A health condition in which a person cannot control bowel movements is called fecal incontinence. In other words, stools begin to leak from the rectum without warning and this condition ranges from mild (occasional leakage) to severe (complete loss of bowel control). In some cases, fecal incontinence is called bowel incontinence.
The primary causes of fecal incontinence include constipation, diarrhea, and damage to the muscles or nerves. This condition happens due to muscle or nerve damage due to aging or giving birth.
However, we recommend to not be ashamed to discuss this condition and visit a doctor. The treatment goal is to reduce stool leakage and improve the quality of life.
Symptoms
While this health problem can appear during a bout of diarrhea it can happen more frequently for some people. In case you cannot stop the urge to defecate, it is called urge incontinence. In such cases, it comes suddenly and you may not reach the toilet in time. However, another form of fecal incontinence happens when you are not aware you need to pass stool (passive incontinence). Usually, people experience bowel incontinence due to diarrhea, constipation, gas, and bloating.
Contact your healthcare professional right away if you or your child experiences stool leakage, the condition is severe, or it provokes emotional distress. In most cases, people are ashamed to tell doctors about this problem, but the sooner you visit a doctor, the sooner you will get treatment to lessen the symptoms.
Causes
Commonly, bowel incontinence occurs due to multiple causes. Examples include:
- Muscle damage – In such cases, an injury to the rings of muscle at the rectum end may cause difficulties in holding the stool. Damage often happens during childhood to these rings (anal sphincter). Damage to the anal sphincter also can occur during delivery if episiotomy or forceps are used.
- Nerve damage – If a person experiences damage to the nerves responsible to control the anal sphincter, it also may lead to fecal incontinence. Things that could damage these nerves include long-lasting constipation, frequent straining during bowel movements, childbirth, spinal cord injury, stroke, diabetes, multiple sclerosis, and others.
- Constipation – Those who suffer from constipation for long periods of time, may provoke a dry and hard mass of stool that collects in the rectum. Usually, such stool masses are too large to pass through the rectum (stool impaction). However, long-lasting constipation can cause damage to the anal sphincter nerves.
- Diarrhea – Hard stool is easier to hold than loose stool. Thus, diarrhea can cause or worsen fecal incontinence.
- Hemorrhoids – This is a health condition in which veins in the rectum become swollen. As a result, the stool may leak out because swollen veins prevent the anus from completely closing.
- Decreased rectum storage capacity – Normally, the rectum stretches to accommodate stool. If you experience scars or stiffness of the rectum, it becomes difficult to stretch the stool as much as needed, provoking the stool to leak out. Commonly, scars and stiffness of the rectum are caused by inflammatory bowel disease (IBD), radiation therapy, surgery, and others.
Other Causes
For example:
- Surgery – Surgery that helps to remove hemorrhoids can damage nerves in the rectum causing bowel incontinence.
- Rectal prolapse – In some cases, fecal incontinence is caused by certain health conditions that provoke the anus to drop down. Early diagnosis and treatment can prevent long-lasting recovery.
- Rectocele – This is a health condition in which the rectum protrudes through the vagina. Therefore, causing fecal incontinence.
Risk Factors
There are different factors that can increase your risk of developing bowel incontinence. Examples include:
- Age – People over 65 years old are more likely to get this health problem.
- Sex – As per studies, women who administer menopausal hormone replacement therapy are more prone to develop fecal incontinence. Furthermore, in women, this health problem can occur due to childbirth.
- Nerve damage – Back trauma (caused by injury or surgery), diabetes, or multiple sclerosis can damage nerves of the rectum causing bowel incontinence.
- Dementia – This condition is frequently diagnosed in people with later stages of Alzheimer’s disease and dementia.
- Physical disability – People who are physically disabled can make it challenging to reach in time the toilet.
Complications
You may wonder what happens if you are not treating this health problem. Check below some complications:
- Emotional distress – Those who experience bowel incontinence may feel uncomfortable and ashamed, especially being out in public. However, it is common for people with bowel incontinence to avoid social engagements because they try to hide the problem.
- Skin irritation – The skin located around the anus is sensitive and delicate. So, multiple stool contact with this skin can provoke pain and itching. Moreover, it may lead to sores (ulcers).
Prevention
There are some tips that could help you prevent or even avoid fecal incontinence. Examples include:
- Manage constipation – You can ease constipation if you regularly exercise, adopt a high-fiber diet, and drink plenty of fluids.
