What is fecal incontinence?

Fecal incontinence is the accidental passing of gas, stool or mucus from the rectum, including the inability to hold a bowel movement until reaching a toilet, as well as passing stool into one’s underwear without being aware of it happening. Stool (feces) is solid waste expelled from the body as a bowel movement and includes undigested food, bacteria, mucus and dead cells. Mucus is a clear liquid that coats and protects the tissues lining the digestive tract.

How common is fecal incontinence?

If you have this condition, you are not alone. Nearly 18 million U.S. adults – or about one in 12 American adults – live with fecal incontinence. [1]

What are the risk factors for developing fecal incontinence?

• Age: Although fecal incontinence can occur at any age, it’s more common in middle-aged and older adults. About one in 10 women older than age 40 has fecal incontinence.
• Being female: Fecal incontinence is slightly more common in women compared with men. One reason is that fecal incontinence can be a complication of childbirth. Still, most women develop fecal incontinence after age 40, so other factors may be involved.
• Nerve damage: People who have longstanding diabetes, multiple sclerosis or other conditions that can damage nerves controlling defecation (having a bowel movement) may be at risk of fecal incontinence.
• Dementia: Fecal incontinence is often present in late-stage Alzheimer’s disease and dementia.
• Physical disability: Being physically disabled may make it a challenge to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage leading to fecal incontinence.

What causes fecal incontinence?

To hold stool and maintain continence, the rectum, anus, pelvic muscles and nervous system must function normally. You also must have the physical and mental ability to recognize and respond to the urge to have a bowel movement.

Some of the causes of fecal incontinence include:

• Chronic constipation
• Chronic use of laxatives
• Bowel surgery
• Decreased awareness of sensation of rectal fullness
• Gynecological, prostate or rectal surgery
• Injury to the anal muscles because of childbirth (in women)
• Nerve or muscle damage from trauma, tumor or radiation treatment
• Severe diarrhea that overwhelms the ability to control the passage of stool
• Severe hemorrhoids or rectal prolapse
• Inactivity caused by chronic illness

Do I have to learn to live with fecal incontinence? Or are there effective treatments available?

Fecal incontinence may be embarrassing, but it is not a hopeless situation. Proper treatment can help most people, and can often eliminate the problem. But the first step in treatment is identifying the cause of the incontinence.

Is there anything I need to bring with me to my first appointment with the doctor?

Bring the following items with you to your first appointment:

• A list of your medications, including vitamins and herbal supplements
• Your past medical history, including surgeries, illnesses and chronic conditions
• A stool diary for the preceding two-week period
• A list of any questions you have for the doctor

Download a FREE copy of a stool diary and stool chart you can print for use at home.

What will happen during my first visit to the doctor?

During your first visit, you will be asked about your past medical history, any medications you are taking and whether you have any allergies. Your doctor also will perform a physical exam, which will include a finger exam of the rectum and anus to evaluate sphincter tone, anal reflexes and to check for any abnormalities of the rectal area. Your doctor may order diagnostic tests, which can help pinpoint the cause of fecal incontinence. Some of these tests may include:

• Anal manometry
• Anorectal ultrasonography
• Balloon expulsion test
• Barium enema
• Blood tests
• Colonoscopy
• Magnetic resonance imaging (MRI)
• Proctosigmoidoscopy
• Stool culture

Are there nonsurgical treatment options for fecal incontinence?

There are a number of nonsurgical treatment options your doctor may ask you try before suggesting surgery. Nonsurgical options may include:

• Dietary changes
• Anti-diarrheal medications
• Laxatives, if chronic constipation is causing fecal incontinence
• Medications to decrease the involuntary motion of your bowel
• Bowel training
• Pelvic floor exercises and biofeedback

If the nonsurgical treatments are ineffective, what types of surgical treatment options are there?

Treating fecal incontinence may require a surgical procedure to correct an underlying problem, such as a rectal prolapse or damage to the sphincter during childbirth. Some of the surgical options include:

• Colostomy
• Sacral nerve stimulation 
• Sphincteroplasty
• Treating rectal prolapse, rectocele or hemorrhoids
• Sphincter repair

Is minimally invasive surgery an option?

No matter what type of surgery you are considering, talk to your doctor about your options. Minimally invasive surgery techniques offer potential benefits compared with traditional abdominal “open” surgery, including:

• Reduced blood loss
• Less postoperative pain
• Less risk of infection
• Shorter hospital stay
• Faster recovery

The decision about which surgical technique is right for you is important. Your surgeon will take into account many factors before choosing which technique to use, including your past medical history, previous surgeries, overall health status and anatomy.

No matter which surgical technique your doctor chooses, it is important to remember that all surgical procedures involve some risk of complications. Before having any type of surgery, discuss all treatment options carefully with your physician. Understanding the risks of each treatment can help you and your doctor decide which option is best for you.

You don’t have to learn to live with fecal incontinence

There is something you can do about it. Fecal incontinence may be embarrassing, but it is treatable. Proper treatment can help most people and can often eliminate the problem.

But you have to take the first step, which is talking to a doctor who can effectively treat this condition.

Summa Health System surgeons Amy George, M.D., and Erica L. Laipply, M.D., take a multidisciplinary, team-based approach to caring for patients with fecal incontinence. Often, patients with fecal incontinence have problems with urinary incontinence, pelvic pain or pelvic organ prolapse, which may also affect a person’s ability to control their bowel.

Don’t suffer in silence any longer – make an appointment today to get the help you need. To make an appointment with Drs. George or Laipply, call (800) 237-8662.

[1] Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in U.S. adults: epidemiology and risk factors, Gastroenterology. 2009; 137(2):512-517.