Understanding Fecal Incontinence
Got questions about fecal incontinence? You’re in the right place. We know it’s not always easy to talk about this issue, so let’s start with this: It’s more common than you might realize.
Fecal incontinence is an inability to control bowel movements, which can cause stool (poop) to leak from your rectum. It can also cause problems controlling when you pass gas. Fecal incontinence can range anywhere from subtle (streaks in your underwear when you go to the bathroom, without realizing how it happened) to severe (an obvious accident).
You may experience both fecal incontinence and urinary incontinence because the same pelvic floor muscles that control urinary function also control bowel function. And as distressing and disruptive as fecal incontinence is, it’s also very treatable with physical therapy and lifestyle changes.
What Does “Normal” Look Like?
Whether you call it defecation, passing stool, pooping, or going number two, this is an important part of your day. It’s the final phase of digestion and is a process that involves multiple systems in your body, including the muscular and nervous systems.
As food moves through your digestive tract, your body pulls out fluid and nutrients. Whatever it can’t use gets collected as stool (or feces) in the rectum, which is the end of your colon. When it’s time to defecate, nerves located between your rectum and anus signal to your brain that it’s time to go. Your pelvic floor muscles ensure everything stays inside until you go to the bathroom. Then they relax to help pass stool. If your pelvic floor muscles are weak, it affects your ability to hold in stool and gas.
What Are the Risk Factors?
Oftentimes moderate to severe fecal incontinence occurs because of a specific event, like a bad tear during childbirth. Other pregnancy and labor-related factors include:
Birthing a large infant (more than eight pounds)
Use of forceps
Anal sphincter injuries (damage or tearing to the muscles around the rectum and anus)
Other risk factors include:
Age: Fecal incontinence is more common among older adults.
Nerve injuries in the low back or pelvic area: Your nerves tell you when it’s time to have a bowel movement. When they don’t work properly (such as from diabetes or a stroke) it’s hard to know when it’s time to visit the restroom.
Anal muscle weakness or injury: This prevents your anus from closing completely and allows stool to leak out without your knowing.
Issues with elasticity of the rectum: This might be due to surgery, radiation, or inflammatory bowel disease.
Chronic diarrhea: Loose, watery stools are harder to “hold in” than solid stools.
Chronic constipation: Large, hard stools are difficult to pass. Over time, straining from constipation can weaken pelvic floor muscles and also stretch rectal muscles, allowing watery stools that build up behind the hard stool to leak out.
Hemorrhoids: Swollen veins in the rectum prevent the anus from closing completely.
Organ prolapse: When the rectum protrudes into the anus or vagina, it prevents muscles around your anus from closing completely.
What Can You Do?
Feeling like you can’t control your bowels is not a good feeling. But there are many ways to treat fecal incontinence.
Work with a pelvic floor physical therapist (PFPT). This is one of the most important parts of a treatment plan. A PFPT can help you with:
Kegels. When weakened pelvic floor muscles contribute to incontinence, Kegels can help. Your PFPT can show you how to perform them correctly. (Did you know that most people don’t do Kegels properly?)
Biofeedback. What? Good question. Biofeedback training retrains your body to sense when you’re ready to defecate and contract your muscles (hold your poop in) if it’s not a good time to go to the bathroom.
Bulk up your diet. Take a closer look at what you’re eating and drinking and make changes to support more regulated bowel movements.
Keep a food log. And also a “log” log. What you eat and drink affects the consistency of your stool. Keep track of what you eat and drink for a few days. Pay attention to whether certain foods impact the consistency of your stool or a bout of incontinence. If you think something in your diet is a contributor, try removing it and see if it makes a difference.
Fill up on fiber. Whether you can’t keep your stool in (diarrhea) or can’t get it out (constipation), fiber can help. With constipation, fiber makes your stool softer and easier to pass. And with diarrhea, it adds bulk to stool to make them less watery and more controllable.
Drink water. Aim for about half your body weight in ounces of water a day. This helps your stool stay soft and formed.
Bowel training. Training your bowels is as important as training your muscles when it comes to fecal incontinence. Bowel training involves going to the bathroom at a specific time each day (say, after breakfast) to establish more control through a routine. While you’re at, it helps to practice those good toilet techniques (ask for our Constipation Management resource for more information).
Medications. This includes options for diarrhea (antidiarrheals) and constipation (laxatives and fiber supplements).Bulking agents. These are non-absorbable and injectable agents that help thicken the walls of your anus to prevent leakage.
Sacral nerve stimulation (SNS). This involves implanting a device in your body that sends continuous electrical impulses to your sacral nerves, which run from your spinal cord to your pelvic muscles. They regulate sensation and strength in the muscles involved in defecation.
Surgery. In severe cases (such as rectal prolapse or sphincter damage that occurs during childbirth), surgery might be needed to address the underlying issues.
One Last Thing: This is Hard
We just provided different ways to manage fecal incontinence. But let’s not pretend that this is easy to deal with. For some, fecal incontinence is relatively minor. But for you, it might be a really big deal — so much so that you don’t do things you used to for fear of not making it to the bathroom in time.
Fear and embarrassment from fecal incontinence may not go away overnight. But as you work toward treating the root of your fecal incontinence, you can also try things like:
Identifying where the bathroom is when you arrive somewhere in case you need to use it suddenly
Wearing a pad or disposable undergarment when you go out
Carrying some cleaning supplies and a change of clothes with you
Talking to your doctor about using fecal deodorants (over-the-counter medications that minimize the smell of your stool and gas)
Fecal incontinence is stressful. But it doesn’t have to control you. There are plenty of ways you can take control of it and get back to living your life to the fullest.
Fecal incontinence is an inability to control bowel movements and when you pass gas, and often occurs in conjunction with urinary incontinence.
Fecal incontinence can be due to pregnancy and labor-related events, like a bad tear during childbirth. It can also be due to factors like nerve damage and chronic diarrhea or constipation.
Fecal incontinence is treatable, particularly with a combination of physical therapy and lifestyle changes.