• Digestive Disorders

Fecal Incontinence: Causes, Symptoms, and Treatment

Medically reviewed and edited by Heather Hanono, FNP

Many people with fecal incontinence often suffer in silence and feel too ashamed or embarrassed to seek help. If you’re one of these people, rest assured, you’re not alone. According to the General Surgery Department of the University of California, San Francisco (UCSF), about 18 million American adults suffer from fecal incontinence, with a higher prevalence among women and older people.

Fecal incontinence can have a profound psychological impact and can potentially lead to depression and anxiety in both men and women.

If you’ve been struggling to control your bowel movements and you suspect you have fecal incontinence, keep reading to learn more.

In this article, we’ll explain what fecal incontinence is, what causes it, and how you can treat and manage the condition.

What is Fecal Incontinence (FI)?

Fecal incontinence is a debilitating condition that involves the loss of the ability to control bowel movements, leading to the unintentional passage of liquid or solid stool.

The degree of severity can range from accidentally expelling a minor amount of feces when passing gas, to the involuntary discharge of the entire content of the bowels.

To maintain control over bowel movements and ensure continence, an individual requires a properly functioning anus, rectum, and nervous system.

Beyond these anatomical and physiological needs, a person must also possess the physical ability to respond to the urge to defecate and the cognitive awareness to recognize and act upon these urges.

Fecal incontinence affects a wide range of individuals, from those with spinal cord injuries to individuals experiencing severe mental health issues, illustrating the diverse spectrum of people impacted by this condition.

To understand fecal incontinence, it's essential to know how the body regulates stool passage. We'll explore this topic in detail below.

How Does Bowel Movement Control Work?

The rectum – a component of the colon – stores stool until it's ready for defecation. Typically, this happens for most people at an appropriate level of regularity.

When the rectum fills, it triggers stretch receptors that relax the internal sphincter, one of two muscles regulating stool passage.

Simultaneously, nerve signals prompt the rectum to contract, while the relaxation of the internal anal sphincter facilitates stool movement for defecation.

Unlike the internal sphincter, which operates involuntarily, the external anal sphincter is under voluntary control, allowing us to delay defecation by contracting this muscle.

Over time, if defecation is postponed, the urge may temporarily diminish until the rectal wall is stimulated again.

What are the Causes of Fecal Incontinence?

Fecal incontinence stems from various causes, including physical issues in the gastrointestinal tract, problems with nerve control during defecation, and failure to recognize appropriate times for stool passage.

As previously discussed, a range of control mechanisms is crucial for preventing involuntary stool passage, highlighting the broad spectrum of potential causes behind fecal incontinence.

Here are just some of the causes:

Damaged anal sphincters

Events such as natural childbirth can damage the anal sphincters, with one study revealing that 5.7% of women are affected by obstetric anal sphincter injury (OASIS).

Sometimes vaginal delivery can cause tears in the pelvic region that damage the muscle needed to control defecation. Forceps delivery — assisted birth that involves using forceps to help deliver a newborn — further increases the risk of injury.

Other causes of potential sphincter damage include previous anal or rectal surgery or an injury to the anus.

Diarrhea or chronic constipation

Both these bowel habit extremes can contribute to fecal incontinence.

Soft or watery stool that occurs during diarrhea can be difficult to control and may easily leak out, leading to fecal incontinence.

Chronic constipation, on the other hand, causes rectal muscles to weaken over time, making it hard to retain watery stool that may accumulate behind harder stool blocks.

This condition – known as overflow diarrhea – highlights how both diarrhea and constipation can impact the ability to control bowel movements effectively.

Nervous system disorders

Conditions like stroke, multiple sclerosis (MS), and Parkinson’s disease can impair the nervous system's ability to control bowel movements.

Brain or spinal cord injury

Injury to the spinal cord, particularly above the sacral nerves, can result in loss of bowel control.

Research shows that as much as 61% of individuals with spinal cord injury (SCI) are affected by fecal incontinence.

Rectal prolapse

This occurs when part of the rectum protrudes through the anus, causing bowel content to leak out.

Statistics from the American Society of Colon & Rectal Surgeons (ASCRS) reveal that rectal prolapse affects around 0.5% of the population and the condition is most prevalent in women over the age of 50.

Loss of rectal stretch

Inflammation caused by radiation or inflammatory bowel disease (IBD) can reduce the rectum’s capacity to hold stool and increase the risk of leakage.

