Fecal incontinence, also known as bowel incontinence, is an involuntary unexpected leakage of liquid stool. Some of the more common causes of this condition include diarrhea, constipation, a tear or separation of the anal sphincter, and muscle or nerve damage. It can affect people of all ages, but it is most common in women (as a result of childbirth) and adults over the age of 65. It is estimated that approximately 9% of women living in the community and 45% of those living in nursing homes experience accidental bowel leakage.

Fecal Incontinence: Types & Symptoms

People who suffer from chronic fecal incontinence are unable to control the passage of gas, liquid, or solid stool. Often they are not able to make it to the toilet in time. There are multiple causes for fecal incontinence. Fecal incontinence is strongly associated with other bowel problems such as diarrhea, constipation, bloating, or abdominal cramps. In addition to bowel disorders, weakness of the anal sphincter complex can result in leakage. This weakness could be caused by injury to the muscles during childbirth or neurologic conditions such as diabetes, Parkinson’s disease, stroke. Because the causes are varied and they are not often reversible, treatments for fecal incontinence are limited.

Fecal Incontinence: Evaluation

A thorough evaluation of fecal incontinence may include:

• Medical history and interview
• Physical examination
• Anorectal manometry
• Anorectal ultrasonography
• Proctography
• Proctosigmoidoscopy
• Anal electromyography

Medical History and Interview

A thorough medical history and interview related to the fecal incontinence is important to discover the cause of the condition and to determine whether it is reversible or chronic. The interview will include questions regarding the frequency and occurrence of the incontinence.

Physical Examination

A physical examination will be conducted that may include:

• A visual inspection of the anus for hemorrhoids, infections, and other possible related
  conditions.
• A digital examination to evaluate the sphincter muscles’ strength and any abnormalities in the rectal area.
• Diagnostic studies of the anal sphincter and rectum.

Anorectal Manometry

Anorectal manometry checks for the strength or tone of the internal and external anal sphincter, which controls a bowel movement. Anorectal manometry also checks its ability to respond to messages from the brain and the sensitivity and function of the rectum.

Anorectal Ultrasonography

The anorectal ultrasonography produces video images of the rectum and anus in order to assist the physician with the evaluation of the anal sphincter muscle structure.

Proctography

Proctography is an x-ray picture of the lower colon and rectum. These pictures give information that determines how much and how well the rectum may hold and evacuate stool.

Proctosigmoidoscopy

The proctosigmoidoscopy is an internal visual examination of the rectum that allows the physician to look for signs of disease or other problems that could cause fecal incontinence.

Anal Electromyography

Anal electromyographies test the nerve supply to the anal sphincter muscle. It checks for correct muscle contraction and relaxation and may reveal signs of nerve damage to the anal muscles. No special preparation is advised or necessary for these physical exams. Some tests may need to be done with the rectum empty (i.e., after a bowel movement or small enema). Patients will learn of the special requirements when scheduled for the test.

Fecal Incontinence: Treatment

Treatment for fecal incontinence is dependent on the cause of the fecal incontinence, severity of symptoms, and quality of life. Treatments may include behavioral, medical or pharmacologic, or surgical.

Behavioral Treatments

Behavioral treatments involve educational training in pelvic floor muscle strengthening and positive reinforcement from a healthcare professional. This form of treatment for fecal incontinence usually includes:

• Diary documentation
• Dietary changes
• Bowel retraining

Diary Documentation

Diaries provide additional important information about the patterns and timing of the incontinence. Patients may be asked to provide documentation of food and fluid intake, bowel movement patterns, and accidents.

Dietary Changes

Certain foods affect bowel function and stool consistency. Some may cause diarrhea while others cause constipation. Both conditions can lead to fecal incontinence even with a normally functioning anal sphincter. Patients suffering from fecal incontinence may be advised to change their diet in order to help improve the condition. Eating regular meals with a high fiber content and drinking sufficient fluids improves bowel motility, symptoms of constipation, and evacuation. Good food sources of fiber include breads, cereals, beans, fruits, and vegetables.

Bowel Training

Bowel training and exercise treatments help to restore muscle strength and regulate bowel movements. This form of training may include learning to use the toilet at specific times throughout the day such as after every meal.

Another exercise therapy, known as biofeedback, addresses the function and coordination of the muscles that control bowel movement. Biofeedback uses electronic or mechanical instruments to relay information to patients about whether they are contracting the proper muscles and the intensity and length of the muscle contraction.

Medical or Pharmacologic

Fecal incontinence can also be controlled or treated through a variety of medications. These medications can include:

• Fiber bulking agents or supplements, which help to develop a more regular bowel
  pattern
• Stool softeners (if hard stool causes constipation)
• Antidiarrheal medication (if diarrhea and/or loose stool is the problem)
• Bowel motility enhancing agents

Surgical

Often surgery is required to treat underlying problems related to fecal incontinence. Surgical procedures have been developed to correct the cause of the incontinence or reduce symptoms. Some of the more common procedures include sphincteroplasty (repair of a torn or separated anal sphincter muscle), artificial sphincter replacement or a colostomy.