Fecal Incontinence

Fecal incontinence is the loss of normal bowel control, leading to accidental leakage of stool or gas through the anus. Some women develop fecal incontinence after childbirth, while others may develop it later in life. 

Fecal incontinence affects an estimated one in 10 women. Many women are too embarrassed to discuss it with their doctor. Untreated, the condition can lead to social isolation. 

Fecal incontinence is also referred to as anal incontinence or accidental bowel leakage.

Fecal incontinence occurs when the muscles or nerves required for normal bowel control are not functioning properly. 

These muscles include the anal sphincter, the circular muscle that surrounds the anal canal, and the pelvic floor muscles, a group of muscles that form a sling around the anal canal. The anal sphincter and pelvic floor muscles help women control their stools and gas from their stomach or intestines. 

Common causes of fecal incontinence include:

• Injury to the anal sphincter muscles or nerves following childbirth (especially if forceps are used)
• Infection of the anal sphincter
• Age, as the muscles that control bowel movements weaken
• Stools that are too loose (diarrhea) or too hard (constipation)
• Gastrointestinal conditions, such as inflammatory bowel disease, irritable bowel syndrome, ulcerative colitis, Crohn’s disease or cancer of the rectum
• Past surgery of the colon or anus
• Pelvic radiation therapy
• Rectal prolapse
• Urinary incontinence
• Some conditions that affect the nervous system

Each woman’s symptoms may vary but can include:

• Involuntary passage of gas or stool
• Urgency or the inability to delay bowel movements
• Stool leakage or stains in the underwear without awareness

Symptoms may occur often or infrequently. In some cases, fecal incontinence occurs with urinary incontinence (accidental loss of urine).

Diagnosis starts with a detailed medical history and discussion of your symptoms. During your visit, your urogynecologist may:

• Ask questions about when and how often you have accidental bowel leakage.
• Ask about the consistency of your stools.
• Ask you to keep a bowel diary to track how often you lose control of gas or stool, your food and fiber intake, and how much fluid you drink
• Conduct a physical exam to help identify other conditions that are related to your anal sphincter.

Your urogynecologist may also recommend diagnostic testing, including:

• 3D pelvic ultrasound to evaluate your anal sphincter and pelvic floor muscles
• Anal manometry to evaluate the pressures in your anal canal, or how well the muscles are functioning.
• MRI defecography to view and evaluate the structure and function internal pelvic organs during straining and evacuation.

Your urogynecologist will use the diagnostic information obtained to determine the probable cause of your symptoms. Then they will work with you to develop a treatment plan based on your unique needs and goals.

In most cases, fecal incontinence will improve with conservative treatments such as behavior modification, diet changes, and pelvic floor muscle exercises, however, some women need more advanced therapies.

Strategies for the treatment of fecal incontinence include:

• Dietary changes
  • Adjust fiber intake gradually. A fiber supplement containing psyllium husk fiber is typically needed to help produce firmer, bulkier stools, which are easier to control.
  • Limit caffeine, alcohol, and artificial sweeteners, which can lead to loose stools that are more difficult to control.
• Medications
  • Medications such as loperamide/Imodium® can slow the passage of material through the colon and increase the ability of the anal sphincter to control stool.
• Pelvic Floor Physical Therapy
  • Physical therapy is one of the best ways to treat anal/fecal incontinence.
  • Women can work with specialized physical therapists to learn how to improve their anal sphincter and pelvic floor muscle function.
• Minimally Invasive Surgery
  • Sacral neuromodulation. This minimally invasive procedure can be used to treat both urinary and fecal incontinence. A thin wire is placed through the skin in the lower back, close to the nerve that controls the bladder and/or bowels. The wire is then connected to a device known as a neurostimulator (similar to a pacemaker) that delivers small impulses to the nerves that control the bowels and anal sphincter muscle system.
  • Anal Sphincteroplasty. This minimally invasive surgery procedure may be recommended to repair a tear in your anal sphincter and strengthen the muscles between the vagina and rectum. After surgery, we recommend pelvic floor physical therapy to improve the function of these muscles. 

Call (832) 826-7500 to make an appointment with a Baylor Medicine urogynecologist.