Bowel Incontinence
Fecal incontinence, also called bowel incontinence or bowel leakage, is the inability to control bowel movements, causing stool to leak from the rectum. Fortunately, it is usually treatable.
There are different types of fecal incontinence. Some individuals may experience occasional accidental bowel leakage (ABL) or diarrhea, while others face more persistent symptoms that can significantly impact their daily lives.
Symptoms
Symptoms of fecal incontinence may range from occasional or frequent accidental fecal leaking, diarrhea, constipation, gas, farting, or bloating. Symptoms can worsen over time, particularly with jumping, lifting or standing activities.
Symptoms are usually relieved when lying down. Whatever the symptom(s), it’s important that you honestly talk with your provider about what you are experiencing even if it is embarrassing.
Causes
There are many causes of fecal incontinence. Some people often experience more than one cause.
- Chronic constipation
- Childbirth, particularly if you had an episiotomy, can lead to muscle or nerve damage around the rectum or pelvic floor
- Nerve or muscle damage around the rectum or pelvic floors, related to childbirth, constipation, stroke or other health conditions
- Medications
- Pelvic organ prolapse, where the vagina, bladder, or other organs “fall down” around the rectum, putting pressure on it
- Rectocele, where the rectum “moves into” the vagina
- Rectal prolapse, where the rectum “falls down” or bulges out
- Surgery for hemorrhoids
Risk Factors for Fecal Incontinence
Fecal incontinence, or occasional stool leakage, is more common than many realize. It frequently affects women, especially those who have given birth or are over 50. Additional risk factors include:
- Age: The likelihood of fecal incontinence increases with age
- Gender: Women are more prone to this condition
- Chronic constipation and straining
- History of pelvic organ prolapse or other incontinence issues
- Neuromuscular conditions such as multiple sclerosis
- Obesity or being overweight
- Inactive lifestyle
- Insufficient fiber and fluid intake
Fecal Incontinence Diagnosis
Many women who experience fecal incontinence also experience urinary incontinence or overactive bladder syndrome (OAB).
The first step to a diagnosis is completing a detailed medical history and an office exam. You’ll be asked about your bowel habits, medications, diet, and other medical conditions. Other exams may help to identify the cause(s). These include:
- You may need urodynamic testing, which is a process used to evaluate how the body stores and empties urine.
- Pelvic ultrasound: We use state-of-the-art 3D and 4D ultrasound imaging at our clinics to “make a picture” of the inside of your pelvis.
- MRI (magnetic resonance imaging): We use magnetic waves to produce images of organs and soft tissue inside your pelvis. MRI studies are performed at Maple Grove Hospital.
Non-surgical Fecal Incontinence Treatment
Behavioral and lifestyle interventions: These interventions include managing fluid and fiber consumption, laxatives, biofeedback, lifting ergonomics, constipation prevention with diet and fluid intake, toilet use “retraining”, smoking cessation, and weight management.
Pelvic floor rehabilitation: Pelvic floor physical therapy: in-clinic and at-home training and education to teach you how to use your pelvic floor muscles correctly and increase pelvic floor muscle strength, which can help improve problems associated with bowel incontinence. Chronic constipation is also addressed at this time.
Outpatient Surgical Procedures
Neuromodulation: Sacral nerve stimulation, or neuromodulation, has proven successful for some women with fecal incontinence. Similar to a pacemaker for the heart, this treatment targets the communication problems between the brain and the nerves that control the bowel and the bladder.
An estimated 30% of women treated for overactive bladder/urge incontinence also improve their bowel concerns.
Surgery Options
Surgery options depend on which organs inside your pelvis are involved in your condition. Based on your symptoms, age, medical history, and your health, our gynecologic surgeons will recommend an option(s) that best suits you. When possible, we use reconstructive minimally-invasive surgery techniques with or without robotics.
Surgeries that may be indicated:
- Laparoscopic colposacropexy, with or without robotics
- Rectocele repair
- Anal sphincter repair
Questions to Ask Your Provider
- What is fecal or bowel incontinence?
- What organs are typically affected?
- What are my treatment options?
- If I choose no treatment, what can I expect over time?