Fecal incontinence is not a hot topic of conversation. Women and men often suffer from this condition in silence because they’re embarrassed to bring it up with their physicians. In fact, one survey found that “less than 30% of patients with fecal incontinence have talked to their doctor about it.” What’s up with that?
Information is power, especially when it comes to your health. So here’s a cheat sheet to equip you with everything from terminology to causes to the many solutions for fecal incontinence. There is hope!
What is fecal incontinence?
Fecal incontinence, also called bowel incontinence, is any involuntary leakage (solid or liquid stool; mucus) from the anus. Generally, there are two types of fecal incontinence.
- Urge fecal incontinence is when you feel the urge for a bowel movement but cannot reach a toilet in time. This condition involves a muscle problem, where there isn’t sufficient control or muscle tone in the pelvic floor to prevent a bowel movement.
- Passive fecal incontinence is when you cannot feel bowel leakage. People don’t have the sensation that tells them to go to the bathroom, so they don’t know when it’s time for a bowel movement. This is primarily a nerve problem.
Is fecal incontinence a common problem?
It’s difficult to nail down statistics for fecal incontinence because patients are often embarrassed to bring up the topic with their physicians. Bowel leakage affects both men and women, but it’s thought that women have a higher incidence because of damage during childbirth. Another train of thought is that the male numbers are underreported because men may be more reluctant than women to report bowel leakage. Regardless of the unknown, some studies shed some light onto frequency, suggesting that up to 12% of adults in the US experience fecal incontinence. Another study puts the prevalence as high as 36% among adults over 18 years old.
- Women. Although studies don’t necessarily agree on the ratio of women to men who suffer from fecal incontinence, studies suggest that women’s quality of life decreases significantly more than men. One study found that women tend to experience more depression and anxiety related to incontinence.
- Men. Fecal continence also plagues men, who lean more toward frustration and shame than depression. Some studies suggest that many patients aren’t diagnosed with fecal incontinence because they don’t bring it up with their physician, a common problem with men.
What causes fecal incontinence?
According to the National Institutes of Health, here are some of the most common reasons men and women develop fecal incontinence.
- Constipation is a common cause of fecal incontinence because chronically large and hard stools can weaken the rectal muscles.
- Diarrhea is another cause of leaky bowels. Liquid or loose stool fills the rectum rapidly and can seep through a weakened anal sphincter.
- Nerve damage caused by injury can lead to bowel leakage. Some possible injuries include habitual straining, spinal cord injury, or brain injury.
- Rectal surgery for hemorrhoids can harm the muscles or nerves in the anus, resulting in incontinence.
- Neurologic diseases, such as Alzheimer’s, stroke, and multiple sclerosis can each contribute to fecal incontinence because of their impact on nerves or cognition.
- Childbirth via vaginal delivery can damage the anal muscles and/or nerves. A large baby, a forceps delivery, and episiotomies are some of the childbirth risk factors for developing fecal incontinence.
What are the treatments for fecal incontinence?
Treatments for fecal incontinence range from at-home devices to surgery. More than 50% of patients suffer from quality of life issues because of bowel incontinence, so seeking treatment early not only may fix the leakage but also helps with mental health and confidence. It’s important to be open and detailed with your doctor so he or she can prescribe the treatment that fits your specific condition.
- Diet. Altering what you eat and drink is the first and easiest step in regaining control of your bowels. In addition to daily hydration, your doctor might instruct you to keep a food diary. Depending on the diary, other recommendations may include eating more fiber and limiting foods that trigger diarrhea or constipation.
- Medication. Over-the-counter remedies include anti-diarrhea medicines that can stop loose stools, and laxative and stool softeners to ease constipation.
- Shots. Injections into the anal walls may help improve leaks by bulking up anal tissue and decreasing the size of the anus. These are called anal sphincter bulking shots. Depending on the material used for the injections (e.g., fat tissue, collagen, Teflon), this solution can be fairly permanent but may require follow-up injections.
- Pelvic floor exercises. Kegel exercises tone the pelvic floor muscles, which stretch from your pubic bone all the way to your tailbone. Toning these muscles may lead to better control of bowel movements. Doing Kegels properly is tricky, so your doctor may recommend a device to help train your pelvic floor muscles.
- Side effects. Non-surgical remedies have a low risk of side effects but may not work for chronic fecal incontinence.
- Over-the-counter medicines may cause nausea, stomach cramps, or bloating.
- Shots are a little more complicated and can lead to inflammation, infection, or anal itching, among others.
- Kegel exercises have no side effects. However, if an internal Kegel exerciser device is used, there is a risk of infection.
If non-surgical solutions don’t work, there are a few types of surgery to remedy fecal incontinence.
- Sphincteroplasty aims to repair the anal sphincter by reconnecting and tightening the muscle. This is one of the most common surgeries used for fecal incontinence.
- Anal sphincter replacement is another option. This surgery involves a cuff and a small pump. When filled with air, the cuff constricts the anus; when air is released via the pump, the patient is free to have a bowel movement.
- Sacral nerve stimulation is an outpatient procedure. A battery-powered device is implanted on the patient’s lower back to deliver electrical pulses to rectum nerves. The hope is to strengthen the muscles that control bowel movements.
- Side effects. Surgical solutions have a higher risk of side effects. As with any surgery with an incision, there is a degree of pain and a risk of infection for all these procedures. If complications arise after surgery, chances increase that the patient will need a second surgery to correct the problem.
- Sphincteroplasty may develop problems with the anus becoming too small, blocking bowel movements. Sepsis, your immune system’s overreaction to infection, can also develop.
- Anal sphincter replacement problems can involve a malfunction of the cuff device, leaking around the wound, or sepsis.
- Sacral nerve stimulation patients can experience device malfunctions.
Are there any safe at-home treatments for fecal incontinence?
Fecal incontinence is related to pelvic floor health, and experts agree that the best way to strengthen the pelvic floor is by doing Kegel exercises. A recent study concluded that pelvic floor therapy, including Kegels, should be the recommended treatment. In addition to dietary changes, consistent Kegel exercises are a safe at-home solution for helping with fecal incontinence. But how do you know if you’re doing Kegels effectively? Here are some devices that can help.
- Biofeedback probes are used in the vagina or anus to measure how and when you are contracting sphincter and pelvic floor muscles.
- Electrical stimulation (E-stim) devices are available in two forms:
- Internal E-stim probes are used anally or vaginally, using electronic stimulation to do your Kegels for you.
- External E-stim devices such as ELITONE are never inserted internally. Instead, the stimulation is delivered through disposable GelPads worn like maxi pads. ELITONE is a discreet device worn under clothing so women can undergo treatment while on the go.
If you are suffering from even occasional fecal incontinence, there is a solution for you. Take the first step and talk to your doctor. Documenting the type and frequency of your symptoms will help identify which treatment might work well for your symptoms.