Fecal incontinence

Overview

Fecal incontinence is accidental passing of solid or liquid stool. Fecal incontinence may happen when a person has a sudden urge to pass stool and cannot get to a toilet in time. Also, stool may leak when a person doesn't sense the need to pass stool.

Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. Fecal incontinence can affect a person's ability to work, socialize or do typical daily activities. It often causes embarrassment or emotional stress.

Diagnosis and treatment are often avoided because the condition is difficult to discuss with a healthcare professional. Treatments can improve fecal incontinence and overall quality of life.

Fecal incontinence also may be called bowel incontinence or accidental bowel leakage.

Symptoms

The main symptom is not being able to control passing stool. This may happen during a short-term illness that causes diarrhea. For some people, fecal incontinence is an ongoing condition.

There are two types of fecal incontinence:

• Urge incontinence is the sudden urge to pass stool but not being able to control the urge. The need to pass stool may come on so suddenly that it's not possible to get to the toilet in time.
• Passive incontinence is passing stool when a person isn't aware of the need to pass stool. A person may not be able to feel that the rectum is full of stool.

Fecal incontinence also may be leakage of stool when a person passes gas.

When to see a doctor

See your healthcare professional if you or your child develops fecal incontinence. This is especially important if fecal incontinence:

• Happens often.
• Causes emotional distress.
• Affects your ability to do daily activities.
• Causes you to avoid time with family and friends.

Often, people are embarrassed to talk about fecal incontinence. But the sooner you're evaluated, the sooner you may find some relief from your symptoms.

Causes

For many people, there is more than one cause of fecal incontinence.

Causes may include:

Diarrhea and constipation. Very soft and very hard stools can lead to fecal incontinence. Problems include:

• Loose or watery stool that quickly fills the rectum and is difficult to hold.
• Large, hard stool that blocks the rectum and results in leakage of softer stool around it.

Damaged or weakened muscles. The muscles of the anus, rectum and pelvic floor control the holding and passing of stool. Damaged or weak muscles can cause fecal incontinence. Conditions that can weaken or damage muscles include:

• Injury during vaginal delivery, particularly with forceps.
• Surgical cut of the vagina during delivery, called an episiotomy.
• Injury from accidents, surgery or radiation therapy.
• Age-related weakening of muscles.

Nervous system disorders. Injury or illness can affect how the nerves and muscles of the anus, rectum or pelvis work. Nervous system disorders also may affect a person's awareness of the need for passing stool. These conditions may include:

• Diseases of the brain, such Parkinson's disease, Alzheimer's disease or other dementias, stroke, or cerebral palsy.
• Long-term diseases affecting nerve function, such as diabetes or multiple sclerosis.
• Spinal cord injury or tumor.
• Damage to nerves during surgery.

Physical problems of the anus or rectum. Irregular physical changes in the anus or rectum can contribute to fecal incontinence. These include:

• Scarring or inflammation of the rectum — from injury or long-term disease — that affects the ability of the rectum to hold stool.
• Dropping of the rectum through the anus, called rectal prolapse.
• Hemorrhoids that may prevent the closing of the anal muscles.
• Bulging of the rectum into the vagina, also called rectocele.

Risk factors

A number of factors may increase your risk of developing fecal incontinence, including:

• Age. Fecal incontinence is more likely in adults over 65.
• Sex. Fecal incontinence is more common in women, likely because of possible injuries during delivery. Hormone treatments for menopause also may increase the risk.
• Diseases of the digestive system. The risk of fecal incontinence is increased with long-term diseases that affect the intestines. These include:
  • Inflammatory bowel disease, such as Crohn's disease.
  • Irritable bowel syndrome.
  • Celiac disease.
• Mental disability. A mental disability or dementia may affect a person's ability to plan to use the toilet or be aware of the need to use the toilet.
• Physical disability. A physical disability or limited mobility may make it difficult to reach a toilet in time. An injury that caused a physical disability may cause nerve or muscle damage that increases the risk of fecal incontinence.
• Lifestyle factors. Lifestyle factors that increase the risk of incontinence include being overweight, not being active, smoking, and drinking caffeinated and alcoholic beverages.

Complications

Complications of fecal incontinence may include:

• Emotional distress. Many people feel embarrassed about fecal incontinence. And they often experience anxiety or depression. They may try to hide the problem and avoid social situations.
• Tissue irritation. The skin around the anus is delicate and sensitive. Repeated contact with stool can lead to pain and itching. Sores, called ulcers, may appear in the tissues of the rectum.

Prevention

Depending on the cause, it may be possible to improve or prevent fecal incontinence. These actions may help:

• Reduce constipation. Increase your exercise, eat more high-fiber foods and drink plenty of fluids.
• Control diarrhea. Avoid food or drinks that may make diarrhea worse, such as caffeinated drinks, alcohol, dairy products and fatty foods.
• Do not strain. Straining during bowel movements can eventually weaken anal sphincter muscles or damage nerves.