Bowel incontinence, also called fecal incontinence, is a loss of bowel control that results in involuntary fecal elimination. Severity can range from an infrequent involuntary passage of small amounts of stool to a total loss of bowel control. Some people with bowel incontinence feel the urge to have bowel movements but are unable to wait to reach a bathroom. Other people don’t feel the sensation of a pending bowel movement and have a complete lack of bowel control. Bowel incontinence can be an embarrassing condition, but it can improve with treatment.
What Causes Bowel Incontinence?
Normal bowel control relies on the proper function of the pelvic muscles, the rectum (the lower end of the large intestine), the sphincter muscles (the muscles in the anus), and the nervous system. Injury to any of these areas can result in bowel incontinence. Common causes of bowel incontinence include:
Chronic constipation can lead to a fecal impaction. This happens when a stool gets stuck in the rectum. The stool can stretch and weaken the sphincter, which makes the muscles incapable of stopping normal passage. Another complication of a fecal impaction is the leakage of liquid fecal matter through the anus.
Diarrhea is the result of loose or liquid stools. These loose stools can cause an immediate need for a bowel movement. The need can be so sudden that you don’t have enough time to reach a bathroom.
Damage to the sphincter will prevent the muscles from keeping the anus tightly closed. Hemorrhoids, surgery, trauma, and constipation can damage the sphincter muscles.
If the nerves that control sphincter movement are damaged, the sphincter muscles won’t close properly. When this happens, you will not feel the urge to go to the bathroom. Some causes of nerve damage include trauma from giving birth, frequent constipation, stroke, diabetes, and multiple sclerosis.
External hemorrhoids can block the sphincter from closing completely. This allows loose stool and mucus to pass involuntarily.
Pelvic Floor Dysfunction
Women can suffer from damage to the muscles and nerves in their pelvis while giving birth, but symptoms of pelvic floor dysfunction may not be immediately noticeable. They may occur years later. Complications include:
weakness of the pelvic muscles that are used during bowel movements
rectal prolapse, which is when the rectum protrudes through the anus
rectocele, which is when the rectum protrudes through the vagina
Who Is at Risk for Bowel Incontinence?
Anyone can suffer from bowel incontinence, but certain people are more likely to get it than others. You may be at risk if:
you’re over the age of 65
you’re a woman
you’re a woman who have given birth
you have frequent constipation
you have a disease or injury that caused nerve damage
How Is Bowel Incontinence Diagnosed?
Your doctor will perform a thorough medical evaluation to diagnose bowel incontinence. Your doctor will ask you about the frequency of the incontinence, when it occurs, diet, medications, and health problems. The following tests may help reach a diagnosis:
physical examination of the rectal area
barium enema (X-ray of the large intestine, including the colon and rectum)
electromyography (to test the function of muscles and related nerves)
How Is Bowel Incontinence Treated?
The treatment for bowel incontinence depends on the cause. Some of the treatment options include:
Foods that cause diarrhea or constipation are identified and eliminated from the diet. This can help normalize and regulate bowel movements. Your doctor many recommend an increase in fluids and fiber.
For diarrhea, antidiarrheal medications such as loperamide, codeine, or diphenoxylate/atropine (Lomotil) may be prescribed to thicken stools. Your doctor may recommend fiber supplements for constipation.
Following a bowel retraining routine can encourage normal bowel movements. Aspects of this routine may include:
sitting on the toilet on a regular schedule
stimulating the sphincter muscles with a lubricated finger
using suppositories to stimulate bowel movements
You have the option of wearing specially designed undergarments for added protection. These garments are available in disposable and reusable forms, and some brands use technology that minimizes odors.
Kegel exercises strengthen the pelvic floor muscles. These exercises involve a routine of repeatedly contracting the muscles that are used when going to the bathroom. You should consult your doctor to learn the correct way to do the exercises.
Biofeedback is an alternative medical technique. With it, you learn to use your mind to control your bodily functions with the help of sensors. If you have bowel incontinence, biofeedback will help you learn how to control and strengthen your sphincter muscles. Sensors are placed in your anus and on your abdomen. Your doctor will then ask you to contract the sphincter muscles. The muscle contractions are visually displayed as a graph on a computer screen so you can observe the strength of the muscle movements. By watching the graph, or the “feedback,” you learn how to improve rectal muscle control, or the “bio.”
Surgical treatment is generally reserved for severe cases of bowel incontinence. There are several surgical options available:
Sphincteroplasty: A defective or scarred portion of the sphincter is removed, and the healthy part of the muscle is tightened.
Gracilis muscle transplant: The gracilis muscle is transferred from the thigh and placed around the sphincter muscles to add strength and support.
Artificial sphincter: An artificial sphincter is a silicone ring that is implanted in the anus. You manually deflate the artificial sphincter to allow for defecation and inflate it to close the anus, which prevents the leakage of feces.
Colostomy: Some people who have severe bowel incontinence choose to undergo surgery for a colostomy. During a colostomy surgery, your surgeon redirects the end of the large intestine to pass through the abdominal wall. A disposable bag is attached to the stoma, which is the portion of the intestine that is visible on the outside of the abdomen. After the surgery is complete, stools no longer pass through the anus but instead empty from the stoma into a disposable bag.
Solesta is an injectable gel that was approved by the United States Food and Drug Administration (FDA) in 2011 for the treatment of bowel incontinence. The goal of Solesta treatment is to increase the amount of rectal tissue. The gel is injected into the anus and effectively reduces or completely treats bowel incontinence in some patients. It works by causing the growth of rectal tissue, which narrows the anal opening and helps it stay tightly closed.
Can Bowel Incontinence Be Prevented?
Age, past trauma, and certain medical conditions can cause bowel incontinence. Unfortunately, the condition isn’t always preventable. The risk, however, can be reduced by maintaining regular bowel movements and by keeping the pelvic muscles strong.
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