What is Fecal Incontinence?
Fecal incontinence is the involuntary loss of gas or stool. When your bowel functions normally, specific nerves send messages from the brain to muscles in the rectum and anus, when to tense up and when to relax. This allows you to control when feces are released. Fecal or bowel incontinence occurs when you no longer have complete control over your bowel movements. This will typically result in you unexpectedly leaking feces.
Fecal incontinence is more common than you might think. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), around 33% of people currently suffer from some form of fecal incontinence. The degree of incontinence can range from you occasionally leaking stool to complete loss of bowel control.
Causes of Fecal Incontinence
There are several possible reasons why you may develop fecal incontinence:
Constipation
If you suffer from chronic constipation, you may eventually get a build-up of dry, hard stool (impacted stool) in your rectum. To cope with the build-up, the muscles in your rectum and intestines will stretch, and if the stool becomes too large to pass, the muscles will eventually weaken. This may allow more watery stool that has become stuck behind the hard stool’s mass to move around it and leak out.
Pregnancy and vaginal delivery
Bowel incontinence is a typical symptom of pregnancy and one of the leading causes of incontinence in women. As the baby grows in the mother’s womb, the pressure on the pelvic floor increases. This may lead to problems in contracting the pelvic floor muscles with the same speed and force as before.
Trauma and nerve damage to the pelvic floor muscles are also common during vaginal delivery as they stretch and contract. Some women even lose feeling in their pelvic floor muscles after delivery. This may lead to the under and over-contracting of the muscles, often leading to incontinence.
Neurologic disease
Damage to the nerves that control and sense your bowel can also lead to fecal incontinence. Conditions such as stroke or multiple sclerosis can affect bowel function. Typically this may have been caused by you constantly straining when you make a bowel movement. It can also be caused by damage sustained during childbirth or if you suffered a spinal cord injury. Nerve damage also occurs as a result of some diseases, including diabetes.
Diarrhea
If you suffer from chronic diarrhea, you might be more susceptible to developing fecal incontinence, as it is not as easy for your body to hold loose stool.
Hemorrhoids
Another cause of fecal incontinence is hemorrhoids, as the swollen veins may stop your anus from closing completely. Also, you may develop fecal incontinence after surgery to treat your hemorrhoids if you suffer nerve or muscle damage.
Treatments for Fecal Incontinence
Whatever the cause, fecal incontinence can be embarrassing. But don’t shy away from talking to your doctor about this common problem. Treatments can improve fecal incontinence and your quality of life.
Some people may experience occasional mild bouts of incontinence. Often, you might choose to manage these symptoms on your own. However, your incontinence may become so frequent or severe, it affects your everyday activities or causes you distress. In that case, you should see your doctor, who can recommend a treatment plan.
Dietary & Lifestyle Changes
Dietary changes are a big part of controlling fecal incontinence – depending on the cause, you may want to eat more of a certain food or avoid others. Your doctor might also recommend keeping a food diary to identify foods or drinks that may exacerbate your symptoms.
Many people think that if they drink less, they will need to go less. However, drinking less can make your fecal incontinence symptoms worse by causing constipation.
Foods that are spicy or have a high acidic content can worsen your symptoms. Also, cutting back on certain drinks like alcohol, carbonated drinks, and caffeinated drinks like coffee and tea will improve your symptoms.
Incontinence symptoms can also be helped by losing weight.
Pelvic Floor Muscle Training
Your doctor may recommend pelvic floor muscle training (Kegel exercises) to help strengthen your pelvic floor. This may improve muscle strength and control by tightening the muscles that control your passing of feces.
Bowel Training
Training yourself only to empty your bowels during certain times can help manage how much you need to go to the toilet throughout the day.
Medicines
Medicines are typically only prescribed for types of fecal incontinence that are associated with urgency to move your bowels. They are usually formulated to help the muscles or nerves around the rectum and anus manage your flow.
Surgery
Surgery may be an option for some people. Anal bulking agents are injected around the anus to narrow the opening if the muscles are too weak to keep the anus closed. A sphincteroplasty (revision of the anal sphincter) can be performed to repair tears in your sphincter muscles that may have occurred as the result of vaginal birth. However, surgery is typically only addressed if other less invasive options are tried.
The “bottom” line is, if you are bothered by fecal incontinence and can’t manage it on your own, you should consider consulting with a gastroenterologist or colorectal surgeon to see what treatment options are appropriate for you.