Fecal incontinence is the loss of normal control of the bowels. This leads to stool leaking from the rectum (the last part of the large intestine) at unexpected times. This problem affects as many as 1 million Americans.
Bowel function is controlled by three things: anal sphincter pressure, rectal storage capacity and rectal sensation. The anal sphincter is a muscle that contracts to prevent stool from leaving the rectum. This muscle is critical in maintaining continence. The rectum can stretch and hold stool for some time after a person becomes aware that the stool is there. This is the rectal storage capacity. Rectal sensation tells a person that stool is in the rectum. Then the person knows that it is time to go to the bathroom.
A person also must be alert enough to notice the rectal sensation and do something about it. She must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur.
Fecal incontinence, when due to a temporary problem such as severe diarrhea or fecal impaction, disappears when that problem is treated. However, in some cases, especially in people who are weak or immobile, fecal incontinence can be so severe that it cannot be controlled.
Who is at Risk for Fecal Incontinence?
- Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It’s especially likely to happen in a difficult delivery that uses forceps and/or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina for delivery of a baby.
- Muscle damage can also occur during rectal surgery (especially surgery for hemorrhoids). It may also occur in people with an abscess in the perirectal area.
- Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement.
- Scars from a surgery or a radiation injury can stiffen the rectum and lead to fecal incontinence.
- Inflammatory bowel disease can also make the rectum less elastic.
- Damage to the nerves that control the anal muscle or that are responsible for rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur in the following situations: childbirth, severe and prolonged straining for stool, and with diseases such as diabetes, spinal cord tumors and multiple sclerosis.
Symptoms of Fecal Incontinence
Symptoms of fecal incontinence can range from mild soiling when passing gas to the complete inability to contain solid stool.
It is important that you have a careful medical evaluation. Attempts at self-treatment are usually unsuccessful. Anorectal manometry, which tests anal pressures, rectal elasticity and rectal sensation, as well as other tests, can pinpoint the cause of your incontinence.
Treatments for Fecal Incontinence
The treatment of fecal incontinence varies and depends on the cause of your problem. Preventing diarrhea and forming a regular bowel movement pattern are usually very helpful.
Medications – If fecal incontinence is the result of diarrhea, over-the-counter fiber laxatives that contain psyllium may help you to have firmer stools, which increase the sensation of rectal fullness. Anti-diarrheal medications such as loperamide (Imodium) are another option for treating diarrhea. If the condition is the result of impaction, the hardened stool can be removed by hand or with enemas.
Behavioral Therapy – For (anal) sphincter weakness or injury, anorectal biofeedback strengthens the muscle. This improves continence in most persons. Biofeedback training can even end the problem of fecal incontinence.
Surgical Procedures – When conservative treatments fail, the final option is surgery. Some people benefit from operations to repair the anal sphincter muscle, tighten the anal canal, or improve the angle of the anal muscles.