Patient education: Fecal incontinence in adults (The Basics)

What is fecal incontinence? — 

This is when a person loses control of their bowels. They might leak solid or liquid bowel movements. "Anal incontinence" includes these issues as well as the leaking of gas.

Fecal incontinence is common in people who gave birth to 1 or more babies when they were younger. This is because the muscles that control bowel movements can get damaged during childbirth. People can also have fecal incontinence for other reasons.

Having fecal incontinence can be embarrassing and stressful. People who have it sometimes stay home instead of going out, because they are afraid of having "an accident." If you have trouble controlling your bowels, know the problem is not a normal part of aging. It can often be treated, and symptoms might improve.

Is there a test for fecal incontinence? — 

Yes. Your doctor or nurse will look at your anus and do a "digital rectal exam." For this, they will put a gloved finger into your anus and rectum to feel for lumps or anything abnormal.

Doctors can also do a few different tests to find out what might be causing fecal incontinence. Your doctor might order 1 or more of these tests:

●Lab tests – Doctors can check a sample of bowel movement for infections that could cause diarrhea.

●Colonoscopy or sigmoidoscopy – During a colonoscopy, the doctor puts a thin tube into your rectum. Then, they move it up into your large intestine, or "colon" (figure 1). The tube has a camera on the end, so the doctor can look inside your colon. They might also take tissue samples, called "biopsies."

A sigmoidoscopy is very similar, but the tube does not go in as far (figure 2).

●Anorectal manometry – This lets the doctor measure the pressure inside your rectum at different points. They insert a very thin tube into your rectum. The tube has a balloon on the end. The doctor inflates the balloon once it is in your rectum. Then, you try to squeeze and relax the muscles in the area. A machine attached to the tube measures how well these muscles are working.

Manometry can help your doctor check if your muscles that control bowel movements are working right. It also shows if your rectum has normal sensation.

●Ultrasound or MRI – These are imaging tests that create pictures of the inside of the body. They can help your doctor check if the parts involved in controlling bowel movements are normal. These parts include the pelvic and "anal sphincter" muscles, as well as the inner wall of the colon.

What can I do on my own to feel better? — 

You might have fewer problems with fecal incontinence if you:

●Avoid foods and drinks that cause loose or frequent bowel movements. Examples might include:

•Dairy foods

•Fatty or greasy foods

•Drinks with caffeine, such as coffee

•Diet foods or drinks

•Sugar-free gum or candy

•Alcohol

●Eat more fiber. Fiber makes bowel movements bulkier and sturdier. This can make bowel movements easier to control. Foods that have a lot of fiber include fruits, vegetables, and whole grains (table 1). You can also get more fiber by taking fiber supplements, such as Metamucil, Citrucel, or Benefiber.

Should I see a doctor or nurse? — 

Yes. If you have fecal incontinence, tell your doctor or nurse. People are sometimes too shy to talk about it. But fecal incontinence is a real medical problem that can be treated.

How is fecal incontinence treated? — 

Treatments can include:

●Fiber pills, powders, or wafers – Fiber supplements make bowel movements bulkier and sturdier. This can make bowel movements easier to control.

●Medicines to reduce the number of bowel movements – These medicines are often used to treat diarrhea. They can decrease the number of "accidents." Examples of these medicines include loperamide (sample brand name: Imodium) and diphenoxylate-atropine (brand name: Lomotil).

●Treatment to empty the bowels – Some people with fecal incontinence have full bowels they cannot empty completely. They need treatment to flush their bowels. Then, once their bowels are cleaned out, they can take medicines to keep bowel movements regular.

●Scheduled bathroom visits – Some people have fewer accidents if they visit the bathroom on a schedule. They try to go even when they don't feel like they need to.

●Biofeedback – This is a way to retrain the muscles that control bowel movements (figure 3). It is done at the doctor's office and involves using devices called sensors that measure muscle activity. The sensors show you if you are using the muscles the right way.

●Electrical nerve stimulation – Doctors can implant devices that send a mild electrical current to the nerves that control the muscles in the anus. These devices sometimes help improve bowel control.

●Surgery – Doctors can sometimes do surgery to repair the muscles that control bowel movements. This is often helpful for people whose muscles were damaged during childbirth. There are also other types of surgery to treat fecal incontinence.

More on this topic

Patient education: Constipation in adults (The Basics)
Patient education: Diarrhea in teens and adults (The Basics)
Patient education: Stool collection for testing (The Basics)
Patient education: Colonoscopy (The Basics)
Patient education: Sigmoidoscopy (The Basics)
Patient education: Anorectal manometry (The Basics)
Patient education: High-fiber diet (The Basics)
Patient education: Fecal incontinence in children (The Basics)

Patient education: Fecal incontinence (Beyond the Basics)
Patient education: Constipation in adults (Beyond the Basics)
Patient education: Chronic diarrhea in adults (Beyond the Basics)
Patient education: Colonoscopy (Beyond the Basics)
Patient education: Flexible sigmoidoscopy (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)