Dr. MJ Bazos MD,
What is fecal
Fecal incontinence is the loss of normal control
of the bowels. This leads to stool leaking from the rectum (the last part of the
large intestine) at unexpected times. This problem affects as many as 1 million
Americans. It is more common in women and in the elderly of both
Many people with fecal incontinence are ashamed
to talk about this problem with their doctor. They think that nothing can help
them. However, many effective treatments for fecal incontinence are
What causes fecal
Bowel function is controlled by 3 things: anal
sphincter pressure, rectal storage capacity and rectal sensation. The anal
sphincter is a muscle that contracts to prevent stool from leaving the rectum.
This muscle is critical in maintaining continence. The rectum can stretch and
hold stool for some time after a person becomes aware that the stool is there.
This is the rectal storage capacity. Rectal sensation tells a person that stool
is in the rectum. Then the person knows that it is time to go to the
A person also must be alert enough to notice the
rectal sensation and do something about it. He or she must also be able to move
to a toilet. If something is wrong with any of these factors, then fecal
incontinence can occur.
Muscle damage is involved in most cases of fecal
incontinence. In women, this damage commonly occurs during childbirth. It's
especially likely to happen in a difficult delivery that uses forceps and/or an
episiotomy. An episiotomy is when a cut is made to enlarge the opening to the
vagina for delivery of a baby.
Young women can often compensate for muscle
weakness. Typically, they only develop incontinence in later life when their
muscles are growing weaker and the supporting structures in the pelvis are
becoming loose. Muscle damage can also occur during rectal surgery (especially
surgery for hemorrhoids). It may also occur in people with inflammatory bowel
disease or an abscess in the perirectal area.
Damage to the nerves that control the anal
muscle or that are responsible for rectal sensation is also a common cause of
fecal incontinence. Nerve injury can occur in the following
- During childbirth.
- With severe and prolonged straining for stool.
- With diseases such as diabetes, spinal cord
tumors and multiple sclerosis.
Fecal incontinence may also be
caused by a reduction in the elasticity of the rectum, which shortens the time
between the sensation of the stool and the urgent need to have a bowel movement.
Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel
disease can also make the rectum less elastic.
Because loose stool (diarrhea) is more difficult
to control than formed stool, diarrhea is an added stress that can lead to fecal
incontinence. A change in stool consistency to a looser form often causes the
problem of incontinence to show up.
If I have fecal
incontinence, what can be done?
It is important that you have a careful medical
evaluation. Attempts at self-treatment are usually unsuccessful. Anorectal
manometry, which tests anal pressures, rectal elasticity and rectal sensation,
as well as other tests, can pinpoint the cause of your
The treatment of fecal incontinence varies and
depends on the cause of your problem. Preventing diarrhea and forming a regular
bowel movement pattern are usually very helpful. For sphincter weakness or
injury, anorectal biofeedback strengthens the muscle. This improves continence
in most persons. Biofeedback training can even end the problem of fecal