Fecal Incontinence

Fecal incontinence (FI) is the accidental passing of gas or the unexpected leakage of stool or mucus from the rectum; i.e., the inability to hold a bowel movement.

Nearly 18 million U.S. adults – or about one in 12 Americans – are living with FI. It can occur at any age, but it’s more common in older adults and also slightly more common in women than in men. Patients with continence issues often have other conditions such as pelvic organ prolapse which also can affect a person’s ability to maintain continence.

If in the last month, you have had accidents with bowel movements or are having any problems with bowel control, you may have a pelvic floor disorder. Summa's team of specialists can help with pelvic floor disorders. Take our 5-minute quiz to find out if you might have a pelvic floor condition. It’s easy and confidential!

Risk factors

• Age: Although fecal incontinence can occur at any age, it’s more common in middle-aged and older adults. Approximately 1 in 10 women older than age 40 has fecal incontinence.
• Gender: Fecal incontinence is slightly more common in women than in men. One reason is that fecal incontinence can be a complication of childbirth. Most women develop fecal incontinence after age 40.
• Nerve damage: People who have long-standing diabetes or multiple sclerosis or other conditions that can damage nerves that control 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, or obtaining an injury that caused a physical disability, may cause rectal nerve damage leading to fecal incontinence.
• Diabetes: Sacral nerve damage may occur as a result of the condition, which can then lead to fecal incontinence.
• Pelvic floor disorders: One in three women older than 65 years suffer from pelvic floor disorders such as dropped pelvic organs and/or incontinence. However, less than 50% of women with pelvic floor disorders pursue medical treatment. Surgery, childbirth, scarring, chronic squeezing of the pelvic muscles, sexual abuse or pelvic fractures can result in a pelvic floor disorder. These types of trauma can cause excessive muscle tightness or weakness that may lead to fecal incontinence.

Causes

To hold stool and maintain continence, the rectum, anus, pelvic muscles and nervous system must function normally. Also, you must have the physical and mental ability to recognize and respond to the urge to have a bowel movement. Some causes include:

• Chronic constipation
• Chronic use of laxatives
• Bowel surgery
• Decreased awareness of the sensation of rectal fullness
• Gynecological, prostate or rectal surgery
• Injury to the anal muscles due to 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
• Rectal prolapse
• Inactivity caused by chronic illness

Treatment

Fecal incontinence may be embarrassing, but it can be treated. The first step is making an appointment with a Summa Health System FI specialist who can correctly identify the cause of the incontinence.

For your first appointment with the FI specialist, you should bring the following items to assist with your diagnosis:

• A list of all of the medications you are taking, including vitamins and herbal supplements
• Your past medical history, including surgeries, illnesses and chronic conditions
• A stool diary for the preceding two-week period. Download a stool diary and stool chart for printing and use at home.
• A list of any questions you have for the doctor

During your first visit, your doctor may perform a physical exam, including a finger exam of the rectum and anus to evaluate your sphincter tone, anal reflexes and to check for any abnormalities of the area.

Your doctor may order diagnostic tests, including:

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

Your Summa specialist will then determine the right treatment path for your condition. 

A number of non-surgical treatment options your doctor may ask you to try before suggesting surgery, 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
• Pelvic floor rehabilitation

If non-surgical treatments are found ineffective, surgical options may be considered to correct an underlying problem, such as rectal prolapse or damage to the sphincter during childbirth. Some of the surgical options include:

• Colostomy
• Sphincteroplasty
• Treating rectal prolapse, rectocele or hemorrhoids
• Sphincter repair
• Minimally invasive surgery technologies
• Sacral Nerve Stimulation. A new option available at Summa Health System involves the use of a surgically implanted neurostimulator. This is used to treat both fecal and urinary incontinence in patients who have failed or could not tolerate more conservative treatments. Like a pacemaker for the heart, a sacral nerve stimulator acts as a pacemaker for the bladder and bowel.

The decision about which surgical technique is right for you is an important one. 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.

Fecal incontinence may be embarrassing, but it is treatable. Proper treatment can help most people, and can often eliminate the problem. Take the first step. Make an appointment with a Summa FI specialist online or by calling 330.761.1111.