Fecal Incontinence

What is fecal incontinence?

Fecal incontinence, also known as accidental bowel leakage, is the inability to control bowel movements, resulting in the involuntary loss of solid stool, liquid stool, or gas. It is a common and distressing condition that can range in severity from occasional leakage of a small amount of stool to a complete loss of bowel control. While it can be embarrassing to discuss, it is important to know that it is a medical condition and effective treatments are available. The problem can arise from issues with the muscles and nerves that control defecation, the consistency of the stool, or the capacity of the rectum to hold stool.

Common Symptoms

The main symptom of fecal incontinence is the inability to control the passage of stool. This can manifest in several ways:

• Urge Incontinence: A sudden, urgent need to have a bowel movement and being unable to reach a toilet in time.
• Passive Incontinence or Soiling: Leakage of stool or gas without being aware of it happening.
• Post-Defecation Leakage: Soiling that occurs after having a bowel movement, often due to incomplete emptying.

Associated symptoms can include:

• Diarrhea or constipation
• Gas and bloating
• Skin irritation and soreness around the anus

What causes fecal incontinence?

Fecal incontinence is often caused by a combination of factors that affect the complex system responsible for maintaining continence.

• Muscle Damage: Injury to the anal sphincter muscles is a leading cause. This most commonly occurs during childbirth, particularly with deliveries that require forceps or result in an episiotomy or a third- or fourth-degree tear.
• Nerve Damage: Injury to the nerves that control the anal sphincters or sense stool in the rectum can lead to incontinence. This can be caused by childbirth, chronic straining from constipation, spinal cord injury, or diseases like diabetes and multiple sclerosis.
• Constipation: Chronic constipation can lead to hard, large stools that stretch and weaken the rectum and damage the nerves. It can also lead to overflow incontinence, where liquid stool leaks around impacted feces.
• Diarrhea: Loose, watery stool is more difficult for the rectum and sphincters to control than solid stool.
• Loss of Rectal Storage Capacity: If the rectum becomes stiff and less elastic, it cannot stretch to hold a normal amount of stool. This can be caused by conditions like inflammatory bowel disease, radiation therapy, or rectal surgery.
• Pelvic Floor Dysfunction: General weakness or poor coordination of the pelvic floor muscles can contribute to both fecal and urinary incontinence.

How is fecal incontinence diagnosed?

The diagnosis of fecal incontinence starts with a thorough medical history and physical examination.

• Medical History: Your doctor will ask about the frequency and type of leakage, your bowel habits, diet, obstetric history, and any past surgeries or medical problems.
• Physical Examination: This will include a visual inspection of the perianal area and a digital rectal exam to assess your sphincter muscle tone at rest and when you squeeze.
• Anorectal Manometry: This test uses a thin, flexible tube with a balloon on the end to measure the tightness of your anal sphincter muscles and the sensitivity and capacity of your rectum.
• Endoanal Ultrasound: An ultrasound probe is gently inserted into the anus to create images of the sphincter muscles and identify any areas of injury or thinning.
• Defecography or MRI Defecography: This is a video X-ray or MRI that shows how your rectum and pelvic floor work during a simulated bowel movement. It can identify problems like a rectocele or internal rectal prolapse that may be contributing to incomplete emptying and leakage.
• Colonoscopy: This may be done to rule out other problems in the colon, such as inflammation or tumors, that could be causing your symptoms.

How is fecal incontinence treated?

Treatment for fecal incontinence depends on the underlying cause and the severity of the problem. A stepwise approach is usually taken, starting with the least invasive options.

Diet and Lifestyle Changes:

• Dietary Modifications: Adjusting your diet to improve stool consistency is often the first step. This may mean increasing fiber to bulk up loose stools or using stool softeners for constipation. Avoiding foods that can cause diarrhea, such as caffeine, alcohol, and artificial sweeteners, may also help.
• Bowel Training: Establishing a regular pattern for bowel movements, such as trying to go at the same time each day (e.g., after a meal), can help improve control.

Medications:

• Anti-diarrheal medications: Loperamide can help slow down the bowel and firm up the stool.
• Bulking agents: Fiber supplements like psyllium or methylcellulose can add bulk to the stool.

Pelvic Floor Muscle Training (Biofeedback):

• Biofeedback is a specialized form of physical therapy that can help you strengthen your pelvic floor muscles and improve coordination and sensation. It is a highly effective treatment for many people with fecal incontinence.

Procedures and Surgery:

• Injectable Bulking Agents: A substance can be injected into the wall of the anal canal to bulk up the tissue and help the sphincter close more tightly.
• Sacral Nerve Stimulation (SNS): This involves implanting a small device, similar to a pacemaker, that sends mild electrical pulses to the sacral nerves. This can significantly improve sphincter function and rectal sensation.
• Sphincteroplasty: If there is a clear defect in the sphincter muscle from an injury, a surgeon can perform an overlapping sphincteroplasty to repair it.
• Artificial Bowel Sphincter: In very severe cases, a device consisting of an inflatable cuff can be placed around the anal canal.
• Colostomy: For the most severe and intractable cases of fecal incontinence that have failed all other treatments, creating a colostomy can be a life-changing procedure that restores comfort, dignity, and quality of life.

Self-Care for Fecal Incontinence

Managing fecal incontinence often involves a combination of strategies to control symptoms and protect your skin.

• Diet: Keep a food diary to identify foods that may be triggering diarrhea or making your symptoms worse.
• Skin Care: It is very important to keep the skin around your anus clean and dry to prevent irritation and breakdown. Use a peri-bottle or sitz bath for gentle cleansing after a bowel movement. Pat the area dry and apply a moisture barrier cream, like one containing zinc oxide.
• Use of Pads: Absorbent pads or disposable underwear can help protect your clothing and skin.
• Plan Ahead: Before going out, locate the restrooms. Carry a change of clothes and cleaning supplies with you for peace of mind.

Is fecal incontinence a normal part of aging?
No. While fecal incontinence is more common in older adults, it is not a normal or inevitable part of aging. It is a medical condition with specific causes that can often be treated successfully at any age.

Can exercise help with fecal incontinence?
Yes, specific exercises to strengthen the pelvic floor muscles, known as Kegel exercises, can be very helpful. A physical therapist specializing in pelvic floor rehabilitation can teach you how to do them correctly and may use biofeedback to help you isolate and strengthen the right muscles.

Will I need surgery for fecal incontinence?
Not necessarily. Many people find significant improvement with non-surgical treatments like dietary changes, medications, and pelvic floor physical therapy. Surgery is usually reserved for people who do not get adequate relief from these more conservative measures.

• da Silva G, Mellgren A. Fecal Incontinence: Evaluation and Treatment. In: Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022:1035-1045.
• National Institute of Diabetes and Digestive and Kidney Diseases. Bowel Control Problems (Fecal Incontinence). Accessed September 28, 2026. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence
• Mayo Clinic. Fecal incontinence. Published March 6, 2021. Accessed October 12, 2025. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397