Fecal Incontinence

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) calls fecal incontinence the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you can get to a toilet. Or stool may leak from the rectum unexpectedly.

More than 6.5 million Americans have fecal incontinence. It affects people of all ages - children as well as adults. Fecal incontinence is more common in women than in men and more common in older adults than in younger ones. It is not, however, a normal part of aging.

Loss of bowel control can be devastating. People who have fecal incontinence may feel ashamed, embarrassed or humiliated. Some don't want to leave the house out of fear they might have an accident in public. Most try to hide the problem as long as possible, so they withdraw from friends and family. The social isolation is unfortunate but may be reduced because treatment can improve bowel control and make incontinence easier to manage.

Fecal incontinence can have several causes, according to NIDDK:

• Damage to the anal sphincter muscles - Fecal incontinence is most often caused by injury to one or both of the ring-like muscles at the end of the rectum called the anal internal and/or external sphincters. The sphincters keep stool inside. When damaged, the muscles aren't strong enough to do their job, and stool can leak out. In women, the damage often happens when giving birth. The risk of injury is greatest if the doctor uses forceps to help deliver the baby or does an episiotomy, which is a cut in the vaginal area to prevent it from tearing during birth. (Read about "Childbirth") Hemorrhoid surgery can damage the sphincters as well. (Read about "Hemorrhoids")
• Damage to the nerves of the anal sphincter muscles or the rectum - Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that sense stool in the rectum. (Read about "Nervous System") If the nerves that control the sphincters are injured, the muscle doesn't work properly and incontinence can occur. If the sensory nerves are damaged, they don't sense that stool is in the rectum. You then won't feel the need to use the bathroom until stool has leaked out. Nerve damage can be caused by childbirth, a long-term habit of straining to pass stool, stroke (Read about "Stroke"), and diseases that affect the nerves, such as diabetes and multiple sclerosis. (Read about "Diabetes" and "Multiple Sclerosis")
• Loss of storage capacity in the rectum - Normally the rectum stretches to hold stool until you can get to a bathroom. But rectal surgery, radiation treatment and inflammatory bowel disease can cause scarring that makes the walls of the rectum stiff and less elastic. The rectum then can't stretch as much and can't hold stool, and fecal incontinence results. Inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease, also can make rectal walls very irritated and thereby unable to contain stool. (Read about "Radiation Therapy" "Ulcerative Colitis" "Crohn's Disease")
• Diarrhea - Diarrhea, or loose stool, is more difficult to control than solid stool that is formed. Even people who don't have fecal incontinence can have an accident when they have diarrhea. (Read about "Diarrhea")
• Pelvic floor dysfunction - Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocele) and/or generalized weakness and sagging of the pelvic floor. Often the cause of pelvic floor dysfunction is childbirth, and incontinence doesn't show up until the mid-forties or later. (Read about "Pelvic Floor Disorders")

Diagnosis & treatment options

To diagnosis the cause, NIDDK says the doctor will ask health-related questions and do a physical exam and possibly other medical tests.

• Anal manometry checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum.
• Anorectal ultrasonography evaluates the structure of the anal sphincters. (Read about "Ultrasound Imaging")
• Proctography, also known as defecography, shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can evacuate the stool.
• Proctosigmoidoscopy allows doctors to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors or scar tissue. (Read about "Flexible Sigmoidoscopy")
• Anal electromyography tests for nerve damage, which is often associated with obstetric injury.

Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training or surgery. More than one treatment may be necessary for successful control since continence is a complicated chain of events.

Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, making it less watery and easier to control. Also, avoid foods that contribute to the problem. They include foods and drinks containing caffeine, like coffee, tea, and chocolate, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly.

You can adjust what and how you eat to help manage fecal incontinence, according to NIDDK. Keep a food diary, list what you eat, how much you eat and when you have an incontinent episode. After a few days, you may begin to see a pattern between certain foods and incontinence. After you identify foods that seem to cause problems, cut back on them and see whether incontinence improves. Foods that typically cause diarrhea, and so should probably be avoided, include:

• caffeine
• cured or smoked meat like sausage, ham, or turkey
• spicy foods
• alcohol
• dairy products like milk, cheese, and ice cream (Read about "Lactose Intolerance")
• fruits like apples, peaches, or pears
• fatty and greasy foods
• sweeteners, like sorbitol, xylitol, mannitol and fructose, which are found in diet drinks, sugarless gum and candy, chocolate, and fruit juices

NIDDK also suggests that you eat smaller meals more frequently. In some people, large meals cause bowel contractions that lead to diarrhea. You can still eat the same amount of food in a day, but space it out by eating several small meals.

Eating and drinking at different times may help. Liquid helps move food through the digestive system. So if you want to slow things down, you could drink something half an hour before or after meals, but not with the meals.

You may need to adjust your fiber intake. (Read about "Fiber and Health") Fiber makes stool soft, formed and easier to control. Fiber is found in fruits, vegetables and grains. NIDDK recommends people eat 20 to 30 grams of fiber a day, but stresses that people should talk with their doctor, and add the fiber to the diet slowly so the body can adjust. Too much fiber all at once can cause bloating, gas, or even diarrhea. Also, too much insoluble, or indigestible, fiber can contribute to diarrhea. So if you find that eating more fiber makes your diarrhea worse, you could try cutting back to two servings each of fruits and vegetables and removing skins and seeds from your food.

It's also important to get enough to drink. NIDDK says people need to drink eight 8-ounce glasses of liquid a day to help prevent dehydration (Read about "Dehydration") and to keep stool soft and formed. Water is a good choice, but avoid drinks with caffeine, alcohol, milk or carbonation if you find that they trigger diarrhea.

Over time, diarrhea can rob you of vitamins and minerals. Ask your doctor if you need a vitamin supplement. (Read about "Vitamins & Minerals")