Fecal incontinence

Overview

Fecal incontinence is not being able to control bowel movements. Stool leaks from the rectum without warning. Fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control. Fecal incontinence is sometimes called bowel incontinence.

Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with aging or with giving birth.

Whatever the cause, fecal incontinence can be difficult to discuss. But don't shy away from talking to your doctor about this common problem. Treatments can improve fecal incontinence and your quality of life.

Symptoms

Fecal incontinence may occur during an occasional bout of diarrhea. But for some people, fecal incontinence happens a lot. People with this condition may not be able to stop the urge to defecate. It may come on so suddenly that you can't make it to the toilet in time. This is called urge incontinence.

Another type of fecal incontinence occurs in people who are not aware of the need to pass stool. This is called passive incontinence.

Fecal incontinence may happen with other bowel problems, such as:

• Diarrhea.
• Constipation.
• Gas and bloating.

When to see a doctor

See your health care provider if you or your child develops fecal incontinence. This is especially important if it happens a lot, is severe or causes emotional distress. Often, people are too embarrassed to tell a provider about fecal incontinence. But the sooner you're evaluated, the sooner you may find some relief from your symptoms.

Causes

For many people, there is more than one cause of fecal incontinence.

Causes can include:

• Muscle damage. Injury to the rings of muscle at the end of the rectum may make it difficult to hold in stool. These rings are known as the anal sphincter. This kind of damage can occur during childbirth. This is most commonly due to having an episiotomy or using forceps during delivery.
• Nerve damage. Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to fecal incontinence. Many things can damage these nerves, including:
  • Childbirth.
  • Repeated straining during bowel movements.
  • Long-lasting constipation.
  • Spinal cord injury.
  • Stroke.
  • Diabetes.
  • Multiple sclerosis.
• Constipation. Chronic constipation may cause a dry, hard mass of stool to form in the rectum and become too large to pass. This is known as stool impaction. The muscles of the rectum and intestines stretch and eventually weaken. This allows watery stool from farther up the digestive tract to move around the impacted stool and leak out. Long-lasting constipation also may cause nerve damage that leads to fecal incontinence.
• Diarrhea. Solid stool is easier to hold in the rectum than is loose stool, so the loose stools of diarrhea can cause or worsen fecal incontinence.
• Hemorrhoids. Hemorrhoids are swollen veins in the rectum. These swollen veins can keep the anus from closing completely, letting stool leak out.
• Loss of storage capacity in the rectum. Usually, the rectum stretches to accommodate stool. If the rectum is scarred or stiff it can't stretch as much as it needs to, and excess stool can leak out. Things such as surgery, radiation treatment or inflammatory bowel disease can stiffen and scar the rectum.
• Surgery. Surgery involving the rectum and anus, such as hemorrhoid removal, can cause muscle and nerve damage that leads to fecal incontinence.
• Rectal prolapse. Fecal incontinence can be a result of this condition, in which the rectum drops down into the anus. The stretching of the rectal sphincter by prolapse damages the nerves that control the rectal sphincter. The longer this lasts, the less likely the nerves and muscles will recover.
• Rectocele. In women, fecal incontinence can occur if the rectum protrudes through the vagina. This condition is known as rectocele.

Risk factors

A number of factors may increase your risk of developing fecal incontinence, including:

• Age. Although fecal incontinence can occur at any age, it's more common in adults over 65.
• Being female. Fecal incontinence can be a complication of childbirth. Recent research also has found that women who take menopausal hormone replacement therapy have a modest increased risk of fecal incontinence.
• Nerve damage. People who have long-standing diabetes, multiple sclerosis, or back trauma from injury or surgery may be at risk of fecal incontinence. These conditions can damage nerves that help control defecation.
• Dementia. Fecal incontinence is often present in late-stage Alzheimer's disease and dementia.
• Physical disability. Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage, leading to fecal incontinence.

Complications

Complications of fecal incontinence may include:

• Emotional distress. Losing control over bodily functions can lead to feeling uneasy about being out in public. It's common for people with fecal incontinence to try to hide the problem or to avoid social engagements.
• Skin irritation. The skin around the anus is delicate and sensitive. Repeated contact with stool can lead to pain and itching. It also may lead to sores, also called ulcers. Ulcers often require medical treatment.

Prevention

Depending on the cause, it may be possible to improve or prevent fecal incontinence. These actions may help:

• Reduce constipation. Increase your exercise, eat more high-fiber foods and drink plenty of fluids.
• Control diarrhea. Treating or eliminating the cause of the diarrhea, such as an intestinal infection, may help you avoid fecal incontinence.
• Do not strain. Straining during bowel movements can eventually weaken anal sphincter muscles or damage nerves.