Fecal incontinence (FI), also referred to as accidental bowel leakage (ABL), occurs when you are unable to hold a bowel movement. Fecal incontinence can be mortifying. Some individuals are ashamed and try to hide the problem, even from their provider. In fact, fewer than 30% of individuals with FI seek care (Brown, et al., 2017).
Fecal incontinence is more common than you think.
Did you know 1 in 3 people experience FI (National Institute of Diabetes and Digestive and Kidney Diseases, 2017)? Do not let embarrassment stand in your way.
Fecal incontinence can vary from person to person. Some people feel a sudden and urgent need to go but they are unable to reach a toilet in time; this is known as urge fecal incontinence (similar to urge urinary incontinence). Others may experience no sensation at all before passing stool; this is known as passive incontinence. Some individuals may lose a small piece of stool while passing gas. Fecal incontinence may occur daily, while others may have problems only from time to time (Bowel & Bladder Community, 2017).
Healthy bowel control relies on muscles and nerves in your rectum and anus that work together to do the following: hold in stool, send you a signal that the rectum is full and that you need to have a bowel movement, and relax when you’re ready to allow the stool to release. These healthy muscles are called sphincters and they close tightly like rubber bands around the anus.
What causes Fecal Incontinence
The most common cause is damage to one or both anal sphincter muscles (Michigan Medicine, 2017). The external anal sphincter is responsible for delaying bowel emptying once the rectum fills and the urge to empty the bowel is felt. People with a weak or damaged external anal sphincter muscle typically have urgency and may experience urge fecal incontinence. People with a damaged internal anal sphincter usually experience passive incontinence. Anal sphincter injury may result from childbirth, rectal surgeries, or other trauma. For some, weakness may occur as part of the normal aging process (Bowel & Bladder Community, 2017).
Constipation is also a major cause of FI. In cases of severe constipation or fecal impaction, a large, solid stool can become stuck in the rectum. This begins to stretch and weaken rectum muscles. Watery stools can leak around the solid mass causing fecal incontinence.
Diarrhea can be a cause, as well as a symptom. Loose stool can slip through the sphincters more easily than solid stool. Diarrhea can be on-going and recurring or sudden and unexpected. Conditions that can cause frequent diarrhea include Crohn’s disease (inflammation of the digestive system), Irritable Bowel Syndrome (a range of digestive symptoms, including diarrhea and bloating) and Ulcerative Colitis (inflammation of the large bowel). These conditions can cause scarring of the rectum and result in FI (National Institute of Diabetes and Digestive and Kidney Diseases, 2017).
Fecal incontinence is also caused by problematic nerves between the brain and the rectum. A nerve problem can mean your body is unaware of stools in your rectum, and make it difficult to control your sphincter muscles. Nerve damage can be related to a wide number of conditions including diabetes, multiple sclerosis, stroke, spina bifida, Parkinson’s, dementia and spinal cord injury.
Conservative medical management consisting of patient education, dietary changes (adequate daily fiber and water), behavioral techniques such as scheduled toileting, and pelvic floor exercises are recommended as first-line therapy. Patients engaging in these conservative treatments can restore up to 25% of their continence. When conservative management fails, biofeedback is another recommended first-line therapy. Biofeedback is a treatment technique in which people are trained to improve their health by using signals from their own bodies. Biofeedback can restore up to 55% of an individual’s continence (Whitehead, et al., 2015).
Some individuals may not find improvement with conservative management or may not be satisfied with the degree of improvement. For those individuals, additional options exist. The Eclipse system is a new inflatable balloon device approved by the U.S. Food and Drug Administration (FDA) for female FI. The Eclipse device is inserted into the vagina. When inflated, the balloon puts pressure through the vaginal wall onto the rectal area, thereby reducing the number of FI episodes.
Despite the success with conservative management, some individuals require additional therapies. Solesta is an in-office procedure in which a bulking agent is injected around the anal canal. Sphincteroplasty is a surgical intervention involving the reconstruction of the anal sphincter (the muscle controlling the anus). Interstim is another surgical intervention for FI. Interstim is a neuromodulation which simply means nerve therapy. Nerve stimulation uses mild electrical pulses to stimulate the sacral nerve which controls the bowel.
Help is Available
Fecal incontinence can be devastating. Individuals with FI often suffer in silence. It’s time to break the silence. Healthcare providers are better equipped than ever before to treat FI with effective, minimally invasive therapies. Be honest with your provider and get the help you deserve.
Bladder & Bowel Community. Bowel Conditions. Retrieved November 3rd, 2017 from
Brown, H., Wise, M., Westenberg, D., Schmuhl, N., Brezoczky, K., Rogers, R., et al., (2017). Validation of an instrument to assess barriers to care-seeking for accidental bowel leakage in women: the BCABL questionnaire. International Urogynecology Journal, 28, 1319-1328.
Michigan Medicine. Accidental Bowel Leakage (Fecal Incontinence). Retrieved November 3rd, 2017 from http://www.med.umich.edu/1libr/MBCP/FecalIncontinence.pdf
National Institute of Diabetes and Digestive and Kidney Diseases (2017). Symptoms & Causes of Fecal Incontinence. Retrieved November 2nd, 2017 from https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/symptoms-causes
Whitehead, W., Rao, S., Lowry, A., Nagle, D., Varma, M., Bitar, K., et al., (2015). Treatment of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases workshop. American Journal of Gastroenterology, 110, 138-146.