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Fecal Incontinence(Incontinence, Fecal; Bowel Incontinence; Incontinence, Bowel)
Definition

Fecal incontinence is the loss of control over the bowels. Some people may have uncontrolled release of just gas and liquid stool. Others have no control over the release of solid waste.

Causes

Women are more likely to suffer from this condition than men. Many cases are a result of an injury to the pelvic floor. The pelvic floor is a group of muscles that support pelvic organs. Injury can happen through complications from childbirth . Other causes include:

  • Constipation
  • Rectal prolapse
  • A condition that is present from birth
  • Trauma or injury to anal sphincter or its nerves—the healthy sphincter opens and closes to control the release of fecal material
  • Diarrhea
  • Scarring of the rectum from radiation therapy or surgery

Rectal Prolapse

Rectal prolapse

The rectum falls through the anal opening.

Copyright © Nucleus Medical Media, Inc.

Risk Factors

Risk factors include:

  • History of episiotomy
  • Increased age
  • Diseases of the nervous system such as stroke
  • Damage to the spinal cord such ascauda equina syndrome
  • Other risk factors thought to contribute to fecal incontinence include:
    • Diabetes
    • Lack of physical activity
    • Being overweight
Symptoms

The main symptom is the inability to control bowel movements, which leads to leakage of solid or liquid stool.

When Should I Call My Doctor?

Call your doctor if you have fecal incontinence. Your doctor can help find the underlying cause.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may send you to a specialist, such as a:

  • Gastroenterologist
  • Colorectal surgeon
  • Proctologist

Your bodily structures may need to be viewed. This can be done with:

  • X-rays
  • Ultrasound
  • MRI scan
  • Proctosigmoidoscopy or colonoscopy

The pressure of your anal canal may need to be checked. This can be done with anorectal manometry.

Treatment

Talk with your doctor about the best plan for you. Options include:

Diet

Your doctor may suggest changes to your diet. You may be referred to a nutritionist for diet ideas. Examples of dietary changes include:

  • Eating smaller meals more frequently
  • Avoiding foods that may trigger diarrhea such as spicy foods or foods with caffeine
  • Eating more fiber and drinking more fluids—if incontinence is due to constipation
Bowel Training

A bowel movement schedule can also train your bowels. For example, you can pick several times throughout the day to try to go to the bathroom such as after meals.

Exercise

Learn how to do Kegel exercises . These exercises help strengthen the pelvic floor muscles.

Surgery

Surgical procedures may be used to treat this condition when other treatments have failed. Examples include:

  • Surgical repair of the anal sphincter
  • Inserting an artificial bowel sphincter that you can open and close as needed
  • Colostomy for severe cases—disconnects the colon and brings the end through an opening in the abdomen
Prevention

To help reduce your chance of getting fecal incontinence, take the following steps:

  • Prevent constipation by eating a high-fiber diet and drinking plenty of fluids.
  • Pay attention to your diet and avoid foods that trigger diarrhea.
  • Try to maintain a regular bowel movement schedule.
  • Talk to your doctor if you are having trouble with diarrhea or constipation.

RESOURCES:

International Foundation for Functional Gastrointestinal Disorders
http://www.iffgd.org

National Digestive Diseases Information Clearinghouse
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Digestive Health Foundation
http://www.cdhf.ca

Canadian Society of Intestinal Research
http://www.badgut.org

References:

Fecal incontinence. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/. Updated November 27, 2013. Accessed December 16, 2013.

Fecal incontinence: treatment. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/fecal-incontinence/treatment.html. Updated January 2011. Accessed December 16, 2013.

Garg, P, Song J, Bhatia A, Kalia H, Menon G. The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Colorectal Diseases. 2010;12:965-970.

Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health State-of-the-Science Conference Statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449-458.

Rectal prolapse. American Society of Colon & Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/rectal_prolapse/. Updated October 2012. Accessed December 16, 2013.

12/4/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Deutekom M, Dobben A. Plugs for containing fecal incontinence. Cochrane Database Syst Rev. 2009;(4):CD005086.

11/5/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pannu HK, Glanc P, et al. ACR Appropriateness Criteria® pelvic floor dysfunction [online publication]. Reston (VA): American College of Radiology (ACR); 2014. 20 p. Available at: http://www.guideline.gov/content.aspx?id=48295#Section420. Accessed November 5, 2014.



Last reviewed December 2013 by Peter Lucas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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