Fecal incontinence is upsetting and embarrassing, but it’s not uncommon. If it happens to you frequently, it’s important to talk to your health care provider to find out what causes fecal incontinence and how to treat it.
What Is Fecal Incontinence?
Fecal or bowel incontinence is when you can’t control your bowel movements. You accidentally pass or leak feces (stool) before you can get to the toilet. You might leak solid feces, liquid, or mucus.
- Urge incontinence is the most common type of fecal incontinence. You feel the urge to have a bowel movement but can’t get to the bathroom in time.
- Passive incontinence is less common. It’s when bowel leakage happens without you knowing it. You might not feel like you have to go.
Frequent incontinence causes irritation and discomfort around your anus (the opening from your rectum). Perhaps more importantly, it can cause emotional and social distress, affecting your quality of life.
What Are Common Causes of Bowel Incontinence?
Although it’s not a normal part of aging, fecal incontinence is more common in older adults. You might have a higher risk if you:
- Are over 65.
- Are sedentary.
- Have certain chronic diseases like diabetes or irritable bowel syndrome (IBS).
- Smoke cigarettes.
Health conditions that affect your digestive tract or pelvic floor can lead to bowel leakage. These are some of the most common causes.
Chronic diarrhea
Loose, watery stools can fill your rectum quickly. It’s harder to hold diarrhea than solid stools, so it’s more likely to leak. Diarrhea is one of the top causes of fecal incontinence.
These health conditions can cause diarrhea and incontinence:
- IBS.
- Inflammatory bowel diseases like Crohn’s or colitis.
- Proctitis, an inflammation in the lining of your rectum.
Constipation
It might sound counterintuitive, but constipation is another leading cause of fecal incontinence.
When you’re constipated, large, hard stool can build up in your rectum.
You can develop constipation from:
- A diet that’s too low in fiber.
- IBS or other functional digestive disorders.
- Physical inactivity.
- Taking certain medications or supplements like opioid pain medicines or iron supplements.
- Thyroid disease.
Injury or weakness in your pelvic floor muscles
Your pelvic floor muscles form a sling that reaches from your pubic bone in front to your tailbone in back. They support the organs in your pelvis, including your large intestine, rectum, and anus, and help control your bowel movements.
These conditions can weaken or injure your pelvic floor muscles and affect your ability to hold your stool:
- Pregnancy and vaginal childbirth.
- Surgery on your rectum or anus.
- Trauma to your pelvic floor region.
Nerve damage or neurologic diseases
Nerves help control your entire digestive tract, including your rectum and anus. They also control your pelvic floor muscles and allow you to feel the urge to have a bowel movement. Damage or injury to the nerves that control these organs can cause fecal incontinence.
Nerve damage can happen from:
- Alzheimer’s disease or other forms of dementia.
- A brain or spinal cord injury.
- Diabetes.
- Multiple sclerosis.
- Parkinson’s disease.
- A stroke.
How You Can Deal with Fecal Incontinence
Treatments for fecal incontinence focus on fixing the root cause, so the first step is to visit your health care provider. It’s normal to feel uncomfortable talking about bowel leakage. But the more information they have, the easier it is for your doctor to identify the cause and find a solution.
To determine the cause and treatment, your health care provider may:
- Review your history to find out when it started. They’ll want to see if it’s related to trauma, like a car accident or an illness.
- Ask about the frequency and symptoms before leakage happens. Do you feel the urge to have a bowel movement, or does it happen without you knowing?
- Review your diet to see if certain foods trigger bowel leakage.
- Do a physical exam, including a rectal exam or a pelvic exam.
- Order tests to see how well the muscles and nerves in your pelvic floor, rectum, and anus work. They may also recommend a colonoscopy or flexible sigmoidoscopy to examine your large intestine.
Once they determine the cause, your health care provider can recommend the proper treatment. You can work on some treatments yourself, including:
- Changing your diet to eliminate any trigger foods or add more fiber to reduce constipation or diarrhea.
- Doing pelvic floor exercises called Kegels to strengthen your pelvic floor muscles.
- Training yourself to have a bowel movement at certain times of the day, like after a meal.
- Using over-the-counter medications as needed to help manage diarrhea or constipation.
For other treatments, you may need to work with a specialist provider who can offer:
- Biofeedback therapy. This therapy uses sensor devices to help you locate and strengthen your pelvic floor muscles with Kegel exercises. Biofeedback can also help you learn to control urgent and passive fecal incontinence.
- Prescription medications to treat an underlying health condition like IBS or Crohn’s disease.
- Sacral nerve stimulation. With this therapy, a health care provider uses electrical pulses to stimulate the nerves that control your rectum, anus, or pelvic floor. It can help your nerves work better and control leakage.
- Surgery can repair conditions contributing to fecal incontinence, like hemorrhoids or a torn rectal sphincter muscle from childbirth or other injury.
You may need a combination of these treatments. But over time, they can significantly improve or stop bowel leakage. Talk to your doctor because there is no need to suffer or feel embarrassed about fecal incontinence.