Fecal Incontinence

Fecal incontinence treatment depends on what is causing your symptoms and how severe they are. Your healthcare team may use one or more therapies to manage your symptoms, from medication and exercises to dietary changes and surgery.

Medications

Medication to help control diarrhea or bulk laxatives to help develop more regular bowel movements may help treat fecal incontinence. Examples include:

• Anti-diarrheal drugs such as loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol, Kaopectate)
• Laxatives, stool softeners, or fiber supplements — such as psyllium (Metamucil) or methylcellulose (Citrucel) — if you have constipation
• Prescription medications for irritable bowel syndrome, Crohn’s disease, and ulcerative colitis to help reduce fecal incontinence episodes
• Bulking agents are injected into the wall of the anus to bulk up the anal tissue, narrowing the opening so the sphincter can close more effectively

Exercise therapies

If muscle damage or weakness triggers your fecal incontinence, you may benefit from exercises and other techniques to strengthen those muscles and train your body to regain control of your bowel movements.

• Kegel exercises: Tightening and relaxing your pelvic floor muscles several times a day can reduce fecal incontinence symptoms by strengthening the muscles of your pelvic floor, anus, and rectum.
• Biofeedback: We offer biofeedback techniques to help control and strengthen your anal muscles. A computer measures muscle contraction while you perform Kegel exercises to strengthen rectal muscles and improve sensation. The computer provides feedback on whether you are performing the exercises correctly and whether your muscles are strengthening.
• Bowel training: If you train yourself to have bowel movements at certain times of day for weeks or months, you may improve fecal incontinence by introducing regularity to your bowel movement schedule.
• Vaginal balloon: By inflating a medical balloon inside the vagina, pressure can be placed on the wall of the rectum and keep stool from passing.

Lifestyle changes

A registered dietitian can work with you to adopt a diet that will help reduce incontinence episodes. The dietitian may ask you to keep a food diary and recommend eating smaller meals more frequently or drinking before or after (but not with) meals. Avoiding or reducing intake of the following foods may help:

• Caffeine
• Alcohol
• Dairy products
• Cured or smoked meat
• Spicy foods
• Fruit
• Fatty foods
• Dietary sweeteners such as sorbitol, xylitol, mannitol, and fructose

To manage irritation, itching, or pain around your anus, you should develop a skin care routine to relieve discomfort and control possible odor. Become familiar with the following kinds of practices:

• Gently wash the area around the anus after each bowel movement and then keep it dry.
• Change soiled underwear as soon as you can.
• Use moisture-barrier creams and nonmedicated powders to help soothe the anal area. Your doctor or nurse can let you know which ones are best for you.
• Wear clothes and underwear made of fabrics that “breathe” and let air pass through easily. They will help keep the anal area dry.
• Wear absorbent pads inside your underwear to wick away moisture and control odor.
• Always carry clean underwear and, if needed, a change of clothes for those moments when you have fecal incontinence away from home. Disposable underwear can be useful in certain settings, such as when you are traveling.

Surgery

If medications, exercises, and dietary changes are not enough to control or treat fecal incontinence, we may recommend sacral nerve stimulation or surgery.

• Sacral nerve stimulation: This is a reversible treatment for people with bowel control problems in whom other treatments have not been successful. A small pacemaker-like device is implanted under the skin and stimulates the sacral nerve in the lower back to restore bowel control.
• Fecal incontinence surgery: Our colorectal surgeons use minimally invasive approaches to repair damage to the anal sphincter, anal canal, pelvic floor, and rectal prolapse (protrusion of the rectum from the anus). These techniques are associated with less postoperative pain and a faster recovery than traditional open surgery. We often use robotic technology to see inside the pelvis and perform very delicate procedures, such as ventral mesh rectopexy — the surgical insertion of a mesh to improve the suspension and support of the rectum.
• Colostomy: This fecal incontinence treatment is reserved for people whose condition cannot be treated well using other therapies. During a colostomy, the surgeon disconnects the colon and brings one end through an opening in the abdomen. Stool exits the body through this opening and is collected in a pouch (ostomy bag) attached to the outside of the abdomen. Our ostomy nurses have the compassion and experience to support you as you adapt to life with a colostomy, which may be temporary or permanent.