Fecal incontinence, as described by the American College of Gastroenterology,  is the “inability to control your bowel movements, causing stool to leak unexpectedly from your rectum.” Also referred to as anal or bowel incontinence, fecal incontinence “can range from occasional leakage of a small quantity of stool while passing gas to a complete loss of bowel control.”

Over five million Americans suffer with this condition, but the shame that can surround it often stops patients from talking about treatment options with their doctor.

Causes

Over time the sphincter muscles naturally weaken, so age plays a part in this condition. On top of that, the muscles and nerves can become damaged due to certain traumas and, in particular, childbirth.

Sphincter injuries can impact 1 in 10 mothers who’ve had a vaginal birth, with women having their first baby at a higher risk. Anal incontinence in mothers is associated with forceps delivery and anal sphincter laceration.

There is a misconception that only women who have sustained significant injury to their perineum — the muscle between the vagina and rectum — are at risk, but that’s not the case. Anal incontinence after childbirth is more common than was previously believed. Around 2-6% of new mothers reported fecal incontinence and, in those who suffered severe tearing, that number rose to 62%, according to the U.S. National Library of Medicine. 

Those with Crohn’s disease may also experience problems. And nerve malfunction can happen in people who strain excessively, and in patients with diabetes or those who have suffered a stroke. 

Symptoms

The symptoms may range from the inability to hold gas to silent leakage of stool during activities or exertion, or sudden urgency to reach the toilet. Other intestinal symptoms such as diarrhea, constipation and abdominal discomfort may also be present. Some find that they must manually manipulate the stool in order to open their bowels. 

Diagnosis

With the social and emotional consequences of this condition, many never seek treatment for their fecal incontinence. But doctors are very familiar with this condition and can offer a variety of treatments. Depending on your symptoms, your primary care doctor may perform an exam, or you may be referred to a gastroenterologist, proctologist or colorectal surgeon.

Some of the tests that may be administered include anal manometry, anorectal ultrasonography, MRI, proctosigmoidoscopy and anal electromyography. These tests can check the strength of sphincter and pelvic floor muscles and check for inflammation or scar tissue. 

Treatment

There are very effective treatments available for fecal incontinence. Depending on the cause, treatment may include dietary changes, medications, special exercises or surgery. Generally speaking, doctors will begin with the less invasive options, such as a change in diet and pelvic floor exercises. If the problem persists, surgery may be required to repair muscle and nerve damage. 

If you are suffering, don’t be embarrassed. Make an appointment with your doctor. Many people, especially women, are affected by fecal incontinence and there is no need to suffer in silence.

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