Fecal/Bowel Incontinence

Fecal/Bowel Incontinence

What is bowel incontinence?

Fecal incontinence refers to a loss of control of gas and/or stool. At Loma Linda University Health, we offer anal biofeedback, which is very effective at reducing the severity of fecal incontinence vs. going straight to more invasive treatments.

What are the symptoms of fecal incontinence?

A wide range of symptoms may occur, from occasional loss of control over gas to regular loss of control of an entire bowel movement. Other symptoms of fecal incontinence may include:

• Diarrhea
• Loose/watery stools that are hard to hold
• Constipation
• Hemorrhoids
• Muscle weakness
• Rectal prolapse

What causes fecal incontinence?

Fecal or bowel incontinence can be caused by a variety of factors, including:

• Trauma during childbirth
• Nerve damage
• Prior anorectal surgery
• Loss of muscle
• Chronic constipation
• Diabetes
• Stroke
• Hemorrhoid surgery
• Multiple sclerosis
• Spinal cord injury

Myths about Fetal Incontinence

Some common myths about fecal incontinence or accidental bowel leakage include:

1. 1. Fecal incontinence only happens when you have loose or watery stools, like diarrhea.
   Although diarrhea can make you feel like you must go right now and this situation may lead to leakage, there could be underlying factors that must be diagnosed. But chronic constipation can also play a role in fecal incontinence.
2. If you’re constipated, you can’t have fecal incontinence.
   When you are constipated, watery stool can leak around hard stools. Frequent bouts of constipation can stretch and weaken the rectum, making it more difficult to get to the restroom before it’s too late.
3. Fecal incontinence only happens in older people.
   Although aging can be a factor with bowel incontinence, it may not be the cause. Bowel incontinence can happen even in young people for other reasons: giving birth, constipation, or muscle or nerve damage.
4. Diet cannot affect, and does not play a role, in how fecal incontinence affects your life.
   Your diet can play a huge role in how fecal incontinence can impact your life. For example, foods and beverages with caffeine can cause problems for some people. For others, triggers are spicy foods or eating large meals. Although you may have fecal incontinence, you may also be able to minimize how it affects you by regulating your diet.
5. 5. There is nothing I can do to treat my fecal incontinence.
   In most cases, fecal incontinence is a very treatable condition. Here are some of the things you can do to improve the quality of your life:
   • Watch what you eat (keep a food diary)
   • Get proper exercise (including pelvic floor exercises)
   • Take prescribed medications

If all else fails, surgery may be the answer for you.

How is fecal incontinence diagnosed?

Fecal incontinence is diagnosed by evaluation. This includes thorough history, physical examination, lab testing and endoscopic evaluation. Stool studies may be ordered to evaluate for infections which cause diarrhea. The endoscopic evaluation is completed by having either colonoscopy or sigmoidoscopy, anorectal manometry, and rectal ultrasound. Imaging studies, such as CT scan, MRI and defecography, may be ordered.

• Colonoscopy or sigmoidoscopy - During a colonoscopy, the physician puts a flexible tube in the rectum and advances it up into your colon. The tube has a camera attached to it, so the physician can look inside the colon (large intestine) and take tissue samples (biopsies). A sigmoidoscopy is very similar, but the tube does not go into the colon as far.
• Anorectal manometry - The manometry study allows the physician to measure the pressures inside the rectum in various areas. It is helpful to reveal if the muscles that control bowel movements are working correctly. This study also reveals if the person has normal sensation or feeling in the rectum.
• CT scan, MRI, or defecography- These are imaging studies which use X-ray equipment to provide a detailed view of the internal organs, bones, soft tissue, and blood vessels. These images provide greater detail than traditional X-ray studies to evaluate bowel movements.

At Loma Linda University Health, our physicians with specialized training may use rectal ultrasound in diagnosing fecal incontinence. This is a procedure in which a flexible tube with an ultrasound attached is passed into the rectum. During this procedure, sound waves are used to evaluate the internal organs in the rectal area. This is helpful in evaluating whether the muscles that control bowel movements are working normally.

How is fecal incontinence treated?

The most commonly prescribed treatments for fecal incontinence include:

Changing your diet - Changing what you eat and drink and how large the meals are that you eat can make a difference. You may also want to add a fiber powder supplement to your diet.

Exercises - If muscle damage is the cause, you may be told to add pelvic floor exercises, Kegel exercises, or other therapies to your daily routine.

Medications - Antidiarrheal drugs or medications may be used to decrease bowel movement frequency or reduce the water content of the stool.

Rectal sensitivity training - This is a type of biofeedback that trains you to recognize the need for a bowel movement so you can get to a bathroom before it's too late.

Injection therapy - This is when a filler of hyaluronic acid is injected into the walls of the anal canal to aid in increasing the anal muscle’s size and boost its thickness and function.  

Neuromodulation - Neuromodulation therapy stimulates the nerves that allow communication between the brain and the nerves that control your bowels.

Surgery - When bowel leakage is the result of muscle weakness or trauma, surgical repair may be recommended.

Colostomy - If all else fails, a colostomy may be the best answer for you.

At Loma Linda University Health, our physicians believe in working to diagnose and correct the problem through minimally invasive treatments, leaving surgery as a last resort.  Every effort is made to correct fecal incontinence non-surgically, including:

• Biofeedback to help you understand how the muscles in the pelvic area are working. It helps you to strengthen the muscles used for a bowel movement. It will also help you recognize when you need to go before it becomes urgent.
• Rectal sensitivity training, a type of biofeedback that trains you to recognize the need for a bowel movement so you can get to a bathroom before it's too late.

What are the complications of fecal incontinence?

If fecal incontinence is left untreated, this may result in increased pain and itching. There is also a risk of developing depression, due to the embarrassment that bowel leakage can cause.

Who is at risk for fecal incontinence?

Women experience fecal incontinence more frequently than men. Risk factors for bowel leakage are:

• Trauma during childbirth
• Frequent constipation
• Loss of muscle tone
• Advancing age
• Diabetes
• Multiple sclerosis
• Nerve damage
• Previous anorectal surgery
• Hormone therapy

NEXT STEPS

Seek medical intervention. If you are experiencing fecal incontinence or bowel leakage, be proactive and seek a medical evaluation. To request an evaluation at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.