Fecal Incontinence

Is This Information Right for Me?

This information is right for you if:

• Your health care professional* said you or your loved one has fecal incontinence (FI). People with FI have trouble holding their stool until they can get to the bathroom. The stool sometimes leaks by accident. FI is also sometimes called “accidental bowel leakage.”

• You want to know what treatments are available for FI and what researchers have found about how well the treatments work.

• You or your loved one are age 18 or older. The information in this summary is from research on adults.

What will this summary tell me?

This summary will answer these questions:

• What is FI?

• What are treatment options for FI?

• What have researchers found about how well FI treatments work?

• What are the possible side effects or complications of the treatments?

• What should I discuss with my health care professional?

Note: This summary only discusses research on treatments for FI. It does not cover products that people with FI use, such as pads, disposable underwear, and skincare products.

* Your health care professional may include your primary care physician, gastroenterologist (a doctor who specializes in the digestive system), proctologist (a doctor who specializes in diseases of the colon, rectum, and anus), gynecologist (a doctor who specializes in the female reproductive system), urogynecologist (a doctor who specializes in disorders of the pelvic floor), surgeon, nurse practitioner, or physician assistant.

Understanding Your Condition

What is fecal incontinence?

Fecal incontinence (FI) is a condition in which you have trouble holding your stool until you can get to the bathroom. The stool sometimes leaks by accident. The stool may be solid or liquid. FI is also sometimes called “accidental bowel leakage.”

The stool is the waste that passes out of your body during a bowel movement. The stool is made of undigested food and mucus. The mucus is a thick liquid that coats your digestive tract.

Any food that cannot be digested moves into your large intestine as waste. The last part of the large intestine is called the rectum. The waste stays in the rectum until it leaves your body through the anus during a bowel movement.

Muscles and nerves in the rectum and anus keep stool in the rectum until you are ready for a bowel movement. A ring of muscles called the anal sphincter (pronounced SFINK-her) acts like a rubber band around the anus to keep it closed tightly. The pelvic floor muscles help support the bladder, rectum, and other organs. They also help control bowel movements.

What causes FI?

FI can be caused by many things, including:

• Damage to the sphincter muscles or to the nerves that control the rectum and sphincter muscles

• This can happen from childbirth, surgery involving the rectum or anus, or straining often to pass stool.

• A spinal cord or brain injury can also damage the nerves that control the rectum and sphincter muscles.

• Loss of stretch or stiffening of the rectum

• This can happen from surgery involving the rectum or anus, radiation treatment for cancer, or inflammatory bowel diseases (disorders that cause irritation to the lining of the lower digestive system).

• Swollen blood vessels in and around the lower rectum and anus (called hemorrhoids)

• A condition in which the rectum drops down through the anus (called rectal prolapse)

• Diarrhea

• Loose stools are more difficult to hold in than solid stools.

How common is FI?

• About 1 out of every 12 people in the United States has FI. That is equal to almost 18 million people.

• FI is more common in older adults and in women.

Many people feel embarrassed and upset about their FI. They may avoid social situations because they are afraid of leaking stool. FI can severely limit a person’s ability to enjoy work or activities. Untreated FI can lead to skin rashes, infections, and other problems.

Understanding Your Options

How is FI treated?

Many treatments have been used to help people with FI:

• Dietary fiber supplements

• Antidiarrhea medicines

• Bowel training

• Pelvic floor exercises (sometimes done with biofeedback)

• Anal sphincter bulking shots

• Surgery

Dietary Fiber Supplements

Dietary fiber supplements, such as psyllium, can help make your stool less loose. These supplements come as pills or powders.

Antidiarrhea Medicines

If your FI is caused by diarrhea, a medicine can help stop the diarrhea. Examples of antidiarrhea medicines include diphenoxylate (Lomotil®) or loperamide (Imodium®).

Bowel Training

Bowel training means trying to have a bowel movement at certain times of the day. You may try when you wake up each morning or after a meal. It may take several weeks or months to develop a regular pattern.

Pelvic Floor Muscle Training and Biofeedback

For pelvic floor muscle training (PFMT), you squeeze and release the muscles you use to stop a bowel movement. PFMT is sometimes done with biofeedback. Biofeedback helps you become more aware of how your muscles work. It uses sensors placed in the anus and rectum to make you feel like you need to have a bowel movement. The sensors then track when you squeeze your pelvic floor and anal sphincter muscles. This helps your health care professional see if you are squeezing your muscles the right way.

Anal Sphincter Bulking Shots

Anal sphincter bulking shots may help build up the tissue around the anus. The shots are given into the walls of the anus. They help to narrow the opening of the anus to help decrease stool leakage.

Surgery

Surgery may help FI that is caused by damaged nerves or muscles. Surgery is usually suggested only if other treatments do not work. There are several types of surgery for FI.

Sacral Nerve Stimulation

A small device is placed under the skin of your lower back. The device uses electrical pulses to stimulate the nerves that control the muscles in your rectum and anus. The area on your lower back will be numbed so you do not feel pain when the device is placed under the skin. The procedure is usually done in an outpatient center. The device runs on a battery that lasts about 5 years. When the battery runs out, you will need another procedure to replace the device.

Anal Sphincter Repair

If you have a tear in your anal sphincter, your doctor may recommend this type of surgery. A tear can be caused by childbirth or injury. The surgeon reconnects the ends of the muscles to fix the tear. This surgery is also called sphincteroplasty.