About Bowel Control Problems (Fecal Incontinence)

Overview

Fecal incontinence, also known as accidental bowel leakage, happens when a person cannot control the release of solid or liquid stool from the anus (the opening through which stool leaves the body). It can happen when there’s a strong urge to have a bowel movement, but the person can’t get to the bathroom in time, or it can happen without the person even realizing it.

There are two types of fecal incontinence:

• Urge incontinence: When a person feels a strong urger to have a bowel movement, but the muscles that control the bowel (called the pelvic floor muscles) are too weak to hold it in.
• Passive incontinence: When stool leaks out without the person knowing.

Fecal incontinence can be upsetting and embarrassing, and some people may try to hide the problem. However, it is important to talk openly with a doctor to get the right diagnosis and treatment options.

Causes and Risk Factors

The causes of fecal incontinence include:

• Dysfunction of the anal sphincter complex: This can happen due to injury or damage to the muscles and nerves that control bowel movements, such as the anal sphincter (the muscles that control the release of stool from the anus).
• Impaired rectal sensation: Conditions such as diabetes, neurological disorders, or previous rectal surgery can affect the ability to sense stool in the rectum (the lower part of the large intestine where stool is stored before leaving the body), leading to incontinence.
• Reduced rectal tone: Certain conditions, such as inflammatory bowel disease or radiation therapy, can cause the rectum to become stiff and less able to hold stool.
• Pelvic floor dysfunction: Weakness or damage to the pelvic floor muscles, which help support the organs involved in bowel movements, can also add to fecal incontinence.

The non-modifiable risk factors of fecal incontinence cannot be changed or controlled. These include:

• Age: The risk of fecal incontinence increases with age, as older adults may experience age-related changes in their bowel function and weakening of the pelvic floor muscles.
• Previous recto-anal or obstetric surgery:
  • Surgeries involving the rectum or anus can affect the muscles controlling bowel movements and increase the risk of fecal incontinence.
  • Obstetric surgeries: In childbirth, certain procedures like episiotomies (a cut made to help deliver the baby) or C-section can also add to weakening the pelvic muscles or damaging the anal sphincter, leading to incontinence.
• Neurological disorders: Conditions such as stroke, multiple sclerosis (MS), or spinal cord injuries can disrupt the signals between the brain and the muscles that control bowel function, making it harder to control bowel movements.

The modifiable risk factors of fecal incontinence can be influenced or changed. These include:

• Obesity: Carrying extra weight can put pressure on the pelvic floor muscles and increase the risk of incontinence.
• Chronic (long-lasting) constipation: Pushing too hard during bowel movements (straining) due to constipation can weaken the pelvic floor muscles over time.
• Diarrhea: Chronic diarrhea can irritate and inflame the rectum, contributing to fecal incontinence.
• Smoking: Smoking may increase the risk of fecal incontinence by affecting blood flow and tissue health.

It's important to understand that these risk factors can influence each other. Making lifestyle changes to address modifiable risk factors may help lower the risk or reduce the severity of fecal incontinence. Talk with your healthcare professional for personalized advice.

Symptoms

The most common early symptoms of fecal incontinence include:

• Urge incontinence: A strong urge to have a bowel movement, but being unable to make it to the toilet in time
• Passive incontinence: Passing stool without being aware of the need to do so

Symptoms that may appear if it worsens or becomes more severe:

• Gas and bloating: This can happen as a result of digestive issues related to fecal incontinence.
• Diarrhea: Loose stools or frequent diarrhea can be a sign of worsening incontinence
• Constipation: Sometimes, people may experience periods of diarrhea followed by times of constipation.
• Soiling of underwear: This is a common symptom as the ability to control bowel movements decreases.

It's important to note that not all people will experience the same symptoms, and the severity of symptoms can be different. If you are experiencing fecal incontinence, it is recommended to talk with a healthcare professional for the right diagnosis and treatments. They can provide personalized guidance based on your specific situation.

Diagnosis

To diagnose fecal incontinence, doctors may use a mix of the following exams, tests, and procedures

• Medical history: Your doctor will ask you specific questions about your symptoms and medical history.
• Physical exam: A complete physical examination will be done to check the muscles and nerves in your anus, pelvic floor, and rectum.
• Lab tests: When checking for fecal incontinence, doctors may use tests to find related health issues.
  • Blood tests check for anemia, infection, or inflammation that could affect bowel control.
  • Stool tests look for blood, infection, and inflammation in the digestive system.
  • Urine tests find diseases like type 2 diabetes that might impact nerve function and bowel control.
• Endoscopy: This is where doctors use a thin, flexible tube with a camera to look inside the anus, rectum, and colon. This helps them see if there are any inflammation or other problems in the digestive tract that might be causing fecal incontinence.

To determine the stage or severity of fecal incontinence, additional exams and tests may include:

• Anorectal manometry: This test checks how well the muscles and nerves around the anus and lower bowel are working.
• Defecography: During this X-ray test, doctors look at how well you can hold in and let out stool.
• Electromyography: This test measures the health of the muscles and nerves in your anus and pelvic floor.

Remember that these are general descriptions, and the specific exams or tests recommended for you may be different It's important to talk with your healthcare professional for personalized advice.

Treatment Options

The goals of treatment for fecal incontinence (FI) are to make the episodes happen less often and be less severe, and to help improve the person’s daily life. Here are different treatment options that can help reach these goals:

• Medication:
  • Anti-diarrheal: If diarrhea is causing the problem, doctors might suggest medicines like loperamide or bismuth subsalicylate to help.
  • Bulk laxatives: If constipation is the issue, fiber supplements like methylcellulose or psyllium might be recommended to make things better.
  • It's important to talk with a doctor before using any medication.
• Therapies:
  • Physiotherapeutic techniques: These exercises strengthen the muscles around the pelvic floor and anus, making them tighter, able to work longer without getting tired (endurance), and work better together (coordination). This helps improve how well you can control your bowel movements.
  • Bowel training: This helps people learn to go to the bathroom at specific times during the day to get better at controlling their bowel movements.
  • Sacral nerve stimulation: This treatment uses a device to send gentle electrical signals to the nerves that manage bowel movements. It helps control these nerves, making it easier to manage when and how you go to the bathroom.
• Therapeutic procedures:
  • Surgical interventions: These surgeries are done to fix physical problems with the rectum, pelvic floor, or anal sphincters that are causing FI.
• Health behavior changes:
  • Dietary changes: Changing what you eat can help reduce or prevent FI. A doctor can tell you which foods and drinks might make diarrhea worse and which can help if you’re constipated.
  • Eating more fiber and drinking plenty of water are good ways to help keep bowel movements regular.

It's important to have a treatment plan that fits your specific needs. Talking with a healthcare professional is important because they can give you advice that’s right for you, based on what’s causing FI and how severe it is.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.