Fecal Incontinence

February 2, 2017

Fecal incontinence is the inability to control bowel movements. This leads to stool (feces) leaking from the rectum at unexpected times. This can be characterized by the occasional leakage of stool with the passage of gas, or complete loss of bowel control.

More than 5.5 million Americans have fecal incontinence. It affects people of all ages-children and adults. Fecal incontinence is more common in women and older adults, but it is not a normal part of aging.

Control of gas and stool is key to organizing everyday activities, and most people don’t consider how important this is until they have a change or loss of control. The ability to control gas and stool is a complex function involving multiple organ systems. The colon, rectum, and anus are parts of the digestive system. They form a long, muscular tube called the large intestine (also called the large bowel). The colon is the first 4 to 5 feet of the large intestine; the rectum is the next six inches, and the anus (opening) makes up the final 1-2 inches.

Partly digested food enters the colon from the small intestine. The colon removes water and nutrients from the food and turns the rest into solid waste (stool). As stool enters the rectum, the rectum relaxes and acts as a reservoir to hold the stool. Meanwhile, the outer muscle that encircles the anus, the external anal sphincter, squeezes to prevent gas or stool leakage.

While the external anal sphincter squeezes, the inner muscle that encircles the anus, called the internal anal sphincter, relaxes to allow stool to enter the anal canal. When stool enters the anal canal, sensory nerves in the anus identify the difference between gas and stool and determine the consistency of the stool (liquid versus solid). Signals are sent to the brain indicating the need to have a bowel movement. Once a socially appropriate time and place to have a bowel movement is found, the anal sphincter muscles, as well as the muscles of the pelvic floor, relax and the abdominal muscles tighten to expel the stool. Loose stools, diseases or injuries to the rectum, the anus, or the nerves controlling the anal muscles, as well as other diseases, can all contribute to fecal incontinence.

There are commonly two terms used when referring to bowel incontinence:

  • Urge bowel incontinence – the individual has a sudden urge to go to the toilet but is unable to get there in time.
  • Passive soiling – nothing is felt to indicate that a bowel movement is about to occur.

Loss of bowel control can be devastating. People who have fecal incontinence may feel ashamed, embarrassed, or humiliated. Some don’t want to leave the house out of fear they might have an accident in public. Most try to hide the problem as long as possible, so they withdraw from friends and family. The social isolation is unfortunate but may be reduced with treatment that improves bowel control and makes incontinence easier to manage.



Types of Fecal Incontinence

  • Flatal incontinence – the inability to control the passage of gas from the rectum.
  • Fecal incontinence – the inability to control the passage of liquid or solid stool from the rectum.
  • Double incontinence – the inability to control both the passage of stool and urine.
  • Rectovaginal fistula – when a connection develops between the vagina and rectum and results in stool being passed uncontrollably through the vagina.


The sphincter muscles are not working as they should – damage to the sphincter muscles is commonly caused by childbirth (labor). The sphincter muscles can become stretched and torn, especially if forceps are used during delivery, or if the mother had an episiotomy. A complication of bowel or rectal surgery can also result in damage to the sphincter muscles. Some other types of injuries may also damage them.

Diarrhea – if a person has diarrhea it is much more difficult for the rectum to hold the stools. Patients with recurring diarrhea often experience bowel incontinence. Chronic or recurring diarrhea can be caused by Crohn’s disease, irritable bowel syndrome (IBS) and ulcerative colitis. These conditions sometimes result in scarring in the rectum, another cause of bowel incontinence.

Certain foods – susceptible people may find that certain foods cause diarrhea and worsen their fecal incontinence symptoms. Examples may include spicy foods, fatty/greasy foods, cured meats, smoked meats, and dairy products if you are lactose intolerant.

Some drinks – drinks containing caffeine may act as laxatives, as can those with artificial sweeteners.

Constipation can also lead to bowel incontinence – if the solid stool becomes stuck (fecal impaction) the muscles of the rectum can become stretched and weaker, watery stools may then leak around the impacted stool and seep out of the anus. Fecal impaction is a large mass of dry hard stool that gets stuck in the rectum – it is literally so hard that it cannot come out.

Rectal cancer – tumors that develop within the rectum can cause bowel incontinence.

Rectal prolapse – if the rectum drops down into the anus, bowel incontinence can occur.

Rectocele – this is when the rectum protrudes through the vagina.

Hemorrhoids – hemorrhoids can result in incomplete closure of the anal sphincter.

Chronic laxative abuse – individuals who overuse laxatives for a long time have a much higher risk of developing bowel incontinence.

Neurological Conditions – Some diseases affect the nerves in the pelvis that help you control your bowel movements; if these nerves are damaged, fecal incontinence occurs. Diseases that can cause nerve damage include:

  • Multiple sclerosis
  • Parkinson’s disease
  • Spinal cord injury
  • Stroke
  • Dementia
  • Diabetic neuropathy

Infectious Enteritis – This is a temporary condition that may be caused by a virus or bacteria. Treatment with antibiotics often improves your bowel control.

Birth Trauma/Injury – Birth trauma is the most common cause of fecal incontinence in young women. During a very difficult vaginal delivery or during a delivery that requires use of forceps, vacuum or episiotomy, a partial tear in the muscles of the anal sphincter can happen. If this tear doesn’t heal properly, it can cause incontinence. This is called a chronic third/fourth degree laceration. This tear may also cause a rectovaginal fistula and causes incontinence because stool can pass inadvertently from the rectum into the vagina.

