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Digestive Diseases

Fecal Incontinence

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Fecal incontinence is characterized by an inability to control bowel movements. Over 5.5 million Americans have fecal incontinence, including both adults (more often women and older adults) and children.

Causes

The internal and external anal sphincter muscles located at end of the rectum keep stool inside the rectum. Fecal incontinence may be caused by a number of conditions including an abscess or inflammation in the rectum or perianal area, damage to the anal sphincter muscles or pelvic floor muscles from complications or trauma of childbirth, nerve damage resulting from neurologic disorders, or surgery to the area around the sphincter muscles.

Stroke, physical disability due to an injury, chronic constipation, diarrhea, radiation treatment, rectal surgery, inflammatory bowel disease (IBD), diseases that affect the nerves such as diabetes or multiple sclerosis also may cause this condition.

Diagnosis

The following tests may be performed during diagnosis:

  • anal manometry to measure the strength of the anal sphincter muscles and their ability to respond to signals.
  • MRI and/or an anorectal ultrasound to visualize the structure of the sphincters.
  • proctography (also known as defacography) to measure how much stool the rectum can hold, how effectively it holds it, and how effectively the rectum can evacuate.
  • proctosigmoidoscopy 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.
  • anal electromyography to measure nerve damage.

Treatment

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

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 may cause diarrhea and incontinence include: 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

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

Biofeedback techniques can help control and strengthen anal muscles. A computer measures muscle contraction while the patient performs muscle exercises (called Kegel exercises) for the pelvic floor with the goal of strengthening rectal muscles and improving sensation. The computer provides feedback on whether the patient is performing exercises correctly and whether the muscles are becoming strengthened.

Surgery

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. In addition, minimally invasive surgery may be possible for patients with rectal prolapse (protrusion of the rectum out of the anus), which allows for less postoperative pain, less medication, and more rapid healing when compared with traditional open surgical techniques.

Colostomy

For individuals with 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 is brought through an opening made in the abdomen, called a stoma. Stool exits the body through this opening and is collected in a pouch attached to the outside of the abdomen.

Contact

Digestive and Liver Diseases, NewYork-Presbyterian/Columbia
Directions
(212) 305-1909
Gastroenterology and Hepatology, NewYork-Presbyterian/Weill Cornell
Directions
(646) 962-4463
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