Encopresis

This is a mental health condition where children who were previously toilet-trained are passing stool in inappropriate circumstances. This may occur due to withholding defecation until overflow diarrhea occurs.

Children with a memory of painful defecation may be affected by encopresis.

What are the Risk Factors for Fecal Incontinence?

The likelihood of fecal incontinence increases for those who:

• Are over 65

• Have poor general health

• Are female

• Have a history of vaginal delivery

• Have had anal or rectal surgery

• Have undergone pelvic radiation to treat cancer

What are the Symptoms of Fecal Incontinence?

As previously highlighted, fecal incontinence has a broad range of severity, from slight soiling to full bowel evacuation.

Below are some of the symptoms of fecal incontinence:

• Inability to reach the toilet before soiling yourself

• Unnoticed passing of stool

• Leaking stool while farting

• Constipation with episodes of diarrhea (overflow diarrhea)

• ‘Skid marks’ on underwear

How is Fecal Incontinence Diagnosed?

Fecal incontinence is diagnosed through an initial assessment by a healthcare provider, which includes a medical history review, general health evaluation, and an assessment of specific complaints related to incontinence.

Following this, a physical examination is conducted, which may be supplemented by specialized diagnostic procedures or examinations, if needed. Key diagnostic tests include:

• Digital rectal exam: During this exam, the strength of the anal sphincter and pelvic floor muscles are tested.

• Stool samples: These are taken to identify the cause of watery stool.

• Colonoscopy: This can be done to identify tumors, scarring, or inflammation in the colon.

• Magnetic resonance imaging (MRI): This assesses the structure of the anorectal area, pelvic muscles, and sphincters, and investigates neurological causes of incontinence.

• Endoscopic ultrasound: A probe is inserted into the anus to determine the thickness of the sphincter muscle.

• Anorectal manometry (ARM): This test evaluates anal sphincter muscle strength, rectal stretchability, and capacity.

• Electromyography (EMG): This detects electrical activity produced by nerves to determine whether nerve damage is the cause of your incontinence.

How Do You Manage or Treat Fecal Incontinence?

Fecal incontinence can adversely affect various aspects of your life, including your physical, psychological, and emotional well-being. A holistic approach to management is therefore required. This may include:

Dietary changes

Keep a food diary to track how different foods affect your bowel habits, allowing you to identify and adjust your diet without making drastic changes.

Common foods that might worsen incontinence include caffeine, artificial sweeteners, greasy foods, dairy, and sugar-free gum.

While dietary fiber supplements can bulk up stool, they may also cause gas and bloating. Consider consulting your healthcare provider before trying fiber supplementation.

Medication

• Be sure to review all underlying chronic conditions. Your doctor may have to adjust your current treatment as some medications worsen fecal incontinence.

• Antidiarrheal agents may help if loose stool is a contributor to incontinence. These should be avoided if overflow diarrhea is suspected. Examples include loperamide (Imodium®) and bismuth subsalicylate (Pepto-Bismol®).

• For those with overflow diarrhea, laxatives, such as polyethylene glycol (MiraLax®), may be helpful.

• Amitriptyline (Elavil®) is an antidepressant that can be used to help decrease rectal contractions and improve the symptoms of incontinence.

Surgery

Surgery is only used if other methods of treatment have failed or are inappropriate.

The specific surgery is tailored to the condition causing your incontinence. Some examples include:

• Sphincteroplasty: This is sphincter repair surgery, an option for those who experience sphincter damage following childbirth or anal surgery.

• Sacral nerve stimulation: This treatment is typically a last resort. It involves implanting a nerve stimulator under the skin in the buttocks to help stimulate normal bowel action.

• Artificial anal sphincters: These cutting-edge solutions are either crafted from the patient's own tissue or may involve the use of silicone-based mechanisms.

Where Can You Learn More About Improving Your Digestive Health?

If you have any concerns about fecal incontinence, LifeMD may be able to answer your questions.

A team of healthcare professionals can help diagnose and treat your condition to prevent long-term complications and give you the peace of mind to live your life with confidence.

Book your appointment today to get started.

Heather Hanono, FNP

Heather is a dedicated Advanced Practice Registered Nurse with experience in urgent care, primary care, emergency medicine, and men's health. A South Florida native, she is bilingual in English and Spanish. Heather completed her Master's in Family Nurse Practitioner at Nova Southeastern University. She is passionate about building trustful relationships with her patients while promoting health and wellness. In her free time, Heather enjoys spending time with her daughter and family, going on vacation, and shopping.

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