Fecal Incontinence

Fecal incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to wait until you can get to a restroom. Stool may leak from the rectum unexpectedly.

CAUSES

  • Constipation.

  • Damage to the nerves of the anal sphincter muscles or the rectum.

  • Diarrhea.

  • Damage to the anal sphincter muscles.

  • Loss of storage capacity in the rectum.

  • Pelvic floor dysfunction.

DIAGNOSIS

Your caregiver will ask questions, do a physical exam, and possibly order other tests. These tests may include:

  • Anal manometry. This checks the anal sphincter tightness and its ability to respond to signals, as well as the sensitivity and function of the rectum.

  • Anorectal ultrasonography. This test evaluates the structure of the anal sphincters.

  • Proctography (also called defecography). This test shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can get rid of the stool.

  • Proctosigmoidoscopy. This test allows caregivers to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors, or scar tissue.

  • Anal electromyography. This tests for nerve damage.

TREATMENT

Treatment depends on the cause and severity of fecal incontinence. It may include dietary changes, medicine, bowel training, or surgery. More than one treatment may be necessary for successful control. Treatment may include:

  • Adjusting what and how you eat.

  • Medicine to help you develop a more regular bowel pattern. Medicine may also be prescribed for diarrhea.

  • Bowel training to help you learn how to control your bowels (biofeedback). In some cases, it involves strengthening muscles. In others, it means training the bowels to empty at a specific time of day.

  • Surgery to repair damaged areas or to replace the anal muscle.

  • A colostomy if other treatments fail. This involves removing a portion of the bowel. The remaining part is then attached to either the anus, or to a hole in the abdomen (stoma) through which stool leaves the body and is collected in a pouch.

HOME CARE INSTRUCTIONS

  • Eat high fiber foods only if directed by your caregiver. Fiber adds bulk and makes stool easier to control. Oppositely, high fiber foods can act as a laxative and can make the problem worse.

  • Keep a food diary. List what you eat, how much you eat, and when you have an incontinent episode. After a few days, you may begin to see a pattern involving certain foods and incontinence. After you identify foods that seem to cause problems, cut back on them and see whether incontinence improves.

  • Avoid the following foods and drinks that often cause diarrhea:

  • Caffeine.

  • Spicy foods.

  • Fatty and greasy foods.

  • Dairy products (milk, cheese, and ice cream).

  • Cured or smoked meat like sausage, ham, or turkey.

  • Alcohol.

  • Fruits like apples, peaches, or pears.

  • Ask your doctor if you need a vitamin supplement.

  • Drink enough water and fluids to keep your urine clear or pale yellow.

  • Wear cotton underwear and loose clothes that "breathe." Tight clothes that block air can worsen anal problems. Change soiled underwear as soon as possible.

  • Wash the anal area with water, not soap, after each bowel movement to help with anal discomfort. Use pre-moistened, alcohol-free wipes. Try using non-medicated talcum powder or corn starch to relieve anal discomfort.

  • Your caregiver may recommend an appropriate cream or ointment that can help prevent skin irritation from direct contact with stool.

  • Talk to your caregiver if you are having emotional distress.

TIPS

  • Take a bag containing cleanup supplies and a change of clothing with you everywhere.

  • Locate public restrooms before you need them so you know where to go.

  • Use the toilet before heading out.

  • Wear disposable undergarments or sanitary pads if you think an episode is likely.

  • Use oral fecal deodorants to add to your comfort level if episodes are frequent.

FOR MORE INFORMATION

American Academy of Family Physicians: www.aafp.org

International Foundation for Functional Gastrointestinal Disorders: www.iffgd.org