Fecal incontinence is the inability to control bowel movements. It’s a common problem, especially among older adults.
Accidental bowel leakage is usually not a serious medical problem. But it can seriously interfere with daily life. People with bowel incontinence may avoid social activities for fear of embarrassment.
Many effective treatments can help people with bowel incontinence. These include:
- medicine
- surgery
- minimally invasive procedures
Talking to your doctor is the first step toward freedom from bowel incontinence.
Causes of Bowel Incontinence
The most common cause of bowel incontinence is damage to the muscles around the anus (anal sphincters). Vaginal childbirth can damage the anal sphincters or their nerves. That’s why women are affected by accidental bowel leakage about twice as often as men.
Anal surgery can also damage the anal sphincters or nerves, leading to bowel incontinence.
There are many other potential causes of bowel incontinence, including:
- Diarrhea (often due to an infection or irritable bowel syndrome)
- Impacted stool (due to severe constipation, often in older adults)
- Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
- Nerve damage (due to diabetes, spinal cord injury, multiple sclerosis, or other conditions)
- Radiation damage to the rectum (such as after treatment for prostate cancer)
- Cognitive (thinking) impairment (such as after a stroke or advanced Alzheimer’s disease)
More than one cause for bowel incontinence is frequently present. It’s also not unusual for bowel incontinence to occur without a clear cause.
Diagnosis of Bowel Incontinence
Discussing bowel incontinence may be embarrassing, but it can provide clues for a doctor to help make the diagnosis. During a physical examination, a doctor may check the strength of the anal sphincter muscle using a gloved finger inserted into the rectum.
Stool testing. If diarrhea is present, stool testing may identify an infection or other cause.
Endoscopy. A tube with a camera on its tip is inserted into the anus. This identifies any potential problems in the anal canal or colon. A short, rigid tube (anoscopy) or a longer, flexible tube (sigmoidoscopy or colonoscopy) may be used.
Surgery may be recommended for people whose bowel incontinence is not helped by noninvasive treatments. The types of surgery include:
Anorectal manometry. Apressure monitor is inserted intothe anus and rectum. This allowsmeasurement of the strength ofthe sphincter muscles.
Endosonography. An ultrasoundprobe is inserted into the anus.This produces images that canhelp identify problems in the anal and rectal walls.
Nerve tests. These tests measure the responsiveness of the nervescontrolling the sphincter muscles. They can detect nerve damage thatcan cause bowel incontinence.
MRI defecography. Magnetic resonance imaging of the pelvis can beperformed, potentially while a person moves her bowels on a specialcommode. This can provide information about the muscles and supportingstructures in the anus, rectum, and pelvis.
Treatments for Bowel Incontinence
Bowel incontinence is usually treatable. In many cases, it can be cured completely.
Recommended treatments vary acc
- Eat 20 to 30 grams of fiber per day. This can make stool more bulky and easier to control.
- Avoid caffeine. This may help prevent diarrhea.
- Drink several glasses of water each day. This can prevent constipation.
Medications. Try these medicines to reduce the number of bowel movements and the urge to move the bowels:
- Imodium
- Lomotil
- Hyoscyamine
Methylcellulose can help make liquid stool more solid and easier to control. For people with a specific cause of diarrhea, such as inflammatory bowel syndrome, other medications may also help.
Exercises. Begin a program of regularly contracting the muscles used to control urinary flow (Kegel exercises). This builds strength in the pelvic muscles and may help reduce bowel incontinence.
Bowel training. Schedule bowel movements at the same times each day. This can help prevent accidents in between.
Biofeedback. A sensor is placed inside the anus and on the abdominal wall. This provides feedback as a person does exercises to improve bowel control.
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