Fecal Incontinence

What is Fecal Incontinence?

Fecal incontinence is when you’re unable to control your bowel movements, causing feces to leak out from your rectum. Fecal incontinence can range from occasional leakage to total loss of bowel control.

There are two main types of fecal incontinence:

  • Urge incontinence: when you have a sudden urge to go but can’t get to a bathroom in time.
  • Passive soiling: when you don’t have any warning that you’re about to go

What causes Fecal Incontinence?

Causes may include:

  • Neurologic disorders like Multiple Sclerosis, Diabetes, ALS, Parkinson’s disease, Alzheimer’s disease, and muscular dystrophy.
  • Stroke and Spinal Cord Injuries
  • Co-existing conditions that physically prevent you from reaching the bathroom or undressing in time.
  • Rectal tears, stretching, or damage to the anal sphincter muscles caused by childbirth.
  • Surgical complications from rectal and anal surgeries resulting in damage to the anal sphincter muscles.
  • Overflow diarrhea secondary to severe constipation. Here, watery stools leak out around solid, impacted stool in the rectum.
  • Bacterial, Viral or Parasitic infections
  • Hemorrhoids can prevent the anal sphincter muscles from closing completely leading to incontinence.
  • Certain foods and artificial sweeteners. Fatty or greasy foods, dairy products, caffeine and artificial sweeteners are common triggers.
  • Diarrhea. Diarrhea makes it difficult for the rectum to hold your stool. Recurring diarrhea, due from Inflammatory Bowel Disease, IBS, lactose intolerance and celiac disease can all make incontinence worse.
  • Lactose deficiency can trigger uncontrollable diarrhea and subsequent fecal incontinence in some people.
  • Some long-distance runners will describe a condition referred to as runner’s diarrhea that can lead to embarrassing fecal incontinence while running.
  • Rectal cancer
  • Benign or malignant masses pushing on the intestinal tract
  • Rectal prolapse, when the rectum drops down or prolapses into the anus
  • Rectocele, when the rectum protrudes through the vagina
  • Chronic laxative abuse

How is Fecal Incontinence Diagnosed?

Often the initial diagnosis is made by history alone. Additional tests used to help us determine the cause of your fecal incontinence may include:

  • Stool Studies to rule out infectious causes
  • Colonoscopy or Flexible Sigmoidoscopy to evaluate for inflammation, tumors, scarring, or decreased muscle tone in the anal sphincter.
  • Anal manometry to evaluate the strength of the anal sphincter muscles.
  • Anal ultrasound to evaluate the anatomy of the anal sphincter muscles.
  • Nerve conduction studies to measure if the nerves involved in bowel control are working properly.
  • Barium enhanced x-rays of the rectum.
  • Magnetic resonance imaging (MRI) of the abdomen and/or pelvis.

How is Fecal Incontinence Treated?

Treatment is dependent on the cause of your symptoms but may include: dietary changes, bowel training (or biofeedback), medications, and/or surgery to repair damaged anal sphincter muscles.

Sometimes minor dietary and lifestyle modifications can be helpful. 

  • Avoid foods that are known to cause loose stools like caffeine, alcohol, some fruit juices, high fructose corn syrup, simple sugars, prunes, beans, vegetables in the cabbage family, dairy products (in the case of lactose intolerance), and artificial sweeteners.
  • Make sure to go to the bathroom when you have to go. Don’t hold it. Over time, this can weaken your anal sphincter muscles
  • Keep a food and symptom diary to identify food and lifestyle triggers.

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