Fecal incontinence is the involuntary loss of bowel control.
Types of fecal incontinence include:
Normal bowel function is a coordination of involuntary and voluntary muscles, and a complex network of nerves. The rectum is the last part of the large intestine. It's function is to hold stool until it is ready for passage through the anal canal. As the rectum fills and stretches, it sends nerve signals to the brain, creating the urge to have a bowel movement. The stool moves down into the anal canal to the anal sphincter. The anal sphincter it is made up of involuntary and voluntary muscles that control the passage of stool out of the body.
Fecal incontinence may be the result of:
Fecal incontinence is more common in adults aged 65 years and older. Other factors that may increase your chance of fecal incontinence include:
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The main symptom is the inability to control bowel movements, which leads to leakage of solid or liquid stool, and/or gas.
You will be asked about your symptoms and medical history. A physical exam will be done, which will include an evaluation of the perianal area. Your doctor may refer you to a specialist.
Your bodily structures may need to be viewed. This can be done with:
Anorectal manometry may be done to check the pressure of the anal canal.
Treatment depends on what is causing the incontinence. A combination of different treatments may be necessary. It may take some time to find the right treatment. Each method may not work on everyone. Talk with your doctor about the best plan for you. Options may include one or more of the following:
Your doctor may suggest changes to your diet. You may be referred to a registered dietitian. Examples of dietary changes include:
Biofeedback may help improve awareness of sensation, muscle tone, coordination, and other functional changes. It may be used with electrostimulation of specific nerves to cause sphincter contraction. Currently, evidence is inconclusive regarding biofeedback, but it has shown some success.
A bowel movement schedule can also train your bowels. For example, you can pick several times throughout the day to try to go to the bathroom, such as after meals.
Learn how to do Kegel exercises. These exercises help strengthen the pelvic floor muscles.
Medications used depend on the cause. They may be in the form of an oral tablet, liquid, topical cream or ointment, or rectal suppository. If fecal incontinence is caused by medications, your doctor may change or stop them. Do not make changes to your medications on your own.
Constipation may be treated with:
Diarrhea may be treated with:
Surgical procedures may be used to treat this condition when other treatments have failed. Examples include:
Other options to manage fecal incontinence may include:
To help reduce your chance of fecal incontinence:
International Foundation for Functional Gastrointestinal Disorders
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Digestive Health Foundation
Canadian Society of Intestinal Research
Fargo MV, Latimer KM. Evaluation and management of common anorectal conditions. Am Fam Physician. 2012;85(6):624-630.
Fecal incontinence. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/fecal-incontinence/Pages/facts.aspx. Updated November 25, 2013. Accessed September 25, 2015.
Fecal incontinence in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114211/Fecal-incontinence-in-adults. Updated September 2, 2016. Accessed September 29, 2016.
Garg, P, Song J, Bhatia A, Kalia H, Menon G. The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Colorectal Diseases. 2010;12(10):965-970.
Rectal prolapse. American Society of Colon & Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/rectal-prolapse. Accessed September 25, 2015.
12/4/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114211/Fecal-incontinence-in-adults: Deutekom M, Dobben A. Plugs for containing fecal incontinence. Cochrane Database Syst Rev. 2009;(4):CD005086.
11/5/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114211/Fecal-incontinence-in-adults: Pannu HK, Glanc P, Bhosale PR, et al. ACR Appropriateness Criteria pelvic floor dysfunction. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=48295#Section420. Accessed September 25, 2015.
7/21/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114211/Fecal-incontinence-in-adults: Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. American Society of Colon and Rectal Surgeons (ASCRS) clinical practice guideline on treatment of fecal incontinence. Available at: https://www.fascrs.org/sites/default/files/downloads/publication/clinical_practice_guideline_for_the_treatment_of_fecal_incontinence.pdf. Updated 2015. Accessed September 25, 2015.
Last reviewed December 2015 by Daus Mahnke, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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