Bowel (Fecal) Incontinence

Fecal incontinence at a glance

  • Fecal incontinence (FI), also known as bowel incontinence, is loss of control over bowel movements.
  • FI may involve a leakage of liquid or an uncontrolled bowel movement that occurs before one can reach a toilet.
  • This form of incontinence occurs primarily among older people and slightly more often in women.
  • Fecal incontinence is caused by various medical problems, including diarrhea, muscle damage or weakness, nerve damage, spinal conditions, constipation, pelvic floor dysfunction, irritable bowel disease and cognitive impairment.
  • Symptoms may be a partial or a complete uncontrolled evacuation of stool. Fecal incontinence can also be a leakage of liquid or solid stool when passing gas, or the leakage of mucus from the anus.
  • Treatments vary, ranging from diet control to exercises, medications and surgery.

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Symptoms & causes of fecal incontinence

Fecal incontinence involves a disruption of the body’s normal bowel control, which relies on the nerves and muscles of the rectum and anus (sphincters around the anus) working together to hold and release stool.

Certain conditions that cause weakness or lack of coordination in this system can result in FI, such as:

  • Diarrhea, which causes loose stool that is more difficult for the body to hold to fill the rectum quickly.
  • Nerve damage to the pudendal nerves that help regulate the anal sphincter muscles may cause them not to hold properly. This can result in a person not sensing the normal urge to go to the bathroom. Nerve damage can be caused by giving birth, nerve-damaging diseases such as diabetes or multiple sclerosis, spinal stenosis or other spinal conditions affecting the nerves going to the pelvis, a stroke, an injury, or a long-term habit of straining to pass stool.
  • Injury to external or internal sphincter muscles can weaken the ability of the anus to close and prevent stool leakage. Such injury can be caused by trauma, cancer surgery or hemorrhoid surgery to repair the inflamed veins around the anus and lower rectum. External hemorrhoids under the skin around the anus can also weaken its ability to hold in fecal matter, resulting in leakage.
  • Constipation can lead to hard, large stools that get lodged in the rectum, with watery stools building up behind them and leaking out around them. Over time, constipation weakens and stretches the sphincter muscles, making it harder for the rectum to hold stool.
  • Loss of stretch in the rectum, resulting from radiation treatment, rectal surgery, inflamed bowel disease or ulcerative colitis, can cause scarring that limits the rectum’s stretching ability, leading to FI.
  • Pelvic floor dysfunction, which is an abnormality in the pelvic floor muscles and nerves, causes FI by impairing the rectum’s sensing ability, impairing muscle contractions, causing the rectum to drop down through the anus or the vagina, and/or weakening the pelvic floor.

Treatment for fecal incontinence

Many people do not discuss fecal incontinence with their physician due to the embarrassing nature of the problem. This results in unnecessary compromises in social activity and lifestyle. However, FI can often be treated and cured.

Since food intake affects stool development, the patient may be able to treat, or help treat, fecal incontinence with dietary changes and maintenance. Eating enough fiber and drinking plenty of water can help greatly improve the condition. Proper medications can help reverse the depleting effects of diarrhea.

Bulk laxatives may lead to more regular bowel movements, and anti-diarrhea medications can result in better bowel control.

Depending on the causes of FI and its severity, exercises to increase pelvic floor muscle strength can improve bowel control. Biofeedback sensors can tell a patient if she is exercising the right muscles. Bowel training, in which the patient develops a regular bowel movement pattern over weeks and months, can reduce constipation that causes fecal incontinence. Surgical treatments may be required for FI cases that are due to injury or are not responding to other treatments. The most common surgery is anal sphincteroplasty, which reconnects the ends of torn sphincter muscles due to injury or childbirth. Another procedure places a “pacemaker” for the rectum under the skin.  Electrical stimulation of anal and rectal nerves by a device placed beneath the skin can also result in improved bowel control.