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Fecal Incontinence

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Fecal incontinence is characterized by an inability to control bowel movements, which may be caused by a number of conditions. Over 5.5 million Americans have fecal incontinence, which affects adults (more women and older adults), and children.

Causes of Fecal Incontinence

Fecal incontinence may be caused by an abscess or inflammation in the rectum or perianal area, or damage to the anal sphincter muscles or pelvic floor muscles from complications or trauma of childbirth, nerve damage resulting from childbirth neurologic disorders, or the result of a previous operation. The anal sphincter muscles are two muscles at the end of the rectum called the internal and external sphincter muscles. These keep stool inside the rectum. Hemorrhoid surgery may sometimes damage the sphincter muscles.

Stroke, physical disability due to an injury, and diseases that affect the nerves such as diabetes or multiple sclerosis can also cause damage to the nerves that control the anal sphincters or sense stool in the rectum. Chronic constipation or diarrhea may also cause this condition.

Loss of storage capacity in the rectum, which may also cause fecal incontinence, may result from radiation treatment and rectal surgery. Inflammatory Bowel Disease (IBD) may cause rectal scarring that stiffens the walls of the rectum, which in turn cannot stretch to hold as much stool.

Pelvic floor dysfunction can also cause fecal dysfunction. This may be seen in rectal prolapse, protrusion of the rectum out of the anus, and rectocele, a protrusion of the rectum through the vagina. Often women do not experience symptoms of fecal incontinence due to pelvic floor dysfunction until their mid-40s or later.

Symptoms of Fecal Incontinence

Symptoms of fecal incontinence are not being able to hold a bowel movement until one reaches the bathroom, or an unexpected leakage of stool or gas.

Risk Factors for Fecal Incontinence

Childbirth, especially using forceps, episiotomies, and delivering larger weight babies may damage nerves or muscles in the anorectal region. Chronic constipation or diarrhea, stroke, diabetes or multiple sclerosis may also affect nerves and/or muscles that control anal sphincter function.

Diagnosis of Fecal Incontinence

The Columbia Anorectal Physiology (ARP) Laboratory at NewYork-Presbyterian is a state-of-the-art center, one of only a few in the New York metropolitan area, that offers a full complement of diagnostic and therapeutic tools for anorectal disorders.

To diagnose fecal incontinence, our physicians conduct a number of tests, including anal manometry, which measures the strength of the anal sphincter muscles and their ability to respond to signals. An MRI and/or an anorectal ultrasound may also be done to visualize the structure of the sphincters. Proctography (also known as defacography) shows how much stool the rectum can hold, how effectively it holds it, and how effectively the rectum can evacuate. Proctosigmoidoscopy enables the physician to view the inside of the rectum and lower colon to detect disease or other problems such as inflammation, scar tissue, or tumors, which can cause fecal incontinence. An anal electromyography, which uses tiny needles to measure nerve damage, may also be done for nerve damage caused by injury during childbirth.

Treatment for Fecal Incontinence

Treatments for fecal incontinence will depend on the cause and severity of the condition, and may include medication, dietary changes, biofeedback, or surgery. Often more than one modality is used to treat fecal incontinence.

Dietary changes to Treat Fecal Incontinence

Dietary changes, which include eating more fiber or less fiber and avoiding caffeine, may help. Keeping a food diary can help pin down what foods trigger an episode of incontinence. Other foods that can cause diarrhea and incontinence are, in addition to caffeine: alcohol, dairy products, cured or smoked meat, spicy foods, fruit, fatty foods, and dietary sweeteners such as sorbitol, xylitol, mannitol, and fructose. Other changes such as eating smaller meals more frequently, or drinking before or after meals but not while eating may also be suggested.

Medication to Treat Fecal Incontinence

Depending on the particular problem, medication to help control diarrhea, or conversely, bulk laxatives to help develop more regular bowel movements may help, depending on the particular problem.

Biofeedback to Treat Fecal Incontinence

Biofeedback techniques can be taught to help control and strengthen anal muscles. A computer measures muscle contraction while the patient performs muscle exercises for the pelvic floor with the goal of strengthening rectal muscles and improving sensation. Called Kegel exercises, these exercises are evaluated by computer and offer feedback – if the patient is performing exercises correctly and whether the muscles are becoming strengthened.

Surgery to Treat Fecal Incontinence

Surgery is an option for individuals for whom dietary changes and biofeedback do not help, or for those with an injury to the anal sphincter, anal canal, or pelvic floor. Surgery can repair injury to the sphincter mechanism, or help constrict the sphincter using the patient's tissue or a device. In addition, minimally invasive surgery may be possible for patients with rectal prolapse, which allows for less postoperative pain, less medication, and more rapid healing when compared with traditional open surgical techniques.

Colostomy to Treat Fecal Incontinence

For individuals with very severe fecal incontinence, for whom other treatments do not help, a colostomy may be performed. In this procedure, which may be temporary or permanent, the colon is surgically disconnected and one end brought through an opening made in the abdomen, called a stoma, through which stool exits the body and is collected in a pouch attached to the abdomen.

Research for Fecal Incontinence

NewYork-Presbyterian has an active research program for digestive diseases and, specifically, anorectal disorders. We are currently conducting research into using nerve stimulation for treating fecal incontinence.