Health
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| Fecal Incontinence |
Fecal incontinence is 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 5.5 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.
Causes
Fecal incontinence can have several causes:
* Constipation
* damage to the anal sphincter muscles
* damage to the nerves of the anal sphincter muscles / rectum
* loss of storage capacity in the rectum
* diarrhea
* pelvic floor dysfunction
Constipation
Constipation is one of the most common causes of fecal
incontinence. Constipation causes large, hard stools to
become lodged in the rectum. Watery stool can then leak out
around the hardened stool. Constipation also causes the
muscles of the rectum to stretch, which weakens the muscles
so they can't hold stool in the rectum long enough for a
person to reach a bathroom.
Muscle Damage
Fecal incontinence can be 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. Hemorrhoid surgery can damage
the sphincters as well.
Nerve Damage
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. 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, and diseases that affect the
nerves, such as diabetes and multiple sclerosis.
Loss of Storage Capacity
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 disease also can
make rectal walls very irritated and thereby unable to contain
stool.
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.
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 midforties or later.
Diagnosis
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.
* 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.
* Anal electromyography tests for nerve damage, which is
often associated with obstetric injury.
Treatment
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.
Dietary Changes
Food affects the consistency of stool and how quickly it
passes through the digestive system. If your stools are hard
to control because they are watery, you may find that eating
high fiber foods adds bulk and makes stool easier to control.
But people with well-formed stools may find that high fiber
foods act as a laxative and contribute to the problem. Other
foods that may make the problem worse are drinks containing
caffeine, like coffee, tea, and chocolate, which relax the
internal anal sphincter muscle.
You can adjust what and how you eat to help manage fecal
incontinence.
* 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 involving 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
o caffeine
o cured or smoked meat like sausage, ham, or turkey
o spicy foods
o alcohol
o dairy products like milk, cheese, and ice cream
o fruits like apples, peaches, or pears
o fatty and greasy foods
o sweeteners, like sorbitol, xylitol, mannitol, and fructose,
which are found in diet drinks, sugarless gum and candy,
chocolate, and fruit juices
* 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.
* Eat and drink at different times. Liquid helps move food
through the digestive system. So if you want to slow things
down, drink something half an hour before or after meals, but
not with the meals.
* Eat the right amounts of fiber. For many people, fiber
makes stool soft, formed, and easier to control. Fiber is found
in fruits, vegetables, and grains, like those listed below. You'll
need to eat 20 to 30 grams of fiber a day, but add it to your
diet slowly so your body can adjust. Too much fiber all at
once can cause bloating, gas, or even diarrhea. Also, too
much insoluble, or undigestible, fiber can contribute to
diarrhea. So if you find that eating more fiber makes your
diarrhea worse, try cutting back to two servings each of fruits
and vegetables and removing skins and seeds from your food.
* Eat foods that make stool bulkier. Foods that contain
soluble, or digestible, fiber slow the emptying of the bowels.
Examples are bananas, rice, tapioca, bread, potatoes,
applesauce, cheese, smooth peanut butter, yogurt, pasta,
and oatmeal.
* Get plenty to drink. You need to drink eight 8-ounce
glasses of liquid a day to help prevent 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.
Medication
If diarrhea is causing the incontinence, medication may help.
Sometimes doctors recommend using bulk laxatives to help
people develop a more regular bowel pattern. Or the doctor
may prescribe antidiarrheal medicines such as loperamide or
diphenoxylate to slow down the bowel and help control the
problem.
Bowel Training
Bowel training helps some people relearn how to control their
bowels. In some cases, it involves strengthening muscles; in
others, it means training the bowels to empty at a specific
time of day.
* Use biofeedback. Biofeedback is a way to strengthen and
coordinate the muscles and has helped some people. Special
computer equipment measures muscle contractions as you do
exercises—called Kegel exercises—to strengthen the rectum.
These exercises work muscles in the pelvic floor, including
those involved in controlling stool. Computer feedback about
how the muscles are working shows whether you're doing the
exercises correctly and whether the muscles are getting
stronger. Whether biofeedback will work for you depends on
the cause of your fecal incontinence, how severe the muscle
damage is, and your ability to do the exercises.
* Develop a regular pattern of bowel movements. Some
people—particularly those whose fecal incontinence is caused
by constipation—achieve bowel control by training themselves
to have bowel movements at specific times during the day,
such as after every meal. The key to this approach is
persistence—it may take a while to develop a regular pattern.
Try not to get frustrated or give up if it doesn't work right
away.
Surgery
Surgery may be an option for people whose fecal incontinence
is caused by injury to the pelvic floor, anal canal, or anal
sphincter. Various procedures can be done, from simple ones
like repairing damaged areas, to complex ones like attaching
an artificial anal sphincter or replacing anal muscle with muscle
from the leg or forearm. People who have severe fecal
incontinence that doesn't respond to other treatments may
decide to have a colostomy, which involves removing a portion
of the bowel. The remaining part is then either attached to
the anus if it still works properly, or to a hole in the abdomen
called a stoma, through which stool leaves the body and is
collected in a pouch.
