What You Need to Know About Fecal Incontinence

Medically Reviewed By Kelsey Trull, PA-C
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“Fecal incontinence” is the term for when you have an accidental bowel movement. It can include solid, liquid, or mucus stools or a combination. Fecal incontinence is a common problem, affecting 1 in 3 people who connect with primary care doctors. Doctors may also refer to the condition as “bowel incontinence” or “accidental bowel leakage.”

Read on to learn more about the causes, treatments, and risk factors for fecal incontinence here.

What are the types of fecal incontinence?

Four port-a-potties in a wooded setting
Jeff Wasserman/Stocksy United

There are three general types of fecal incontinence:

  1. Urge incontinence is the most common type of fecal incontinence. It is the strong urge to have a bowel movement, which can feel difficult to control. Difficulty controlling your bowels may be due to weakened pelvic floor muscles, possibly resulting from an injury or nerve damage.
  2. Passive incontinence occurs when you are unaware that you are leaking stool, possibly because you cannot feel when your rectum is full.
  3. Fecal seepage occurs when stool leaks after a typical bowel movement.

What are the causes of fecal incontinence?

Various experiences can cause fecal incontinence.

Diarrhea

Diarrhea can cause incontinence if you have a hard time controlling the flow of liquid stool. Diarrhea can occur for many reasons, including:

Learn more about diarrhea.

Constipation

Constipation can cause the muscles in your rectum and anus to stretch and weaken, allowing liquid stools behind the hard stool to leak out. Constipation is one of the most common causes of fecal incontinence in children.

Learn more about constipation.

Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum or anus. They can prevent the muscles in the anus from closing all the way, allowing stool to leak out.

Learn more about hemorrhoids.

Rectal prolapse

Rectal prolapse occurs when your rectum falls through your anus. The anus cannot close all the way, leading to incontinence.

Learn more about rectal prolapse.

Childbirth

Childbirth can be one of the causes of bowel incontinence in people assigned female at birth. Vaginal deliveries may cause damage to the anus.

Chronic conditions

Certain chronic diseases — such as type 2 diabetes or conditions that affect the nerves in your pelvic floor, rectum, or anus — may also lead to fecal incontinence.

Neurological conditions

Neurological conditions can affect the nerves in the pelvic floor, rectum, or anus. Some of these conditions that may cause bowel incontinence include:

Pelvic floor damage

Damage to your pelvic floor or the muscles in your rectum or anus may make controlling your bowels difficult. This damage may be due to:

Nerve damage

Damage to the nerves that control your pelvic floor, rectum, or anus may prevent the muscles from working correctly or make it difficult to sense when you need to have a bowel movement. Nerve damage may result from a brain or spinal cord injury or frequent straining to have a bowel movement.

Congenital disabilities

Specific congenital disabilities that affect the muscles or nerves in the intestine, rectum, or anus can cause fecal incontinence. For example, Hirschsprung’s disease is a congenital condition that affects the large intestine.

What are the symptoms of fecal incontinence?

Symptoms range from mild to severe, and you may have fecal incontinence only a few times or frequently.

The symptoms may include:

  • difficulty holding gas
  • “silent” leakage, which occurs without you being aware you have leaked
  • a strong urge, making it hard to reach a bathroom in time

You may also have other symptoms, such as diarrhea, constipation, or abdominal pain or discomfort.

Some doctors also consider soiling, or spots of stool or mucus on your underwear, to be an accompanying symptom of fecal incontinence.

How do doctors diagnose fecal incontinence?

To diagnose the cause of fecal incontinence, your doctor will examine you and assess your personal and family medical history. They will also ask you some questions, which may include:

  • When do you have fecal incontinence?
  • How often does it happen?
  • What is going on before it happens?
  • Do any foods make it better or worse?
  • Do you have more after eating?
  • What does it look and smell like?

You might feel uncomfortable about answering these questions, but your doctor will need this information to determine the proper treatment. They may also ask you to keep a stool diary for a few days or weeks, describing the foods you eat and the characteristics of your stools.

They may also need blood, stool, or urine samples for testing. Other tests may include:

What are the treatments for fecal incontinence?

Treatments for fecal incontinence focus on relieving the underlying issue and may include:

  • diet changes
  • medications, such as antidiarrheals or stool softeners
  • bowel training
  • Kegel exercises to strengthen your pelvic floor muscles
  • fecal incontinence pads
  • biofeedback therapy
  • sacral nerve stimulation
  • vaginal balloons
  • nonabsorbable bulking agents 

If other treatments are ineffective for you, your doctor may recommend surgery. There are several surgical procedures that doctors may perform, including:

  • sphincteroplasty, which can reconnect the ends of a torn anal sphincter
  • artificial anal sphincter implantation, which involves placing a small pump under your anus’ skin that you can inflate or deflate
  • colostomy to reroute the intestine to an opening in the abdominal wall, allowing stool to collect in a bag outside the abdominal wall
  • hemorrhoidectomy to remove hemorrhoids

Your doctor may also have the following tips to relieve the irritation, itching, or pain due to fecal incontinence.

  • Keep the area clean.
  • Use disposable underwear or absorbent pads.
  • Change soiled underwear and pads as soon as possible.
  • Wear underwear and clothing that will let air pass through easily.
  • Use moisture barrier creams or nonmedicated powders in the area.

What is the outlook for people with fecal incontinence?

The outlook for people with fecal incontinence varies depending on the underlying condition. Some causes, such as diarrhea or constipation, may be short-lived with treatment. However, certain chronic conditions may require lifelong management.

Reduced quality of life and mental health distress can be common concerns with fecal incontinence.

What are some potential complications of fecal incontinence?

Complications of fecal incontinence might include:

In addition, surgery to correct fecal incontinence may lead to infection, pain, or continued incontinence.

What are the risk factors for fecal incontinence?

Some people may be at a higher risk for developing fecal incontinence if they:

  • are older than 65
  • currently smoke
  • live a sedentary lifestyle
  • have had gallbladder removal surgery
  • experience chronic health conditions that affect the body’s ability to hold stool

Children born with specific congenital disabilities involving the spinal cord, rectum, or anus may have fecal incontinence. In addition, frequent constipation can also cause fecal incontinence in children.

Can you prevent fecal incontinence?

You may be able to prevent fecal incontinence through certain lifestyle or medical changes. You can try the following:

  • Increase your activity level.
  • Talk with your doctor or a dietitian about the proper diet for your needs.
  • Work with your doctor to manage any underlying conditions.

Summary

Fecal incontinence is the accidental leakage of stool. It’s possible to feel uncomfortable discussing this topic. As a result, some people may be hesitant to talk about it with their doctors.

However, an open and honest discussion about your incontinence can help your doctor diagnose and treat your condition.

Talk with your doctor if you experience fecal incontinence. Also, contact your doctor if it causes you mental health distress and affects your quality of life.

Aside from finding the right treatments for you, they may be able to help you find resources to address your mental health and improve your experiences making social connections with people, for example.

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Medical Reviewer: Kelsey Trull, PA-C
Last Review Date: 2022 Oct 23
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