Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 14, 2026
What causes fecal incontinence in women?
Accidental bowel leakage usually has more than one cause at the same time. About 80% of women with this problem have multiple factors working together. Knowing what is behind your symptoms helps me figure out the best treatment for you.
You may have heard this called “fecal incontinence.” Many of my patients prefer the term “accidental bowel leakage,” and I do too.
Common causes
- Childbirth injury is the most common cause in women. Vaginal delivery can tear the anal sphincter muscles or damage the nerves that control them. Sometimes the injury goes unnoticed at the time. An anal sphincter tear during delivery doubles the risk of bowel leakage afterward.
- Nerve problems from diabetes, spinal conditions, or prior pelvic surgery can weaken bowel control.
- Muscle weakening happens naturally with age. The anal sphincter gradually loses strength over time.
- Loose or urgent stools from IBS, inflammatory bowel disease, or other gut conditions can overwhelm even a healthy sphincter.
- Rectal prolapse or incomplete emptying can lead to leakage. When stool stays trapped after a bowel movement, it can seep out later.
- Chronic straining from constipation can stretch and weaken the pelvic floor muscles and nerves over time, which can actually cause leakage.
The childbirth connection
Many women I see had a sphincter tear during delivery years or even decades ago. The injury may not have caused problems right away. Over time, age, menopause, and other changes chip away at the body’s ability to compensate. That is when leakage starts.
The median age when women first notice bowel leakage symptoms is 55, often long after the original injury. This “multiple hit” pattern is one of the most common stories I hear in clinic.
How common is this?
About 9% of adult women have monthly bowel leakage. The true number is probably higher because fewer than 30% of women with symptoms ever mention it to a doctor. Many women deal with this quietly for years before seeking help.
Treatment works
I want you to know that effective treatments exist. Depending on what is causing your leakage, options include dietary changes to optimize stool consistency, pelvic floor physical therapy (which is much more than Kegels), medications like loperamide, and a procedure called sacral neuromodulation. Sacral neuromodulation is sometimes called a “bowel pacemaker.” It is the most effective procedure for bowel leakage and works even if you have a sphincter injury.
We will talk through your options together and choose a plan that fits your life and goals.
Getting help
I bring up bowel symptoms with my patients because I know how hard it is to raise the topic yourself. You would be surprised how many women are quietly dealing with this. If you are experiencing accidental bowel leakage, I can evaluate what is going on and put together a treatment plan.
References
- Borello-France D, Burgio KL, Richter HE, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006. doi:10.1097/01.AOG.0000232592.82165.78
- Meyer I, Richter HE. Impact of fecal incontinence and its treatment on quality of life in women. Womens Health. 2015. doi:10.2217/whe.14.66
- Sultan AH, Monga A, Lee J, et al. IUGA/ICS joint report on terminology for female anorectal dysfunction. Int Urogynecol J. 2017. doi:10.1007/s00192-016-3140-3
- Goldman HB, Lloyd JC, Noblett KL, et al. ICS best practice statement for use of sacral neuromodulation. Neurourol Urodyn. 2018. doi:10.1002/nau.23596
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019. doi:10.1097/GCO.0000000000000584
- Brown HW, Dyer KY, Rogers RG. Management of fecal incontinence. Obstet Gynecol. 2020. doi:10.1097/AOG.0000000000004054
- Meyer I, Richter HE. Accidental bowel leakage/fecal incontinence: evidence-based management. Obstet Gynecol Clin North Am. 2021. doi:10.1016/j.ogc.2021.05.003
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