INCONTINENCE, FECAL

 Basic information

description

Fecal incontinence is the loss of bowel control. It can be due to several problems. Bowel control requires normal function of the rectum, anus, and nervous system. Bowel control also requires that a person be mentally alert and physically able to get to a bathroom. Fecal incontinence is common and can affect anyone over age four. It occurs more often in older adults and women. It greatly affects a person’s quality of life. They won’t leave home in fear of an accident. They avoid talking about the problem with their health care provider. Urinary incontinence (lack of bladder control) often occurs along with fecal incontinence.

FREQUENT SIGNS & SYMPTOMS

• Unable to control the passage of gas or stools.
• It can range from an occasional stool leakage to a complete loss of bowel control.
• Cramping, bloating, constipation, or diarrhea.

causes

• The muscles of the anus (called sphincters) can become weak or damaged.
• Nerves in the anus or rectum are damaged.
• The rectum loses its ability to hold stool.
• Weakness of the pelvic floor muscles that hold the rectum in place.

risk increases with

• Older adults; females more than males.
• Obesity and/or lack of physical activity.
• Childbirth; episiotomy (cut in skin to assist delivery).
• Muscle or nerve injury; pelvic surgery or radiation.
• Diabetes, fecal impaction, irritable bowel syndrome, inflammatory bowel disease, constipation, or diarrhea.
• Physical disability (e.g., bedridden) or a cognitive disorder (e.g., stroke, dementia, or Alzheimer’s disease).
• Chronic laxative use. Use of certain weight loss drugs.

PREVENTIVE MEASURES

• None specific. Get medical care for treatable risk factors. Maintain healthy weight. Exercise regularly.
• Avoid episiotomy during childbirth if possible. After giving birth, pelvic floor muscle training and biofeedback may help prevent future problems.
• Avoid routine use of laxatives.

expected outcomes

Simple treatment measures help many patients improve bowel function and restore their quality of life. Surgery improves symptoms for others, but may fail with time.

possible complications

• Embarrassment and shame. Avoiding social activities.
• Surgical treatments may lead to complications.
• Irritated skin around the anus.

 diagnosis & treatment

general measures

• Your health care provider may do a physical exam of the anal area. A pin or probe can be used to check for nerve damage. A digital rectal exam (inserting a finger into the rectum) checks for muscle strength. Questions will be asked about your symptoms, diet, activities, and medical history. Medical tests may include ultrasound, nerve and muscle studies, sigmoidoscopy, or others.
• Treatment depends on the cause, how severe the symptoms are, and the patient’s physical and mental health. Steps may include treating an underlying cause, diet changes, drugs, bowel training, biofeedback, surgery, or other specific therapy.
• Wear disposable underwear or pads if needed.
• Bowel training can involve strengthening muscles or training the bowels to empty at a specific time of day.
• Biofeedback is a type of behavior change therapy. It helps you learn to control bodily functions.
• Surgery to repair sphincter muscles may be an option.
• Other types of treatment may be discussed. They can include injections in the anus, anal plugs, nerve stimulation, an artificial bowel sphincter, surgical procedures, or other newer therapies.

medications

• Drugs may be prescribed for diarrhea or constipation.
• Fiber supplements may be recommended.
• Use protective creams to prevent skin irritation.

activity

You may be taught how to perform pelvic floor muscle exercises (called Kegel). Do these on a regular basis.

diet

• Eat several, small meals each day. Eat the right amount of fiber. Eat and drink at different times.
• Keep a food diary to see if foods cause incontinence.

 notify our office if

• You or a family member has symptoms of fecal incontinence.
• Symptoms worsen or don’t improve with treatment.

Special Notes: