Fecal Incontinence: Causes, Treatments, and Management Strategies

Fecal (Bowel) Incontinence: Causes, Treatment Options, and Management Strategies

Fecal incontinence, also called bowel incontinence, occurs when you experience difficulty managing or controlling your bowel movements. Stool (feces) leaks out without control, and the severity can vary, from slight leakage when passing gas to more significant incontinence of solid stools. Treatment options include dietary changes, exercises, medications, or surgery, depending on the underlying cause.

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What is Fecal (Bowel) Incontinence?

Fecal incontinence is when you cannot control when and how you have a bowel movement. This leads to unintentional stool leakage, which may happen at inconvenient or socially embarrassing times. Several factors can affect your ability to regulate bowel movements, including the proper functioning of the muscles in the pelvic floor, rectum, and anus, along with the nerves that signal the need to defecate.

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Types of Fecal Incontinence

There are two main types of fecal incontinence:

• Urge Incontinence: You feel the urge to have a bowel movement but cannot reach the toilet in time, often due to muscle problems.
• Passive Incontinence: You have difficulty sensing the need to poop, leading to unintentional leakage. This type is associated with nerve issues affecting communication with the muscles.

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Causes of Fecal Incontinence

Several factors contribute to fecal incontinence, including:

• Constipation: Chronic constipation can weaken rectal muscles or cause nerve damage, leading to incontinence.
• Diarrhea: Frequent loose stools may stretch or weaken the anal muscles, making it difficult to retain stool.
• Muscle or Nerve Damage: A difficult vaginal delivery, pelvic surgeries, or conditions like diabetes can damage the muscles and nerves required for bowel control.
• Inability of the Rectum to Stretch: Conditions like Crohn’s disease or previous radiation therapy can lead to scarring, preventing the rectum from expanding to hold stool.
• Pelvic Organ Prolapse (POP): Weakened pelvic muscles can cause organs like the rectum or bladder to drop, leading to fecal incontinence.

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Risk Factors for Fecal Incontinence

While anyone can experience fecal incontinence, some risk factors include:

• Age: Older adults, especially those over 65, are at increased risk due to muscle weakening over time.
• Sex: Women and people assigned female at birth (AFAB) are more likely to experience fecal incontinence, often due to factors like vaginal childbirth and hormone therapy.
• Chronic Conditions: Conditions such as diabetes, Parkinson’s disease, stroke, or multiple sclerosis increase the risk of nerve damage, leading to fecal incontinence.

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Symptoms of Fecal Incontinence

Common signs and symptoms include:

• Poop leaking when passing gas or during physical activity
• Feeling an urgent need to poop but not making it to the toilet in time
• Finding stool in your underwear after a bowel movement
• Complete loss of bowel control in severe cases

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Diagnosis and Tests

If you experience fecal incontinence, consult with a gastroenterologist or colorectal surgeon. Tests to diagnose the cause may include:

• Anorectal Manometry: Measures the strength of your anal sphincter muscles.
• Balloon Expulsion Test: Assesses the function of your rectum and anal muscles.
• MRI or Ultrasound: Used to examine anal sphincter structure and surrounding tissues.
• Pudendal Nerve Test: Checks how well the nerve controlling the anal sphincter is functioning.

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How Can I Manage and Treat My Fecal Incontinence?

You can help manage and treat your fecal incontinence in the following ways:

1. Wearing Absorbent Pads

Wearing absorbent pads inside your underwear is the most frequently used treatment for fecal incontinence. For milder forms of fecal incontinence — such as a few bowel leakage accidents, small volumes of stool, or staining of underwear — wearing absorbent pads can make a big difference in your quality of life. Wearing absorbent pads can be combined with other treatments.

2. Dietary Changes

Changing what you eat can help prevent or relieve your fecal incontinence. If diarrhea is the problem, your doctor will recommend avoiding foods and drinks that make your diarrhea worse. To track what foods and drinks make your fecal incontinence better or worse, your doctor may recommend keeping a food diary. In the case of constipation or hemorrhoids, your doctor may suggest adding more fiber and liquids to your diet.

3. Over-the-Counter Medicines

Depending on the cause, over-the-counter medicines can help reduce or relieve your fecal incontinence. If diarrhea is causing your fecal incontinence, your doctor may recommend medicines such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol). If constipation is the cause, your doctor may recommend laxatives, stool softeners, or fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel).

4. Bowel Training

Your doctor may recommend that you train yourself to have bowel movements at specific times of the day, such as after meals. Developing regular bowel movements may take weeks to months to improve fecal incontinence.

5. Pelvic Floor Muscle Exercises (Kegels)

Pelvic floor muscle exercises can improve fecal incontinence symptoms. Tightening and relaxing your pelvic floor muscles several times a day can strengthen the muscles in your anus, pelvic floor, and rectum. Your doctor can guide you to ensure you’re performing the exercises correctly.