What is Bowel Incontinence?
Bowel incontinence (also called fecal incontinence) is when you’re not able to control your bowel movements. It's a common problem, especially among older adults, and ranges from irregular stool leaks while passing gas to a total loss of control of your bowels.
Accidental bowel leakage isn’t usually a serious medical problem. But it can dramatically interfere with daily life. People with bowel incontinence may avoid social activities for fear of embarrassment.
Many effective treatments can help people with bowel incontinence. These include:
- Minimally invasive procedures
Talking to your doctor is the first step toward freedom from bowel incontinence.
Symptoms of Bowel Incontinence
Bowel incontinence may be a short-term problem or one that happens on a regular basis. You could suddenly feel the urge to use the bathroom (called urge incontinence) or you might not be aware that you need to go (called passive incontinence). Bowel incontinence may also happen with other bowel problems such as:
- Loose, watery stool (diarrhea)
- Trouble passing stool or irregular bowel movements (constipation)
- Bloating and gas
Causes of Bowel Incontinence
The most common cause of bowel incontinence is damage to the muscles around the anus (anal sphincters). Vaginal childbirth can damage the anal sphincters or their nerves. That's why women are affected by accidental bowel leakage about twice as often as men.
Anal surgery can also damage the anal sphincters or nerves, leading to bowel incontinence.
Other potential causes of bowel incontinence include:
- Diarrhea (often due to an infection or irritable bowel syndrome)
- Impacted stool (due to severe constipation, often in older adults)
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
- Nerve damage (due to diabetes, spinal cord injury, multiple sclerosis, or other conditions)
- Radiation damage to the rectum (such as after treatment for prostate cancer)
- Cognitive (thinking) impairment (such as after a stroke or advanced Alzheimer's disease)
- Rectal prolapse, where your rectum drops down into your anus
- Rectocele, a condition in women where your rectum pushes through your vagina
- Loss of stretch of the rectum, which can happen with scarring and stiffening after surgery, radiation treatment, or inflammatory bowel disease
It’s common to have more than one cause of bowel incontinence. Doctors sometimes are unable to determine the cause.
Diagnosis of Bowel Incontinence
Discussing bowel incontinence can provide clues for a doctor to help make the diagnosis. During a physical examination, a doctor may check the strength of the anal sphincter muscle using a gloved finger inserted into the rectum.
Other tests may be helpful in identifying the cause of bowel incontinence, such as:
- Stool testing. If diarrhea is present, stool testing may identify an infection or other cause.
- Endoscopy. A tube with a camera on its tip is inserted into the anus. This identifies any potential problems in the anal canal or colon. A short, rigid tube (anoscopy) or a longer, flexible tube (sigmoidoscopy or colonoscopy) may be used.
- Anorectal manometry. A pressure monitor is inserted into the anus and rectum. This allows measurement of the strength of the sphincter muscles.
- Endosonography. An ultrasound probe is inserted into the anus. This produces images that can help identify problems in the anal and rectal walls.
- Nerve tests. These tests measure the responsiveness of the nerves controlling the sphincter muscles. They can detect nerve damage that can cause bowel incontinence.
- MRI defecography.Magnetic resonance imaging of the pelvis can be performed, potentially while a person moves their bowels on a special commode. This can provide information about the muscles and supporting structures in the anus, rectum, and pelvis.
- Balloon expulsion test. This is where your health care provider inserts a small balloon filled with water into your rectum. You’ll then go to the bathroom and push out the balloon. If it takes longer than 3 minutes, you may have trouble passing stools.
- Colonoscopy. Your health care provider will insert a flexible tube into your rectum to closely examine your colon.
Treatments for Bowel Incontinence
Bowel incontinence is usually treatable. In many cases, it can be cured completely.
Recommended treatments vary according to the cause of bowel incontinence. Often, more than one treatment method may be required to control symptoms.
Non-surgical treatments are often recommended as initial treatment for bowel incontinence. These include:
These steps may be helpful:
- Eat 20 to 30 grams of fiber per day. This can make stool more bulky and easier to control.
- Avoid caffeine. This may help prevent diarrhea.
- Drink several glasses of water each day. This can prevent constipation.
These medicines reduce the number of bowel movements and the urge to move the bowels:
Methylcellulose can help make liquid stool more solid and easier to control. For people with a specific cause of diarrhea, such as inflammatory bowel syndrome, other medications may also help.
Begin a program of regularly contracting the muscles used to control urinary flow (Kegel exercises). This builds strength in the pelvic muscles and may help reduce bowel incontinence.
Bowel training. Schedule bowel movements at the same times each day. This can help prevent accidents in between.
Biofeedback. A sensor is placed inside the anus and on the abdominal wall. This provides feedback as a person does exercises to improve bowel control.
Surgery may be recommended for people whose bowel incontinence is not helped by non-invasive treatments. The types of surgery include:
- Sphincter surgery. A surgeon can stitch the anal muscles more tightly together (sphincteroplasty). Or the surgeon takes muscle from the pelvis or buttock to support the weak anal muscles, a procedure known as muscle transposition. These surgeries can cure many people with bowel incontinence that is caused by a tear of the anal sphincter muscles.
- Sacral nerve stimulator. A surgeon implants a device that stimulates the pelvic nerves. This procedure may be most effective in people with bowel incontinence due to nerve damage.
- Sphincter cuff device. A surgeon can implant a cuff that is filled with air and surrounds the anal sphincter. A person deflates the cuff during bowel movements and reinflates it to prevent bowel incontinence.
- Colostomy. This is surgery to redirect the colon through an opening created in the skin of the belly. Colostomy is only considered when bowel incontinence keeps happening even when all other treatments have been tried.
Newer non-surgical procedures
There are newer, non-surgical procedures to treat bowel incontinence, such as:
- Radiofrequency anal sphincter remodeling. A probe that goes into the anus directs controlled amounts of heat energy into the anal wall. Radiofrequency remodeling causes mild injury to the sphincter muscles, which become thicker as they heal.
- Injectable biomaterials. Materials such as silicone, collagen, or dextranomer / hyaluronic acid can be injected into the anal sphincter to boost its thickness and function.
These procedures can reduce bowel incontinence in some people, without the risks of surgery. Because they are relatively new, their long-term effectiveness and safety aren't as well-known as other treatments.
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