What is fecal incontinence (FI)?

Fecal incontinence is the inability to hold a bowel movement until reaching a bathroom or accidental leakage while passing gas. Although patients often understandably feel afraid or embarrassed to talk with their physicians about this problem they should realize that it can be caused by several medical conditions which may be treatable. 

 Who gets fecal incontinence?

About 1 in 12 U.S. adults have FI and it is more common among women.  Risk factors include older age, chronic diarrhea, damage to the nervous system, other chronic illnesses (such as diabetes), pelvic injuries and history of difficult childbirths.

 What causes fecal incontinence?

Fecal incontinence occurs when control of the anal sphincter (the “social muscle”) is no longer adequate and stools are passed before ready.   The muscles and nerves of the rectum and anus are supposed to work together to hold and then release stool.  FI may result when the sphincter weakens or the rectal sensation is reduced due to the conditions mentioned above.

 How is fecal incontinence diagnosed?

A medical history, physical examination and medical tests will be used to help diagnose FI and identify possible causes.    There are several tests that can help diagnose FI:

 Anal manometry – a pressure tube is used to check the sensitivity and function of the rectum and sphincter function.  

Magnetic resonance imaging (MRI) – uses detailed pictures of the rectum and anal sphincter muscles.

Anorectal ultrasonography – ultrasound is used to send waves into the anal area which then create pictures of the anal sphincter muscles to detect damage

Proctography – an Xray that shows how much stool the rectum can hold.

Proctosigmoidoscopy – a lighted, flexible tube is inserted into the rectum to examine the end of the large intestine and rectum to determine if there is inflammation, a tumor or scar tissue.

Anal electromyography – this test checks for pelvic and rectal nerve damage.

 How is fecal incontinence treated?

Once the underlying problem causing FI is diagnosed, one of the following treatments may be used:

• Medications such as fiber and anti-diarrhea drugs
• Diet and nutrition
• Pelvic exercises
• Bowel training
• Surgery