Risk Factors

A number of factors may increase your risk of developing fecal incontinence, including –

  • Age – Although fecal incontinence can occur at any age, it’s more common in middle-aged and older adults.
  • Being female – Fecal incontinence is slightly more common in women. One reason may be that fecal incontinence can be a complication of childbirth. But most women with fecal incontinence develop it after age 40, so the connection with pelvic floor injury during childbirth is unclear. However, it’s possible that the injury doesn’t cause symptoms for many years.
  • Nerve damage – People who have long-standing diabetes or multiple sclerosis — conditions that can damage nerves that help control defecation — may be at risk of fecal incontinence.
  • Dementia – Fecal incontinence is often present in late-stage Alzheimer’s disease and dementia.
  • Physical disability – Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage, leading to fecal incontinence. Also, inactivity can lead to constipation, resulting in fecal incontinence.


Most adults who experience fecal incontinence do so only during an occasional bout of diarrhea. But some people have recurring or chronic fecal incontinence. They may be unable to resist the urge to defecate, which comes on so suddenly that they don’t make it to the toilet in time. This is called urge incontinence. Another type of fecal incontinence occurs in people are not aware of the need to pass stool. This is called passive incontinence.

Fecal incontinence may be accompanied by other bowel problems, such as –

  • Diarrhea
  • Constipation
  • Gas and bloating


Untreated, fecal incontinence can contribute to –

  • Urinary tract infections
  • Skin rashes and skin ulcers around the anus
  • Lack of sleep
  • Social withdrawal
  • Depression
  • Low self-esteem
  • Falls and fractures
  • Sexual problems



Medication – Sometimes taking medications to change the consistency of the stool can provide relief, since a person can usually control stool better when it is firm rather than loose or liquid form. Stool consistency can be improved by using bulking agents such as fiber supplements (Citrucel, Metamucil). Stool frequency can be decreased with over-the-counter anti-diarrheal medications including Imodium.

Biofeedback – Patients with bowel incontinence related to physical limitations or change in mental function will likely benefit from scheduled or timed trips to the restroom. Furthermore, biofeedback training for bowel incontinence involves putting a pressure probe in the anus and a sensing electrode on the abdomen. These devices are attached to a visual or sound display to tell the patient when the proper anal muscles are being used. Biofeedback helps a patient improve the strength and coordination of the anal muscles that help control bowel movements, and heightens the sensation related to the rectum filling with stool.

Exercise – Muscle-strengthening exercises (called Kegel exercises or pelvic floor exercises) can be very helpful in treating bowel incontinence. To do Kegel exercises, contract the muscles of the anus, buttocks, and pelvis, hold as hard as possible for a slow count of five, and then relax. Imagine you are trying to stop the flow of stool or trying not to pass gas. A series of 30 of these exercises should be done three times daily. In a few weeks, the pelvic floor muscles will be stronger and often the incontinence improves or resolves.

Surgery – Patients who continue to experience bowel incontinence despite other treatments may require surgery to regain control. Surgery may especially be needed for patients who have experienced anal muscle injuries (as can occur during childbirth).

  • Sphincteroplasty – Rectal sphincter repair is the most common procedure used to correct a defect in the sphincter muscles.
  • Muscle transfer – During this procedure, gluteal (buttock) or gracilis (inner thigh) muscles are used to encircle and strengthen the anal canal.
  • Colostomy – In rare and very difficult cases, the only alternative may be a colostomy, a surgically created opening in the abdominal wall through which the colon passes, and where a bag is fitted to collect stool.

Complementary & Alternative Treatment

L-Glutamine eases gastrointestinal pain.

Pancreatic enzyme before eating helps break down fats, relieving symptoms of irritable bowel.

Probiotics are friendly bacteria that help gut health.

Multivitamin/minerals with food ensures your daily requirements of nutrients.

Lobelia is a useful antispasmodic remedy.

Activated charcoal treats diarrhea.

Psyllium relieves both constipation and diarrhea.

Aloe Vera juice helps ease discomfort of irritable bowel.

Antimonium crudum treats indigestion after a big meal. Alternation between constipation and diarrhea.

Argentum nitricum is indicated in the treatment of gastrointestinal conditions accompanied by anxiety. Emotional diarrhea caused from stress or eating sweets. The patient is impulsive and in a hurry to do things.

Arsenicum album treats intolerable abdominal pain. The patient is restless with excessive thirst for small quantities of water. The remedy is indicated in the treatment of psychosomatic ailments.

Cantharis relieves intestinal colic. Burning sensation in the intestinal tract, burning diarrhea. The person has a disgust for food.

Bryonia for gastric affections and constipation. The stool is hard and dry, it looks as if burnt.

Colocynthis is indicated in the treatment of irritable bowel syndrome. Symptoms include severe colic pains, ameliorated doubled over Intestinal colic, stabbing abdominal pains, ameliorated by hard pressure.

Ignatia produces a calming effect in the body. It treats stress-related health conditions.

Staphysagria treats irritable bowel syndrome caused from suppressed anger.

Veratum album treats watery diarrhea accompanied by cold sweats, worse after eating fruits or drinking cold fluids.

Lycopodium is indicated in the treatment of gastrointestinal problems. Symptoms include indigestion, nausea, abdominal pain, and an urge to stool without success.

Mercurius corrosivus treats intestinal inflammation, burning diarrhea, and rectal tenesmus.

Nux vomica treats intestinal inflammation caused from food poisoning or excessive alcohol consumption.

Plumbum is indicated when one is unable to digest food. Symptoms include acute pain, spasm of the anal sphincter, constipation. The stools are hard, black balls that look like sheep poop.

Acupuncture for Incontinence – An acupuncturist can correct imbalances in the flow of vital energy, or qi. Urinary incontinence, for example, is thought to result from a deficiency of qi in the kidney.


Reference –














Posted in A-Z-Search