Patient education: Fecal incontinence (The Basics)

What is fecal incontinence? — This is the medical term for when a person loses control of their bowels. A person with fecal incontinence might leak solid or liquid bowel movements. The term "anal incontinence" includes these issues as well as the leaking of gas.

Fecal incontinence is most 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 in childbirth. People can also have fecal incontinence for other reasons.

Having fecal incontinence can be embarrassing and stressful. People who have it sometimes stay at home instead of going out, because they are afraid of having "an accident." If you have trouble controlling your bowels, you should know that 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 attached to it, 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 test allows the doctor to measure the pressure inside your rectum at different points. The doctor inserts a very thin tube into your rectum. The tube has a balloon on the end. The balloon is inflated once it is in the rectum. Then, you are asked to 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 the doctor find out if your muscles that control bowel movements are working right. The test also shows whether your rectum has normal sensation.

●Ultrasound or MRI – These are imaging tests that create pictures of the inside of the body. They can help the doctor check whether 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.

Is there anything I can do on my own to feel better? — Yes. Some people have fewer problems with fecal incontinence if they:

●Avoid foods and drinks that cause loose or frequent bowel movements. Examples can 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 that your doctor might suggest 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" that a person has. 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 that they cannot empty completely. These people 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 go.

●Biofeedback – Biofeedback 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. These sensors tell 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 in 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: High-fiber diet (The Basics)
Patient education: Colonoscopy (The Basics)

Patient education: Fecal incontinence (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)