Fecal Incontinence
Fecal incontinence means losing control of gas or stool when you don’t mean to. It’s also called accidental bowel leakage. For some it’s trouble holding gas now and then. For others it’s regular leakage of loose or formed stool. Even the mild version changes how you plan your day, and it can make you think twice about leaving the house.
I think this is one of the most underreported problems I see. Most doctors don’t ask about it, and most women don’t bring it up. It’s a medical condition, and I have real ways to treat it.
How common is it?
More common than most people think. Studies put it at somewhere between 7 and 15% of women living in the community. The real number is probably higher, since so many women never tell their doctor.
Types of fecal incontinence
I sort bowel leakage into a few patterns. They often overlap, and many women have more than one:
- Urge leakage. You feel the need to go but can’t get to the bathroom in time.
- Passive leakage. Stool comes out without you feeling it, and you find soiling later.
- Seepage. A small amount leaks after an otherwise normal bowel movement, often with a feeling that you didn’t empty all the way.
- Stress leakage. Coughing, laughing, lifting, or other effort brings it on.
Your pattern matters because it points me toward the cause and helps me choose a treatment.
What causes it?
Usually more than one thing. In my practice, the most common cause is probably injury from childbirth. A vaginal delivery can tear the anal sphincter muscles or damage the nerves that run them.
Loose stool is the other big one. If your stool is watery or soft, even a slightly weak sphincter can’t hold it. The sphincter muscles also lose some strength as you get older. Surgery on the anus or rectum, including hemorrhoid surgery, can play a part too.
Other things that can add to it: nerve conditions that affect the rectum and anus, diabetes, obesity, inflammatory bowel disease, and medicines that change your stool or how fast your bowels move.
Symptoms
They vary a lot from one woman to the next. You might have:
- Trouble holding in gas
- Leakage of liquid or formed stool
- A sudden, strong need to have a bowel movement with little warning
- Soiling you find without having felt anything
If any of these sound familiar, bring it up with a doctor, even if it only happens once in a while.
How I evaluate fecal incontinence
At your first visit I’ll ask about your symptoms, your bowel habits, your pregnancies and deliveries, and any surgeries you’ve had. Then I do a focused exam. Depending on what I find, I may suggest one or both of these tests:
- An anal ultrasound, which shows whether the sphincter muscles are intact
- Anorectal manometry, which measures how well the sphincter muscles and rectum are working
Both are done in the office. They help me sort out what’s going on so I can pick the right treatment.
Treatment options
Most women with fecal incontinence get better with treatment. I go over all the options with you, and we decide together where to start. Most patients never need surgery of any kind.
Lifestyle and diet changes
I start here with almost everyone. Changing your diet to firm up your stool helps more than most women expect. I’ll also talk with you about keeping regular bowel habits and how you sit on the toilet.
Pelvic floor physical therapy
A pelvic floor physical therapist works on the muscles that control your bowel. It helps many women, especially those with milder symptoms. We have pelvic floor PTs in our office, and I can refer you to one closer to home if that’s easier.
Medications
If loose stool is part of the problem, medicine to firm up your stool or slow your bowel down can help. These are simple and most women tolerate them well. I use them a lot.
Sacral neuromodulation
If diet, therapy, and medicine haven’t helped enough, sacral neuromodulation is usually the first surgery I recommend. That’s true even when the sphincter has a tear. A small device stimulates the nerves that control your bowel. You try it out first, so you know whether it works before anything permanent goes in. For most women in this spot, it works better and lasts longer than repairing the sphincter.
Sphincter repair
When the sphincter is torn, sewing it back together (sphincteroplasty) can help, and in some cases it’s still the right choice. The catch is that the benefit often fades over the years. That’s a big reason I now reach for sacral neuromodulation first for most women.
Living with fecal incontinence
While we work on treatment, a few things can make daily life easier.
Keep the skin around your anus clean and dry. That prevents irritation and skin breakdown. Pay attention to which foods make your leakage worse, and tell me what you notice so we can adjust your diet.
This problem also wears on you. If it’s affecting your mood or keeping you home from things you used to do, tell me that too. It’s part of what I treat.
When to see a doctor
If you have any bowel leakage, even a little, bring it up with your doctor or make an appointment with me. Many women wait years before they mention it, and that’s years spent putting up with something that’s very treatable. At your visit I’ll ask what’s been happening, examine you, and lay out a plan, usually starting with simple changes to your diet and your stool.
References
- Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512-517. doi:10.1053/j.gastro.2009.04.054
- Bharucha AE, Dunivan G, Goode PS, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110(1):127-136. doi:10.1038/ajg.2014.396
- Bordeianou LG, Thorsen AJ, Hawkins AT, et al. The ASCRS clinical practice guideline for the management of fecal incontinence. Dis Colon Rectum. 2023;66(5):647-661. doi:10.1097/DCR.0000000000002796