Definition

Fecal incontinence is the loss of control over the bowels. Some people may have uncontrolled release of just gas and liquid stool. Others have no control over the release of solid waste.

Causes

Women are more likely to suffer from this condition than men. Many cases are a result of an injury to the pelvic floor. The pelvic floor is a group of muscles that support pelvic organs. Injury can happen through complications from childbirth . Other causes include:

• Constipation
• Rectal prolapse
• A condition that is present from birth
• Trauma or injury to anal sphincter or its nerves—the healthy sphincter opens and closes to control the release of fecal material
• Diarrhea
• Scarring of the rectum from radiation therapy or surgery

Risk Factors

This condition is more common in older adults.

Risk factors include:

• History of episiotomy
• Diseases of the nervous system such as stroke
• Damage to the spinal cord such as cauda equina syndrome
• Other risk factors thought to contribute to fecal incontinence include:
  • Diabetes
  • Lack of physical activity
  • Being overweight

Symptoms

The main symptom is the inability to control bowel movements, which leads to leakage of solid or liquid stool.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may send you to a specialist, such as a:

• Gastroenterologist
• Colorectal surgeon
• Proctologist

Your bodily structures may need to be viewed. This can be done with:

• X-rays
• Ultrasound
• MRI scan
• Proctosigmoidoscopy or colonoscopy

The pressure of your anal canal may need to be checked. This can be done with anorectal manometry.

Treatment

Talk with your doctor about the best plan for you. Options include:

Prevention

To help reduce your chance of getting fecal incontinence, take the following steps:

• Prevent constipation by eating a high-fiber diet and drinking plenty of fluids.
• Pay attention to your diet and avoid foods that trigger diarrhea.
• Try to maintain a regular bowel movement schedule.
• Talk to your doctor if you are having trouble with diarrhea or constipation.

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

Canadian Society of Intestinal Research http://www.badgut.org

Fecal incontinence: treatment. American Academy of Family Physicians website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/fecal-incontinence/treatment.html
Updated April 2014. Accessed December 18, 2014.

Garg, P, Song J, Bhatia A, Kalia H, Menon G. The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Colorectal Diseases. 2010;12:965-970.

Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health State-of-the-Science Conference Statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449-458.

Rectal prolapse. American Society of Colon & Rectal Surgeons website. Available at:
http://www.fascrs.org/patients/conditions/rectal_prolapse/
Updated October 2012. Accessed December 18, 2014.

12/4/2009 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Deutekom M, Dobben A. Plugs for containing fecal incontinence. Cochrane Database Syst Rev. 2009;(4):CD005086.

11/5/2014 DynaMed’s Systematic Literature Surveillance
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Pannu HK, Glanc P, et al. ACR Appropriateness Criteria® pelvic floor dysfunction [online publication]. Reston (VA): American College of Radiology (ACR); 2014. 20 p. Available at: http://www.guideline.gov/content.aspx?id=48295#Section420. Accessed November 5, 2014.