Bowel incontinence: Symptoms, treatment, and prevention

A person with bowel, or fecal, incontinence, cannot control their bowel movements. The stools, or feces, leak from the rectum, because of some underlying condition.

Bowel incontinence can vary in severity from passing a small amount of feces when breaking wind to total loss of bowel control. It is not life-threatening or hazardous, but it can affect the person’s quality of life, emotional and mental health, and self-esteem.

Fecal incontinence is a common condition, affecting around 18 million people, or 1 in 12 adults, in the United States.

It is slightly more common among women, possibly as a complication of pregnancy.

Many people do not report bowel incontinence due to embarrassment and a mistaken belief that it cannot be treated. Many believe it is an unavoidable part of the aging process.

In some cases, bowel incontinence resolves on its own, but it usually requires treatment.

Treatment

[abdominal surgery]
Surgery may be needed, depending on the cause.

Treatments for bowel incontinence aim to help restore bowel control or reduce its severity.

Options include medications, dietary changes, bowel training, stool impaction therapy. If these do not work, surgery may be recommended.

If an underlying condition is detected, this will need appropriate treatment.

Medications

These include:

anti-diarrheal medications, such as loperamide, or Imodium

laxatives, such as milk of magnesia, may be used in the short term, if the problem stems from chronic constipation

medications that decrease bowel motility, or decrease water content in the stool

Dietary changes

A change of diet can sometimes relieve bowel incontinence. A food diary can help monitor the impact of different foods.

Drinking more fluid and eating more fiber-rich food can help reduce bowel incontinence due to constipation. High-fiber foods that add bulk to the stools may also help people with chronic diarrhea.

Bowel training

Patients with poor sphincter control or low awareness of the urge to defecate may find a bowel training program effective.

This can involve:

exercises to help restore the strength of vital muscles for bowel control

learning to use the bathroom at certain times of the day, such as after a meal

Pelvic floor muscle training, or Kegel exercises, can help strengthen muscles that have been weakened or stretched during labor. Women are advised to do the exercises several times a day during pregnancy and for about 2 months after childbirth.

Biofeedback

This is another type of bowel training.

A pressure-sensitive probe is inserted into the anus. Each time the muscles of the anal sphincter contract around the probe, the device senses it. This can give the patient an idea of the patterns of their muscle activity.

By practicing muscle contractions and viewing their strength and response on a screen, the patient can learn to strengthen those muscles.

Other intervention

Stool impaction treatment may be needed to remove an impacted stool, if other treatment is not effective. The surgeon uses two gloved fingers to break the stool into small pieces, making it easier to expel.

If the problem is caused by fecal impaction, and other treatments are ineffective, an enema may help. A small tube is placed into the anus, and a special solution is inserted to wash out the rectum.

In sacral nerve stimulation, four to six small needles are inserted into the muscles of the lower bowel. The muscles are stimulated by an external pulse generator that emits electrical pulses.

Patients who respond well to this treatment may have permanent pulse generator, similar to a pacemaker, implanted under the skin of the buttock. The sacral nerve runs from the spinal cord to muscles in the pelvis and is involved in bowel and urinary continence.

Surgery

Surgery is normally only used if other treatments have not worked or to treat an underlying condition.

Sphincteroplasty is surgery to repair a damaged or weakened anal sphincter. The surgeon removes damaged muscle, overlaps the muscle edges and sews them back together. This provides extra support to the muscles and tightens the sphincter.

Stimulated graciloplasty, or gracilis muscle transplant, uses a small amount of muscle from the patient’s thigh to create an artificial sphincter. Electrodes attached to a pulse generator are inserted into the artificial sphincter, and impulses gradually change the way the muscles work.

Sphincter replacement uses an inflatable cuff to replace damaged anal sphincter. The cuff is implanted around the anal canal. When inflated, the cuff keeps the anal sphincter firmly shut until the person is ready to defecate. A small external pump deflates the device, allowing the stool to be released. The device then reinflates automatically about 10 minutes later.

Surgery for a prolapsed rectum may be done if other treatments have not worked. The sphincter muscle may be repaired at the same time.

A rectocele may be corrected by surgery, if it leads to significant symptoms of fecal incontinence.

Prolapsed internal hemorrhoids may prevent the anal sphincter from closing properly, resulting in bowel incontinence. Hemorrhoidectomy is a surgical procedure to remove them.

A colostomy can be used as a last resort. The stools are diverted through a hole in the colon and through the wall of the abdomen. A special bag is attached to the opening to collect the stool.

person holding stomach
Conditions that lead to fecal incontinence can also cause abdominal pain.

Accidental fecal leakage normally only affects adults when they have severe diarrhea.

Chronic fecal incontinence can involve frequent or occasional accidental leakage, an inability to hold in gas, silent leakage of feces during daily activities or exertion, or not reaching the bathroom in time.

Two types of bowel incontinence are:

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