The Basics of Fecal Incontinence: You Are Not Alone

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Causes of Fecal Incontinence

Good bowel control relies on the muscles and nerves in your rectum working together to hold in stool. They alert you when your rectum is full, and move the stool when appropriate.  When your muscles and nerves are not working properly, fecal incontinence can happen. Things that can cause fecal incontinence include poor stool consistency (diarrhea or constipation), muscle damage or weakness, nerve damage, or loss of the stretch capacity of the rectum from chronic disorders. 

Tests and Diagnoses

After a detailed history and physical examination, your doctor may order some additional tests to evaluate the cause of your incontinence.  These tests can include: anal manometry, anal ultrasound, MRI, defecography, flexible sigmoidoscopy, or colonoscopy. However, anal manometry and anal ultrasound are the two most common tests used to understand the cause of fecal incontinence. Both tests take approximately 30 minutes to complete and neither test is painful; therefore, no sedation or anesthesia is required. 

Anal Manometry

Anal manometry uses pressure sensors and a balloon that can be inflated in your rectum to check the sensitivity and function of the rectum. Anal manometry also checks the tightness of the anal sphincter muscles around your anus.

Anal Ultrasound

Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off from your organs to create an image of their structure. An anal ultrasound is specific to the anus and rectum.  The images can show the structure of your anal sphincter muscles. To prepare for these tests, your doctor will usually suggest using an enema and fasting for two hours before the test.

Treatment Options

Treatment for fecal incontinence depends on the cause of your problem and may include one or more of the following: dietary modifications, medications, bowel training, pelvic floor exercises or pelvic physical therapy, or surgery.

Dietary Modifications and Medications

Changing your diet may significantly improve your bowel control. Fiber and fluid intake are the key to doing this.  Adequate fiber intake will give your stool bulk and form. Larger and heavier stools are easier for your body to keep in place than smaller stools. Anti-diarrheal medications may also be recommended to slow down your bowels and help control them. 

Bowel Training

Another simple treatment option your doctor may recommend is developing a regular bowel movement pattern. This can improve your fecal incontinence, especially if your incontinence is due to constipation.  Bowel training involves trying to have bowel movements at specific times of the day.  Over time, your body will become used to a regular bowel movement pattern, thus reducing constipation and related fecal incontinence.

Pelvic Floor Exercises and Physical Therapy

Exercises to strengthen pelvic floor muscles can improve your bowel control. Pelvic floor exercises involve squeezing and relaxing the pelvic floor muscles several times a day. Biofeedback therapy (physical therapy) can also help you perform these exercises properly. This therapy improves your awareness of the sensations in your rectum; teaching you how to coordinate squeezing your external sphincter muscle with the sensation of rectal filling. Success with pelvic floor exercises depends on the cause of your fecal incontinence, it’s severity, and your ability to follow your health care provider’s recommendations.

Surgery

The most common fecal incontinence surgery is a sphincteroplasty.  This procedure is generally recommended if you have a defect in the muscles that restrain a bowel movement.  During this operation, the surgeon reconnects the separated ends of a sphincter muscle torn by childbirth or another injury. 

Another surgical option includes injecting non-absorbable bulking agents into your anus wall. This bulks up the anal tissues, and makes the anal opening narrower. Allowing your sphincter muscles to close more effectively.

Electrical stimulation by way of implant, also called sacral nerve stimulation or neuromodulation, involves placing electrodes in the nerves that control the muscles of your anus and rectum and continuously stimulating the nerves with electrical pulses. The sacral nerves connect to the part of your spine in the hip area. A battery-operated stimulator is placed beneath your skin. Based on your response to this treatment, your health care provider can adjust the amount of stimulation. You can turn the stimulator on or off at any time.

No matter the cause, fecal incontinence impacts your daily life. It is an embarrassing and life altering problem. If you are experiencing bowel control issues, you can regain your life. Talk to your doctor about your non-surgical and surgical options for correcting your fecal incontinence.