Fecal Incontinence

Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control in someone who is older than 4 years old.

Common causes of fecal incontinence include constipation, diarrhea, and muscle or nerve damage. Fecal incontinence may be due to a weakened anal sphincter associated with aging or to damage to the nerves and muscles of the rectum and anus from giving birth.

Whatever the cause, fecal incontinence can be embarrassing. But don't shy away from talking to your doctor. Treatments are available that can improve, if not correct, fecal incontinence.

Treatments and drugs

A variety of treatments are available for fecal incontinence, depending on the severity of your symptoms. Treatment may include dietary changes, medications, special exercises that help you better control your bowels, or surgery.

Medications
Sometimes, doctors recommend medications to treat fecal incontinence, such as:

Anti-diarrheal drugs. Your doctor may recommend medications to reduce diarrhea and help you avoid fecal incontinence. A drug called loperamide (Imodium) may be used because it helps treat diarrhea.
Laxatives. If chronic constipation is to blame for your incontinence, your doctor may recommend the temporary use of mild laxatives, such as milk of magnesia, to help restore normal bowel movements.
Stool softeners. To prevent stool impaction, your doctor may recommend a stool-softening medication.
Other medications. If diarrhea is the cause of your fecal incontinence, your doctor may recommend drugs that decrease the spontaneous motion of your bowel (bowel motility) or medications that decrease the water content of your stool.
Therapies
A variety of therapies may improve fecal incontinence:

Dietary changes. What you eat and drink affects stool consistency. Your doctor may recommend changes to your diet to help improve your bowel movements.

For example, if chronic constipation is to blame for fecal incontinence, your doctor may recommend that you drink plenty of fluids and eat fiber-rich foods. A fiber supplement may also be recommended. If diarrhea is contributing to the problem, your doctor may recommend that you increase your intake of high-fiber foods to add bulk to your stools, making them less watery. In general, your doctor will recommend a diet that helps you gain good stool consistency for increased control of your bowels.

Bowel training. If fecal incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel-training program and exercise therapies aimed at helping you restore muscle strength.

In some cases, bowel training means learning to go to the toilet at a specific time of day. For example, your doctor may recommend that you make a conscious effort to have a bowel movement after eating. This helps you gain greater control by establishing with some predictability when you need to use the toilet.

Biofeedback is another bowel-training treatment for fecal incontinence. It involves inserting a pressure-sensitive probe into your anus. This probe registers muscle strength and activity of your anal sphincter as it contracts around the probe. You can practice sphincter contractions and learn to strengthen your muscles by viewing the scale's display. These exercises can strengthen your rectal muscles.

Treatment for stool impaction. Your doctor may have to remove an impacted stool if taking laxatives or using enemas doesn't help you pass the hardened mass. To remove an impacted stool, your doctor inserts one or two gloved fingers into your rectum to break apart the impacted stool. These smaller pieces are easier to expel.
Sacral nerve stimulation. Another treatment for fecal incontinence is sacral nerve stimulation. The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Sacral nerve stimulation is carried out in stages. First, small needles are positioned in the muscles of your lower bowel, and these muscles are stimulated by an external pulse generator to identify which muscle stimulates anal contractions the most. The muscle response to the stimulation generally isn't uncomfortable. After a successful response, you may have a permanent pulse generator implanted. This treatment is usually done only if other treatments haven't worked.
Surgery
For some people, treatment of fecal incontinence requires surgery to correct an underlying problem. Surgical procedures to treat fecal incontinence aren't necessarily easy or free of complications. But, certain causes of fecal incontinence — anal sphincter damage caused by childbirth or rectal prolapse, for example — can often be effectively treated with surgery. Surgical options include:

Sphincteroplasty. This is surgery to repair a damaged or weakened anal sphincter. In this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscle, tightening the sphincter.
Treating rectal prolapse, a rectocele or hemorrhoids. If you have other problems, such as a condition in which a portion of your rectum protrudes through your anus (rectal prolapse), a protrusion of the rectum into the vaginal wall (rectocele) or hemorrhoids that are causing fecal incontinence, surgical correction of these problems will likely reduce or eliminate your fecal incontinence.
Sphincter replacement. An artificial anal sphincter can be used to replace a damaged anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you're ready to defecate. To go to the toilet, you use a small external pump to deflate the device and allow stool to be released. It then reinflates itself.
Sphincter repair. During a surgical procedure called a gracilis muscle transplant, a muscle is taken from your inner thigh and wrapped around your sphincter. This restores muscle tone to your sphincter.
Injection of biomaterials. Injection of a silicone-based material into the anal sphincter may improve incontinence by increasing the size of the anal sphincter. Other types of biomaterials are under study.
Colostomy. As a last resort, a colostomy may be the most definitive way to correct fecal incontinence. Colostomy is generally considered only after other treatments have failed. A colostomy is an operation that diverts stool through an opening in the abdomen. A special bag is attached to this opening to collect the stool.