Fecal incontinence is the inability to control your bowels. You may have stool leakage or you may not be able to hold your bowels until you can reach a toilet. Close to seven million Americans suffer from fecal incontinence, affecting people of all ages, more commonly women.  This is not a normal part of aging, and many people feel ashamed and embarrassed.  

Fecal incontinence can have several causes, including anal sphincter muscle damage, damage of the nerves to the anus or rectum, stool consistency (diarrhea), decreased rectal storage capacity, or pelvic floor dysfunction.  The anal sphincter muscles normally are strong enough to keep stool inside the rectum, but damage from childbirth, surgery or trauma can cause the muscles to weaken. Often, people are not aware of the need to use the bathroom until the stool has already leaked out; this can be caused by decreased nerve sensation or diminished rectal storage capacity.  There are many disease states that can cause this, including diabetes, multiple sclerosis, stroke or pelvic radiation.  The consistency of your stool is also an important factor, since it is more difficult to control gas than it is liquids or solids.  

Diagnosis of fecal incontinence involves a history and physical examination by your doctor. At that time, you may need further testing which will be scheduled for you. Testing may include anal ultrasound (to look at the shape of the anal sphincters), anal manometry (to determine the tightness of the sphincters and the ability of the sphincters to sense and create pressure), and pudendal nerve motor latency testing (to test for nerve damage).  

Treatment of fecal incontinence depends on the cause and severity of the symptoms. Typically it will include dietary changes, bowel training and may include surgery. Dietary changes involve adding foods that will bulk up the stool to decrease its water content to make it easier to control. Soluble fiber is often helpful to slow the emptying of the bowels.  Avoiding caffeine is also helpful since caffeine relaxes the anal sphincter muscles.   

Keeping a food diary of what you eat and when you have an incontinence episode may help identify “trigger” foods that cause accidents. Developing a regular pattern of bowel movements such as going to the toilet 30 to 45 minutes after every meal can also be helpful in avoiding incontinence. Surgery may be an option for people whose fecal incontinence is caused by sphincter damage.  

Test results will be reviewed with you during an office appointment scheduled one week after the tests are completed.  This is done to review your ultrasound images and test results with you, explaining the findings and discussing your treatment options in person.    

To make an appointment, call Colorectal Physicians & Surgeons of PA at 814-453-2777.