- Treating diarrhea – If you receive treatment as soon as possible, you may avoid fecal incontinence. Usually, diarrhea is caused by intestinal infection.
- Avoid straining during bowel movement because it may damage nerves or weaken rectum rings.
Diagnosis
First, doctors ask questions about symptoms and medical history and perform a physical examination. During a physical exam, doctors will perform a visual inspection of the anus to check for abnormalities. Check some tests usually done to confirm the condition:
- Digital rectal examination – This test involves a gloved and lubricated finger into the rectum to determine the strength of the sphincter muscles. It is usually used to check for rectal prolapse.
- Balloon expulsion test – This test helps to determine if you have a defecation disorder. It involves a balloon with water inserted into the rectum. Thereafter, you should go to the toilet to expel it. In case it lasts more than 3 minutes it means you have a problem.
- Anal manometry – It involves a thin and flexible tube that is inserted into the anus and rectum to determine the tightness of the anal sphincter.
- Anorectal ultrasonography – This test produces video images of the anus and rectum to check for abnormalities in the sphincter structure.
- Proctography – This test involves an X-ray and it is usually done during a bowel movement to measure how much stool the rectum can hold.
- Colonoscopy – To inspect the entire colon doctors use a special flexible tube.
- MRI (magnetic resonance imaging) scan – Doctors usually perform this scan to get detailed images of the sphincter. This procedure is also known as defecography.
Treatment
Medicines
Doctors usually prescribe the following medicines for patients with fecal incontinence. Examples include:
- Anti-diarrheal medicines (including Loperamide, Diphenoxylate, and Atropine).
- Bulk laxatives (such as Methylcellulose and Psyllium)
Other Therapies and Exercise
Doctors usually recommend the following therapies and exercise if fecal incontinence is provoked by muscle damage. The following options often help to strengthen pelvic muscles and improve anal sphincter control. For example:
- Kegel exercise – These exercises are effective for both men and women. Doing the Kegel exercise helps to improve the bladder, bowel, and uterus (women).
- Biofeedback – Special exercise that improves anal muscle strength. You can learn these exercises with a specially trained physical therapist. Benefits of these exercises include strengthening the pelvic floor muscles, improving the sense of when the stool is ready to be released, and others.
- Bowel training – Sometimes, doctors recommend making a significant effort to have a bowel movement.
- Bulking agents – Physicians may give you some injections that thicken the anus walls, preventing the leakage.
- Sacral nerve stimulation – This nerve begins from the spinal cord and goes into the pelvis. It is responsible for regulating the strength and sensation of the rectal and anal sphincter muscles. Healthcare professionals usually implant a small device that stimulates the nerves with small electrical impulses.
- Posterior tibial nerve stimulation – This is a minimally invasive procedure that helps to stimulate this nerve located at the ankle.
- Vaginal balloon (Eclipse System) – It involves a pump-type device that is inserted into the vagina. When it is inflated it puts pressure on the rectal region causing a decrease in the fecal incontinence episodes.
- Radiofrequency therapy – This treatment option is used to improve muscle tone. It involves radiofrequency energy that is sent to the anal walls. This therapy is also known as the Secca procedure.
Surgery
In some cases, surgery is required to get rid of bowel incontinence. It is usually used when someone experiences this condition due to rectal prolapse, sphincter damage (due to childbirth), and others. Check below some surgery types:
- Sphincteroplasty – This surgery is recommended by the doctors when you have weakened or damaged anal sphincter due to childbirth.
- Surgery to treat rectal prolapse, hemorrhoids, or rectocele – These health problems usually require a surgical correction.
- Colostomy (bowel diversion) – During this procedure, doctors attach a special bag in an opening of the abdomen and divert stool. After surgery, the stool is collected in this bag. This treatment option is usually used when other treatment options do not work.
Frequently Asked Questions
What is the primary cause of fecal incontinence?
Most people suffer from this condition due to constipation, which lasts for long periods.
What are the best treatments for bowel incontinence?
To treat this health problem, doctors usually recommend a combination of treatments and lifestyle changes. Examples include:
- Dietary fiber supplements
- Antidiarrheal medications
- Bowel training
- Pelvic floor exercises
- Anal sphincter bulking shots
In case previous options do not improve fecal incontinence symptoms, you may need surgery.
What are the potential complications of bowel incontinence?
If you leave this condition untreated it may lead to emotional and social distress, skin irritation, and poor nutrition. If you have additional questions, ask your healthcare professional.
