Fecal incontinence, also known as bowel incontinence or accidental bowel leakage, refers to the inability to control bowel movements. Those who experience fecal incontinence may face unexpected stool leakage or accidents, which can range from occasional occurrences to a chronic problem. Over 5 million people in the United States are affected by fecal incontinence, and it tends to be more common in older adults and women.

While fecal incontinence can result from a variety of causes, it's important to recognize the underlying condition and receive proper treatment. This guide will discuss the common causes of fecal incontinence, its symptoms, and available treatments to manage this condition.

Symptoms of Fecal Incontinence

Fecal incontinence is marked by an inability to control bowel movements. Symptoms can vary from person to person, and some individuals may be aware of the issue, while others might not realize when it happens. The most common signs include:

  • The inability to hold in a shart (gas with watery stool)

  • Unexpected stool leakage during the day

  • Inability to reach the bathroom in time

  • A sudden, strong urge to have a bowel movement

  • Streaks or stains on your underwear

In addition to these, fecal incontinence may be accompanied by diarrhea, constipation, and discomfort in the abdominal region. The frequency and severity of symptoms can vary depending on the underlying cause, with some people experiencing occasional accidents while others face frequent issues.

What Causes Fecal Incontinence?

Fecal incontinence generally happens when the rectum and anus lose the ability to hold in stool. This loss of control can be triggered by several factors, including dietary changes, nerve or muscle damage, and other health conditions.

1. Diarrhea

Diarrhea is one of the most common causes of fecal incontinence. Loose and watery stool is harder to control, and its sudden and urgent nature can lead to unexpected leakage. Diarrhea is often a short-term issue caused by gastrointestinal infections or food intolerance. However, if diarrhea persists due to digestive disorders like inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS), fecal incontinence may become chronic.

Symptoms of diarrhea-induced fecal incontinence include:

  • Stomach cramps and bloating

  • Nausea and vomiting

  • Dizziness or lightheadedness

2. Constipation

Constipation can also contribute to fecal incontinence. People with chronic constipation often experience hard, dry stools that are difficult to pass. This can stretch and weaken the rectum muscles, which might cause stool to leak out when a person passes gas. Additionally, severe constipation can lead to overflow diarrhea, where watery stool escapes around the impacted stool.

Symptoms related to constipation include:

  • Dry, hard stools

  • Less than three bowel movements per week

  • Straining during bowel movements

  • Feeling blocked up

  • Abdominal pain or bloating

3. Muscle or Nerve Damage

Your ability to control bowel movements relies on the proper function of the anal sphincter muscle, the rectum’s capacity to store stool, and the sensation that signals the need to use the bathroom. Damage to the muscles or nerves in the anus, rectum, or pelvic floor can impair these functions, leading to fecal incontinence.

Conditions that cause muscle or nerve damage include:

  • Surgery or trauma to the anus or rectum

  • Chronic straining to pass stool

  • Brain or spinal cord injuries

  • Vaginal childbirth

  • Pelvic floor dysfunction

  • Neurological disorders like multiple sclerosis, Parkinson's disease, stroke, and diabetes

As people age or experience a lack of physical activity, the muscles may naturally weaken, making them more susceptible to incontinence.

4. Other Health Conditions

Several other medical conditions can trigger fecal incontinence. These conditions interfere with the normal bowel movement process, contributing to leakage and accidents.

Conditions that can lead to fecal incontinence include:

  • Inflammatory Bowel Disease (IBD): Chronic inflammation from conditions like Crohn's disease or ulcerative colitis can cause rectal scarring and inflammation, leading to fecal leakage.

  • Hemorrhoids: Swollen veins around the anus can prevent proper muscle closure, allowing stool to leak.

  • Rectal Prolapse: This condition involves the rectum protruding through the anus, which interferes with proper muscle function.

  • Anal Cancer: This condition, along with radiation therapy, may result in fecal incontinence.

  • Birth defects: Certain congenital conditions affecting the anus, colon, or rectum can also lead to incontinence.

When to See a Healthcare Provider

While occasional fecal incontinence may not be a cause for concern, you should seek medical advice if you notice consistent or severe leakage. It's especially important to consult with a healthcare provider if you experience other concerning symptoms, such as:

  • Skin irritation or sores around the anal area

  • Severe diarrhea

  • Bloody stool or rectal bleeding

A healthcare provider will evaluate your symptoms, perform a physical exam, and may order further tests to determine the underlying cause of your fecal incontinence.

Diagnostic Tests for Fecal Incontinence

To properly diagnose fecal incontinence, your healthcare provider will conduct a series of assessments, including:

  • Imaging Tests: X-rays, ultrasounds, or MRIs to examine the muscles and rectum.

  • Colonoscopy: A scope used to view the inside of the colon, which helps diagnose conditions like IBD.

  • Electromyography (EMG): A test to check the function of nerves involved in the anal muscles.

  • Anorectal Manometry: A test that measures the pressure and function of the anal and rectal muscles.

These tests can help identify the exact cause of your fecal incontinence and guide your treatment plan.

Treatments for Fecal Incontinence

Treating fecal incontinence typically involves a combination of lifestyle changes, medications, and sometimes surgical interventions. The goal is to restore control over bowel movements and reduce the frequency of accidents.

First-line treatments include:

  • Dietary Changes: Adjusting your diet to avoid foods that cause diarrhea or to increase fiber intake if constipation is an issue.

  • Medications: Your healthcare provider may recommend anti-diarrheal medications, fiber supplements, or laxatives.

  • Bowel Retraining: Establishing a routine to help your body recognize when to go to the bathroom.

  • Pelvic Floor Exercises: Exercises that strengthen the muscles involved in controlling bowel movements.

If nerve or muscle damage is identified, more advanced treatments like surgery may be necessary. In severe cases, a referral to a specialist, such as a gastroenterologist or colorectal surgeon, may be required.

How to Prevent Fecal Incontinence

While some causes of fecal incontinence cannot be entirely prevented, you can reduce your risk by adopting healthy habits:

  • Monitor your diet: Avoid foods and drinks that may trigger diarrhea or constipation.

  • Exercise regularly: Physical activity can help maintain healthy bowel function and prevent constipation.

  • Establish a bathroom routine: Going to the bathroom at the same times each day can help regulate your bowel movements.

  • Manage chronic conditions: Treat underlying health conditions like IBD or hemorrhoids.

For those worried about accidents in public, consider carrying wet wipes, clean underwear, or wearing disposable pads for easier cleanup.

Complications of Fecal Incontinence

Fecal incontinence can have significant emotional and social effects, leading to anxiety, embarrassment, and a decreased quality of life. Additionally, frequent accidents can result in skin irritation or sores due to constant exposure to stool.

Complications include:

  • Skin irritation, sores, or infections due to frequent cleaning

  • Anxiety or depression due to the emotional impact of incontinence

  • Difficulty socializing or leaving the house

A Quick Review

Fecal incontinence is the inability to control bowel movements, leading to unexpected stool leakage. This condition can be caused by diarrhea, constipation, nerve damage, or other health conditions. Treatment options, including diet changes, medications, pelvic floor exercises, and in some cases, surgery, can help manage the symptoms of fecal incontinence and improve your quality of life.