Fecal Incontinence

Fecal incontinence is the loss of control over bowel movements.

Fecal incontinence can occur briefly during bouts of diarrhea or when hard stool becomes lodged in the rectum (fecal impaction). People with injuries to the anus or spinal cord, rectal prolapse (protrusion of the rectal lining through the anus), dementia, neurologic injury from diabetes, tumors of the anus, or injuries to the pelvis during childbirth can develop persistent fecal incontinence.

A doctor examines the person for any structural or neurologic abnormality that may be causing fecal incontinence. This involves examining the anus and rectum, checking the extent of sensation around the anus, and usually performing a sigmoidoscopy. Other tests, including an examination of the function of nerves and muscles lining the pelvis, may be needed.

The first step in correcting fecal incontinence is to try to establish a regular pattern of bowel movements that produces well-formed stool. Dietary changes, including the addition of a small amount of fiber, often help. If such changes do not help, a drug that slows bowel movements, such as loperamide, may succeed.

Exercising the anal muscles (sphincters) by squeezing and releasing them increases their tone and strength and helps prevent fecal incontinence from recurring. Using biofeedback, a person can retrain the sphincters and increase the sensitivity of the rectum to the presence of stool. About 70% of well-motivated people benefit from biofeedback.

If fecal incontinence persists, surgery may help in a small number of cases--for instance, when the cause is an injury to the anus or an anatomic defect in the anus. As a last resort, a colostomy (the surgical creation of an opening between the large intestine and the abdominal wall (see Section 9, Chapter 131)) may be performed. The anus is sewn shut, and stool is diverted into a removable plastic bag attached to the opening in the abdominal wall. A colostomy does not always have to be permanent.