Fecal incontinence, also known as bowel incontinence or bowel leakage, is the inability to control your bowel movements, leading feces (stool) to leak uncontrollably from your rectum. Fortunately, fecal incontinence is generally treatable.
There are different “types” of fecal incontinence. Some women experience occasional accidental bowel leaking (ABL) or diarrhea, while others are chronically impacted to a greater, life-changing degree.
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 leaking is more common that you might think. Many women, particularly those who have had children or are 50 years of age or older experience occasional or chronic problems. Other risks factors include:
- Age: fecal incontinence or leaking is more common with age
- Gender: women experience a greater likelihood of this condition
- Chronic constipation, straining
- History of pelvic organ prolapse or incontinence
- Nerve and muscle (neuromuscular) conditions, such as multiple sclerosis
- Obesity, being overweight
- Inactive lifestyle
- Inadequate fiber and fluid consumption
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 radio waves to produce images of organs and soft tissue inside your pelvis. MRI studies are performed at Maple Grove Hospital.
Based on your history, the exam and test results, your GYN provider will work with you to determine next steps, which may include non-surgical and surgical options.
Many women who experience bowel incontinence also experience bladder problems. At the Center for Urinary and Pelvic Health, we use conservative non-surgical fecal incontinence treatments first followed by office or surgical procedures. Following a thorough health history and exam, our team works with you to create a care plan and carefully evaluate your progress over time.
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 muscle rehabilitation: ObGyn 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.
Office-based 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 neuromodulator is one device of many we use to improve this communication and better control bladder and bowel contractions.
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
Understanding Risks
While your risk of complications is low, surgical and non-surgical options can bring risks. Talk with your surgeon more about your risks and concerns.
What to Expect
Based on your symptoms, age, health, and lifestyle, your surgeon may first recommend non-surgical options. If surgery is necessary, you will receive pain medication and receive detailed self-care instructions. You may need to avoid sex, heavy lifting, and vigorous physical activity up to several days or weeks, depending on your surgery.
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?