Content Source NIDDK.NIH
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 5.5 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.
Causes
Fecal incontinence can have several causes:
* Constipation
* damage to the anal sphincter muscles
* damage to the nerves of the anal sphincter muscles / rectum
* loss of storage capacity in the rectum
* diarrhea
* pelvic floor dysfunction
Constipation
Constipation is one of the most common causes of fecal
incontinence. Constipation causes large, hard stools to
become lodged in the rectum. Watery stool can then leak out
around the hardened stool. Constipation also causes the
muscles of the rectum to stretch, which weakens the muscles
so they can't hold stool in the rectum long enough for a
person to reach a bathroom.
Muscle Damage
Fecal incontinence can be 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. Hemorrhoid surgery can damage
the sphincters as well.
Nerve Damage
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. 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, and diseases that affect the
nerves, such as diabetes and multiple sclerosis.
Loss of Storage Capacity
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 disease also can
make rectal walls very irritated and thereby unable to contain
stool.
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.
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 midforties or later.
Diagnosis
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.
* 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.
* Anal electromyography tests for nerve damage, which is
often associated with obstetric injury.
Treatment
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.
Dietary Changes
Food affects the consistency of stool and how quickly it
passes through the digestive system. If your stools are hard
to control because they are watery, you may find that eating
high fiber foods adds bulk and makes stool easier to control.
But people with well-formed stools may find that high fiber
foods act as a laxative and contribute to the problem. Other
foods that may make the problem worse are drinks containing
caffeine, like coffee, tea, and chocolate, which relax the
internal anal sphincter muscle.
You can adjust what and how you eat to help manage fecal
incontinence.
* 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 involving 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
o caffeine
o cured or smoked meat like sausage, ham, or turkey
o spicy foods
o alcohol
o dairy products like milk, cheese, and ice cream
o fruits like apples, peaches, or pears
o fatty and greasy foods
o sweeteners, like sorbitol, xylitol, mannitol, and fructose,
which are found in diet drinks, sugarless gum and candy,
chocolate, and fruit juices
* 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.
* Eat and drink at different times. Liquid helps move food
through the digestive system. So if you want to slow things
down, drink something half an hour before or after meals, but
not with the meals.
* Eat the right amounts of fiber. For many people, fiber
makes stool soft, formed, and easier to control. Fiber is found
in fruits, vegetables, and grains, like those listed below. You'll
need to eat 20 to 30 grams of fiber a day, but add it to your
diet slowly so your body can adjust. Too much fiber all at
once can cause bloating, gas, or even diarrhea. Also, too
much insoluble, or undigestible, fiber can contribute to
diarrhea. So if you find that eating more fiber makes your
diarrhea worse, try cutting back to two servings each of fruits
and vegetables and removing skins and seeds from your food.
* Eat foods that make stool bulkier. Foods that contain
soluble, or digestible, fiber slow the emptying of the bowels.
Examples are bananas, rice, tapioca, bread, potatoes,
applesauce, cheese, smooth peanut butter, yogurt, pasta,
and oatmeal.
* Get plenty to drink. You need to drink eight 8-ounce
glasses of liquid a day to help prevent 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.
Medication
If diarrhea is causing the incontinence, medication may help.
Sometimes doctors recommend using bulk laxatives to help
people develop a more regular bowel pattern. Or the doctor
may prescribe antidiarrheal medicines such as loperamide or
diphenoxylate to slow down the bowel and help control the
problem.
Bowel Training
Bowel training helps some people relearn how to control their
bowels. In some cases, it involves strengthening muscles; in
others, it means training the bowels to empty at a specific
time of day.
* Use biofeedback. Biofeedback is a way to strengthen and
coordinate the muscles and has helped some people. Special
computer equipment measures muscle contractions as you do
exercises—called Kegel exercises—to strengthen the rectum.
These exercises work muscles in the pelvic floor, including
those involved in controlling stool. Computer feedback about
how the muscles are working shows whether you're doing the
exercises correctly and whether the muscles are getting
stronger. Whether biofeedback will work for you depends on
the cause of your fecal incontinence, how severe the muscle
damage is, and your ability to do the exercises.
* Develop a regular pattern of bowel movements. Some
people—particularly those whose fecal incontinence is caused
by constipation—achieve bowel control by training themselves
to have bowel movements at specific times during the day,
such as after every meal. The key to this approach is
persistence—it may take a while to develop a regular pattern.
Try not to get frustrated or give up if it doesn't work right
away.
Surgery
Surgery may be an option for people whose fecal incontinence
is caused by injury to the pelvic floor, anal canal, or anal
sphincter. Various procedures can be done, from simple ones
like repairing damaged areas, to complex ones like attaching
an artificial anal sphincter or replacing anal muscle with muscle
from the leg or forearm. People who have severe fecal
incontinence that doesn't respond to other treatments may
decide to have a colostomy, which involves removing a portion
of the bowel. The remaining part is then either attached to
the anus if it still works properly, or to a hole in the abdomen
called a stoma, through which stool leaves the body and is
collected in a pouch.
Content Source NIDDK.NIH