How to manage the fecal incontinence

Living with fecal incontinence may require taking certain steps so that you can keep enjoying your life. These include the following:

• Work with your doctor: Some treatment approaches may take time to become effective. Follow instructions for any medications your doctor gives you. Ask your medical team if you do not understand how to properly use supplies. Contact your doctor if you don't see any improvement.
• Try therapy: If fecal incontinence is damaging your relationships, work life, or your overall quality of life, talking to a psychologist may help.
• Keep a food diary: Keeping track of the foods you eat and the days or times when fecal incontinence strikes could help reveal a pattern in your diet that contributes to your fecal incontinence.
• Train your bowels: One way to reduce your risk of fecal incontinence is to use the toilet regularly and attempt a bowel movement.
• Pack a change of clothing: Always be prepared. Carry fresh clothes and shoes, cleansing cloths, and a spare bag to store any soiled items.
• Wear absorbent pads: While you're learning to manage fecal incontinence, invest in incontinence products, such as pads, that absorb leaks and odors.
• Take "fecal deodorant" medication: Talk to your doctor about medication that can reduce odors associated with fecal incontinence.
• Learn to care for delicate skin: Use cleansing and barrier products to prevent skin irritation and pain from fecal incontinence.