Diagnosis

Your doctor will ask questions about your condition and perform a physical exam that usually includes a visual inspection of your anus. A probe may be used to examine this area for nerve damage. Normally, this touching causes your anal sphincter to contract and your anus to pucker.

Medical tests

A number of tests are available to help pinpoint the cause of fecal incontinence:

  • Digital rectal exam. Your doctor inserts a gloved and lubricated finger into your rectum to evaluate the strength of your sphincter muscles and to check for any abnormalities in the rectal area. During the exam your doctor may ask you to bear down, to check for rectal prolapse.
  • Balloon expulsion test. A small balloon is inserted into the rectum and filled with water. You are then asked to go to the toilet and expel the balloon. The length of time it takes to expel the balloon is recorded. A time of one minute or longer is usually considered a sign of a defecation disorder.
  • Anal manometry. A narrow, flexible tube is inserted into the anus and rectum. A small balloon at the tip of the tube may be expanded. This test helps measure the tightness of your anal sphincter and the sensitivity and functioning of your rectum.
  • Anorectal ultrasonography. A narrow, wand-like instrument is inserted into the anus and rectum. The instrument produces video images that allow your doctor to evaluate the structure of your sphincter.
  • Proctography. X-ray video images are made while you have a bowel movement on a specially designed toilet. The test measures how much stool your rectum can hold and evaluates how well your body expels stool.
  • Proctosigmoidoscopy. A flexible tube is inserted into your rectum to inspect the last two feet of the colon (sigmoid) for signs of inflammation, tumors or scar tissue that may cause fecal incontinence.
  • Colonoscopy. A flexible tube is inserted into your rectum to inspect the entire colon.
  • Magnetic resonance imaging (MRI). MRI can provide clear pictures of the sphincter to determine if the muscles are intact and can also provide images during defecation (defecography).
Dec. 19, 2015
References
  1. Fecal incontinence. National Digestive Diseases Information Clearinghouse. http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/fecal-incontinence/Pages/facts.aspx. Accessed Aug. 8, 2015.
  2. Feldman M, et al. Fecal incontinence. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Aug. 14, 2015.
  3. Cook AJ. Decision Support System. Rochester, Minn. July 15, 2015.
  4. Robson KM, et al. Fecal incontinence in adults: Etiology and evaluation. http://www.uptodate.com/home. Accessed Aug. 8, 2015.
  5. Robson KM, et al. Fecal incontinence in adults: Management. http://www.uptodate.com/home. Accessed Aug. 8, 2015.
  6. Bharucha AE, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: State of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Workshop. American Journal of Gastroenterology. 2015;110:127.
  7. Whitehead WE, et al. Treatment of fecal incontinence: State of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases Workshop. American Journal of Gastroenterology. 2015;110:138.
  8. Richter HE, et al. A vaginal bowel-control system for the treatment of fecal incontinence. Obstetrics & Gynecology. 2015;125:540.
  9. Schwartz DA, et al. Endorectal endoscopic ultrasound in the evaluation of fecal incontinence. http://www.uptodate.com/home. Accessed Aug. 8, 2015.
  10. Kaiser AM, et al. Current status: New technologies for the treatment of patients with fecal incontinence. Surgical Endoscopy. 2014;28:2277.
  11. Wald A, et al. ACG Clinical Guideline: Management of benign anorectal disorders. American Journal of Gastroenterology. 2014;109:1141.
  12. Paquette IM, et al. The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the treatment of fecal incontinence. Diseases of the Colon & Rectum. 2015;58:623.
  13. Pico MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Aug. 25, 2015.