Sometimes referred to as bowel incontinence or anal incontinence, fecal incontinence is the inability to control bowel movements, causing an unintentional passing of solid or liquid stool or mucus from the rectum. Fecal incontinence can occur in people of any age, but it is more common in adults over the age of 50. Fecal incontinence is also slightly more common in women. The National Digestive Diseases Information Clearinghouse (NDDIC) estimates that more than 18 million people in the United States suffer from fecal incontinence.
Common causes of fecal incontinence include diarrhea, constipation and muscle or nerve damage associated with age or giving birth.
Symptoms of Fecal Incontinence
- Inability to hold a bowel movement before reaching the toilet
- Inability to control the passing of gas or stools
Fecal incontinence can be accompanied with other bowel problems such as diarrhea, constipation, gas and bloating.
- Age- fecal incontinence is more common in older adults.
- Gender- it is slightly more common in women than men, most likely because fecal incontinence may be a complication of childbirth.
- Nerve damage- people with conditions that can damage nerves that control bowel movements such as diabetes or multiple sclerosis may be at increased risk for fecal incontinence.
- Dementia- fecal incontinence is often present in late-stage Alzheimer’s disease and other forms of dementia
- Physical disability- being physically disabled may make it difficult to reach the toilet in time.
Complications of Fecal Incontinence
- Emotional distress- losing control of one’s bowel movements can lead to embarrassment and shame, frustration, anger and depression
- Skin irritation- repeated contact with stool to the anus can lead to pain and itching and potentially, sores or ulcers that require medical treatment.
Tests to Diagnose Fecal Incontinence
- Digital rectal exam- your doctor inserts a gloved and lubricated finger into your rectum to evaluate the strength of your sphincter muscles and to check for any abnormalities in the rectal area.
- Balloon expulsion test- a small balloon is inserted into the rectum and filled with water. You are then asked to go to the toilet and expel the balloon. The length of time it takes to expel the balloon is recorded. A time of one minute or longer is usually considered a sign of a defecation disorder.
- Anal manometry- a narrow, flexible tube is inserted into the anus and rectum. A small balloon at the tip of the tube may be expanded. This test helps measure the tightness of your anal sphincter and the sensitivity and functioning of your rectum.
- Anorectal ultrasonography- a narrow, wand-like instrument is inserted into the anus and rectum. The instrument produces video images that allow your doctor to evaluate the structure of your sphincter.
- Proctography- X-ray video images are made while you have a bowel movement on a specially designed toilet. The test measures how much stool your rectum can hold and evaluates how well your body expels stool.
- Proctosigmoidoscopy- a flexible tube is inserted into your rectum to inspect the last portion of the colon (sigmoid) for signs of inflammation, tumors or scar tissue that may cause fecal incontinence.
- Endorectal ultrasound- a special endoscope is inserted to look at the rectum and to use sound waves to provide images of the anal sphincters.
- Anal electromyography- tiny electrodes inserted into muscles around the anus can reveal signs of nerve damage.
- MRI- magnetic resonance imaging (MRI) can provide clear pictures of the sphincter to determine if the muscles are intact and can also provide images during defecation.
Treatments for Fecal Incontinence
Certain medications may be able to help relieve your symptoms, depending on the cause of your fecal incontinence. Medical options include anti-diarrheal drugs, if diarrhea is the cause, laxatives, if constipation is the cause, and other medications make be taken to reduce the spontaneous motion of your bowel.
Stool consistency is affected by what you eat and drink. Your doctor may suggestion that you drink more fluids and eat more fiber-rich food to bulk up your stools and make them less watery.
There are some exercises and therapies that can restore muscle strength if that is the cause of your fecal incontinence. These treatments can improve anal sphincter control and the awareness of the urge to defecate.
- Biofeedback- specifically trained physiotherapists can teach you simple exercises that increase anal muscle strength
- Bowel training- your doctor may suggest making a conscious effort to have a bowel movement at specific times of the day such as after eating. Establishing when you need to use the toilet can help you gain better control.
- Sacral nerve stimulation- the sacral nerves run from your sphincter cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can strengthen muscles in the bowel.
- SOLESTA®- SOLESTA is an injectable gel that is used to treat individuals 18 years or older who have fecal incontinence. Comprised of naturally made materials, SOLESTA works by bulking up tissue in the anal canal. It is an alternative to surgery for fecal incontinence patients who have not been able to improve their condition through more conservative efforts.
If medications, exercises, lifestyle changes and other therapies do not work for you, there are some surgical options that may be able to treat the cause of your fecal incontinence.
- Sphincteroplasty- surgery to repair a damaged or weakened anal sphincter. An injured area of muscle is identified, and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together, strengthening the muscle and tightening the sphincter.
- Treating rectal prolapse, a rectocele or hemorrhoids- surgical correction of these problems will likely reduce or eliminate fecal incontinence.
- Sphincter replacement- a damaged anal sphincter can be replaced with an artificial anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you're ready to defecate. To go to the toilet, you use a small external pump to deflate the device and allow stool to be released. The device then re-inflates itself.
- Sphincter repair- muscle is taken from the inner thigh and wrapped around the sphincter, restoring muscle tone to the sphincter.
- Colostomy- surgery that diverts stool through an opening in the abdomen. A special bag is attached to this opening to collect the stool. Colostomy is generally considered only after other treatments have been tried.