Bowel or fecal incontinence is the loss of voluntary control of stool, or
bowel movements. This condition can vary from being partial, in which a person
loses only a small amount of liquid waste, to complete, in which the entire
solid bowel movement cannot be controlled.
Bowel incontinence affects more than 2% of the U.S. population. Both men and
women suffer from this problem, though it is more common in women because of
injury to the anal muscles or nerves that can occur during childbirth. Bowel
incontinence becomes more common with advancing age as the muscles that control
bowel movements (anal sphincter muscles) weaken.
Often, embarrassment and the stigma associated with incontinence prevent
people from seeking treatment, even when incontinence affects his or her quality
of life. Many people resort to altering their social and physical activities,
even their employment, to cope with the problem. In addition, some people with
bowel incontinence do not see a doctor because they just don't realize that
their problem can be effectively treated. It's important to understand that
bowel incontinence is not uncommon and can be successfully treated.
What causes bowel incontinence?
Normal control of bowel movements depends on proper functioning of the colon
and rectum, the muscles surrounding the anus (anal sphincter muscles), the
brain, and the body's nerves (the nervous system), plus the amount and
consistency of waste products produced.
There are many causes of bowel incontinence, including:
- Damage or injury to the anal sphincter muscles or the nerves
surrounding these muscles
- Anal surgery for another condition
- Certain medications, such as antibiotics or Neurontin
- Improper diet
- Radiation treatment to the lower pelvic region
- Conditions associated with chronic diarrhea or constipation
- Systemic (whole-body) diseases such as diabetes or scleroderma
- Spinal cord damage
What can I do if I have bowel incontinence?
See your doctor. Tests to determine the cause for incontinence can be
completed during an outpatient appointment and are not painful.
Once these tests have confirmed the cause of your incontinence, your doctor
can make specific recommendations for treatment, many of which do not require
No matter how serious the problem seems, incontinence is a condition that can
be significantly helped and, in most cases, cured.
How is bowel incontinence diagnosed?
Endosonography, also called rectal ultrasound, makes it possible to view the
anal sphincter muscles and precisely identify abnormalities. Ultrasound can be
used to locate the exact position of a tear in a muscle, even before bowel
incontinence becomes a problem.
Other diagnostic procedures that may be used include:
- Flexible sigmoidoscopy. By using a thin, flexible,
lighted tube called an endoscope, your doctor can examine the lining of the
lower digestive tract.
- Manometry. This test measures the pressure and strength
of the anal muscles and can determine if they are too weak to function
- Nerve studies. These tests check for nerve damage to
determine if the nerves that communicate with the sphincter muscles are
- MRI: Magnetic resonance imaging identifies areas of
weakness in the sphincter muscle.
How is bowel incontinence treated?
Once the underlying cause of bowel incontinence has been identified, most
people with this condition can be cured or the condition can be significantly
improved. However, the method of treatment depends on the cause of the
Sometimes simple changes in diet or eliminating certain medications can be
effective in helping patients regain bowel control. More frequently, treatment
involves a combination of medication, biofeedback, and exercise.
- 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.
Over-the-counter anti-diarrheal medications may include Imodium, and
prescription medications may include Lomotil.
- Biofeedback. Biofeedback training for bowel incontinence
involves putting a pressure probe in the anus or a sensing electrode on the
skin. 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, as well as 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 and then 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).
What surgical procedures are used to treat bowel incontinence?
Surgical options include:
- Sphincteroplasty. Rectal sphincter repair is the most
common procedure used to correct a defect in the sphincter muscles. There
are two anal muscles that control bowel movements, similar to two round
doughnuts, one inside the other. If a defect exists in the complete circle
of muscle, the problem can be corrected with this surgery. During the
sphincteroplasty, the two ends of the muscle are cut and overlapped onto one
another, then sewn in place to restore the complete circle of muscle.
- Muscle transposition. During this procedure, gluteal
(buttock) or gracilis (inner thigh) muscles are used to encircle and
strengthen the anal canal. When the inner thigh muscle is used,
pacemaker-like electrodes are implanted into the grafted muscle to train it
to remain contracted. When the buttock muscle is used, the lower portion of
this muscle is freed from the tailbone region and wrapped around the anus to
construct a new anus. The buttock muscle transposition does not require the
use of a pacemaker. This procedure is an option for the small percentage of
patients whose condition cannot be successfully treated with
- 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
If conservative treatment or surgical repair of the anal sphincter fails to
improve a patientís situation, an artificial bowel sphincter may be an option.
The Acticon Neosphincter is a circular plastic device implanted around the anus.
The device can be inflated like a balloon to prevent the passage of stool. When
a person has to move the bowels, the plastic ring can be deflated for stool to
Can bowel incontinence be prevented?
Since fecal incontinence in women is often caused by anal muscle or nerve
damage that occurred during childbirth, prevention is not always possible.
However, if the use of forceps can be avoided during childbirth, the period of
labor not prolonged, and the baby not delivered too rapidly, injury to the
pelvic muscles and nerves can be avoided.
Also, chronic constipation may result in incontinence. Getting sufficient
water, fiber, and exercise can be effective in treating constipation.
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