Fecal Incontinence: What to Know About This Common but Treatable Problem

Fecal incontinence is when you are not able to control the passage of gas or stool. The lack of control results in the accidental or unexpected release of stool from the rectum. The severity of this ranges  from occasional soiling your underwear to accidentally having a complete bowel movement.

Fecal incontinence is common, but often underreported due to embarrassment. It affects up to almost 40% of people visiting their primary care provider. Although it is not a medical emergency, it can be life-changing and cause social isolation.

In this article, we discuss the causes, symptoms, and treatment options for fecal incontinence.

What causes fecal incontinence?

For a person to have a normal bowel movement, many things in the body must happen correctly. The muscles and nerves of the rectum and pelvic floor must work together. Stools have to be the correct texture, not too hard or too soft. And you must have the mental and physical ability to sense the urge and make it to the bathroom in time. 

An abnormality in any of these steps can result in fecal incontinence. Common causes of this include:

• Nerve and/or sphincter muscle weakness

• Pelvic floor damage

• Inability of rectum to stretch

• Changes in stool consistency

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Nerve and/or sphincter muscle weakness 

The most common cause of fecal incontinence is damage to the nerves and muscles around the anus. Many factors can lead to this type of damage, including:  

• Being older than 65

• Vaginal childbirth

• Previous anorectal surgery, like for hemorrhoids or an anal fistula

• Straining with bowel movements, which can occur with constipation or diarrhea

• Degenerative nerve diseases, such as multiple sclerosis or spina bifida

Pelvic floor damage 

Pelvic muscles keep the rectum in place. When these attachments are weak or damaged, the rectum may move out of position. This can lead to fecal incontinence. 

Conditions in which the rectum moves out of place include:

• Rectal prolapse: the rectum falls out of the anus

• Rectocele: the rectum pushes into the vagina

Inability of rectum to stretch 

If your rectum has scarring, it can lose the ability to stretch for a normal bowel movement. The rectum may get scarred from:

• Radiation: like for treatment of prostate cancer

• Inflammatory bowel disease: like Crohn’s disease or ulcerative colitis

Changes in stool consistency

The consistency or texture of your bowel movements is very important. You do not want your stools to be too hard or too full of liquid. The goal is for your stools to look like toothpaste. If the consistency is too hard or soft, it can lead to fecal incontinence.

Changes in your stool texture causing fecal incontinence can be the result of:

• Constipation: Passing hard stools over time can lead to damage of the muscles and nerves around the rectum. This can lead to the overflow of stool. It can also worsen rectal prolapse or rectocele, which are both causes of fecal incontinence. 

• Diarrhea: If your stools have too much liquid, it can cause accidental leakage.

What are the symptoms of fecal incontinence? 

Symptoms of fecal incontinence all involve leakage of stool. But there are two main types of fecal incontinence:

1. Passive incontinence: This is when stool leaks without you knowing you need to move your bowels. 

2. Urge incontinence: This is when stool leaks because you can’t make it to the toilet in time. 

It’s important to know which type of incontinence you have because your treatment options may be different. Talk with your provider about your symptoms, so that they can help you determine if you have passive or urge incontinence.

How do I determine the cause of my bowel incontinence?

Your medical history is important when your provider is determining whether or not you should be diagnosed with fecal incontinence. It may be difficult to talk about, but it’s important to provide as much detail as you can about your bowel habits, diet, and symptoms.

Your healthcare provider may perform tests to help confirm the diagnosis. These tests may include:

• Rectal exam: This exam involves your healthcare provider inserting a gloved finger into your rectum. This can help check for any muscle damage, hemorrhoids, prolapse, or masses.

• Stool tests: If you are having diarrhea, your provider may order a stool sample. This is to check for infection or evidence of inflammation.

• Anal manometry: This test checks the strength of the anorectal muscles (sphincter). 

• Endoscopy: This involves your provider inserting a flexible, lighted tube with a camera into the anus. An endoscopy can help to look at the inside of the anus and rectum.

• Endosonography: An ultrasound of the anorectal muscles (sphincter) can check for damage or weakness.

• Nerve tests: These tests check the nerve response when you get the urge to have a bowel movement.

• MRI defecography: This scan produces pictures of the anus, rectum, and pelvic floor muscles. During the test, you will have a bowel movement to release contrast placed in the rectum.

What can be done to treat fecal incontinence? 

If you have fecal incontinence, you and your provider will come up with a treatment plan that works best for you.

Your treatment options will depend on the cause of your incontinence. Typically, that includes either surgical or non-surgical treatment. And sometimes your provider may use various treatments in combination, if necessary. 

Non-surgical treatment options

Non-surgical options are typically what your healthcare provider suggests first. They include: 

• Dietary changes: Avoiding foods that cause or worsen diarrhea, like caffeine or dairy, may help. And increasing your fiber intake can add bulk to your stools and make your bowel movements more regular. You can also try increasing your water intake to prevent constipation.

• Kegel exercises: These exercises involve squeezing and relaxing pelvic floor muscles. They can help strengthen the muscles and improve your bowel movement control.

• Bowel training: This is where you train your body to have a bowel movement at the same time every day, which can help you avoid accidents.

• Medications: Sometimes, medications are taken to prevent diarrhea or constipation. Which medication your doctor prescribes will depend on the cause of your bowel incontinence.

Surgical treatment options

If non-surgical methods don’t work, your healthcare provider may have you see a surgeon.  Surgical treatment options include:

• Sphincteroplasty: If your symptoms are due to damage of the anal muscle, it may need to be repaired. A surgeon may be able to fix the damage by stitching the torn muscle. 

• Sacral nerve stimulator: If your incontinence is due to nerve damage, an implantable device may help. This device stimulates the pelvic nerves to help you know when you need to have a bowel movement.

• Colostomy: This surgery prevents stool from coming out of the anus. Instead, stool is brought to the surface of your belly and will empty into a bag attached to your skin.

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Written by:

Valerie Emuakhagbon, MD

Valerie Emuakhagbon, MD, is a board-certified colorectal surgeon. A native of Dallas, Texas, she completed the six-year BA/MD program at the University of Missouri-Kansas City.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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