Incontinence - Fecal

One out of 13 adults in the United States suffers from problems with fecal incontinence (loss of bowel control). Fecal incontinence is the involuntary leakage of stool or gas from the anal canal. In many cases, fecal incontinence may not develop immediately after an injury, but may occur later in life. It is estimated that two-thirds of people with fecal incontinence do not seek medical attention due to:

  • Embarrassment
  • Fear of sudden public incontinence events
  • Lack of knowledge that treatment is available
  • Stigma
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Symptoms

With increasing age, fecal incontinence affects men and women similarly and is the second leading cause of nursing home admission for the elderly. Symptoms of fecal incontinence include an inability to control the passage of gas, liquid or solid.

Causes and Risk Factors

Fecal incontinence can occur from:

  • Congenital conditions such as spina bifida
  • Injury to the pelvic floor muscles due to vaginal delivery or anal surgery
  • Muscle tone change due to the normal aging process
  • Nerve damage due to vaginal delivery or surgery
  • Neurologic disease (altered nerve function) such as multiple sclerosis, stroke or diabetes
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Diagnosis

The physical examination may include a visual inspection of the anus or digital examination to evaluate the strength of the sphincter muscles.

A more common diagnostic study of the anal sphincter and rectum used to help identify fecal incontinence may involve one of the following procedures:

Anal electromyography: tests the nerve supply to the anal sphincter muscle for muscle contraction and relaxation

Anorectal ultrasound: produces video images of the rectum and anus

Manometry: evaluates the strength or tone of the internal and external anal sphincter

Proctography: an x-ray of the lower colon and rectum to help determine how well the rectum holds stool

Proctosigmoidoscopy: an internal visual examination of the rectum with a scope

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Treatments

Nonsurgical treatment may include lifestyle modifications, such as:

  • Behavioral therapy: helps strengthens the pelvic floor muscles by having the patient perfrom excercises. such as Kegel exercises. A sensor is placed in the anal canal to help determine the progress of this therapy
  • Diet: avoiding foods that increase motility and keeping a daily journal of the types of foods consumed may help identify foods that cause problems with incontinence
  • Fiber supplements
  • Protective undergarments
  • Pharmacologic therapy: bowel slowing medications that help reduce the frequency of bowel movements.

If common treatments fail, minimally invasive surgical procedures are available at the Anorectal Disorders Program, including the artificial bowel sphincterstoma and sphincteroplasty.