What Causes Fecal Incontinence?

Fecal incontinence, also known as bowel incontinence or accidental bowel leakage, is the inability to control your bowel movements. Someone with fecal incontinence may experience frequent accidents or unexpected stool leakage. More than 5 million people in the United States are affected by fecal incontinence, though it's more common in older adults and women.

There are a variety of reasons why someone might experience fecal incontinence, including damaged nerves or muscles in the rectum or anus. Diarrhea, constipation, or another health condition can also cause fecal incontinence, which is why it's important to get an accurate diagnosis and treatment.

Depending on the underlying cause, fecal incontinence can happen occasionally or be a long-term issue.

Symptoms

Fecal incontinence is an inability to control your bowel movements. This symptom can feel different for each person. Some people are aware that fecal incontinence is happening but can't control it, while others may not be aware.

When you experience fecal incontinence, you may not be able to hold in a shart (gas with watery stool), have unexpected stool leakage during the day, or not be able to reach the bathroom in time. You may also notice a strong, sudden urge to have a bowel movement or stool streaks or stains on your underwear.

Fecal incontinence can vary in frequency and severity. It's possible to experience occasional bouts or recurring accidents over a long period. Depending on the cause, fecal incontinence may also present with diarrhea, constipation, and stomach pain or discomfort.

Causes of Fecal Incontinence

Fecal incontinence generally happens when your rectum and anus cannot hold in stool. This can result from various factors, such as a change in bowel habits (like diarrhea or constipation) or an underlying health condition.

Diarrhea

When you have diarrhea, your stool is loose and watery. Because this type of stool can be sudden, urgent, and more difficult to control, it can lead to fecal incontinence. Diarrhea is the most common cause of fecal incontinence in people who aren't in a hospital or assisted living facility.

Diarrhea that causes fecal incontinence is sometimes temporary. You may experience short-term diarrhea if you have a gastrointestinal (GI) infection or ate something that upset your stomach.

For people with a digestive disorder that involves diarrhea as a common symptom, fecal incontinence may be chronic or ongoing. This includes conditions like inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).

In cases where you're experiencing fecal incontinence as a result of diarrhea, you may also notice symptoms such as:

• Stomach pain or cramping
• Nausea and vomiting
• Feeling dizzy or lightheaded
  

Constipation

Constipation—having infrequent bowel movements that may be difficult to pass—can be another cause of fecal incontinence. Chronic constipation can stretch and weaken the rectum muscles, allowing built-up stool to leak out. People with severe constipation may also experience overflow diarrhea, causing fecal incontinence.

Along with fecal incontinence, people with constipation may experience:

• Dry or hard stools
• Less than three bowel movements per week
• Straining while trying to pass a bowel movement
• Feeling "blocked up"
• Stomach pain or bloating

Constipation is the most common cause of fecal incontinence in children.

Muscle or Nerve Damage

Your bowel function is controlled by the anal sphincter muscle's ability to hold in stool, the rectum's capacity to store stool, and the sensation that alerts you that a bowel movement is coming.

When the muscles or nerves related to your anus, rectum, and pelvic floor are damaged, they can't perform normal functions like closing the anus properly, holding stool in the rectum, or signaling that you need to go to the bathroom—leading to stool leakage.

This muscle or nerve damage can happen when you've experienced:

• Surgery or trauma to the anus or rectum
• Frequent straining to pass stool
• Brain or spinal cord injury
• Vaginal childbirth
• Pelvic floor dysfunction
• Neurological disorders like diabetes, multiple sclerosis (MS), Parkinson's disease, and stroke

These muscles may also naturally weaken with age or lack of physical activity.

Other Health Conditions

Several other health conditions can trigger fecal incontinence by interfering with the bowel movement process.

Some of these conditions include:

• Inflammatory bowel disease (IBD): This includes Crohn's disease or ulcerative colitis (UC), which can cause rectum scarring or inflammation.
• Hemorrhoids: Swollen blood vessels in and around the anus can keep the muscles in that area from closing completely and allow stool leakage.
• Rectal prolapse: This condition causes the rectum to protrude outside of the anus and prevents the anal muscles from closing properly.
• Anal cancer: Fecal incontinence may be a symptom of anal cancer. Radiation therapy to treat anal cancer may also damage the anal tissue, contributing to incontinence.

Certain birth defects that impact the anus, colon, or rectum can also cause fecal incontinence.

When To See a Healthcare Provider

Consider visiting a healthcare provider if you notice any fecal incontinence, especially if it accompanies symptoms like:

• Skin irritation or sores in the anal area
• Severe diarrhea
• Bloody stool

A healthcare provider will review your medical history and ask questions about your symptoms. They will also perform a physical exam, particularly on the stomach and rectum.

The provider may also order one or more of the following diagnostic tests:

• Imaging tests: An ultrasound, MRI scan, or X-ray can provide a closer look at the muscles around the anus and determine how the rectum and anus perform during a bowel movement.
• Colonoscopy: A medical doctor will use a scope tool to view the inside of the colon. This test can help diagnose underlying conditions like IBD and rule out any additional issues that may be occurring, such as polyps or cancer.
• Electromyography (EMG): This test evaluates whether the nerves that work with the anal muscles are functioning correctly.
• Anorectal manometry: By measuring the pressure and function of the muscles in the anus and rectum, this test can help determine the exact cause of your fecal incontinence.
  

Treatments for Fecal Incontinence

Treatment for fecal incontinence aims to restore or improve control over your bowel movements.

A healthcare provider may start with a few treatment options to reduce your chances of experiencing a bowel movement accident. Data suggests these first-line options can improve symptoms by about 60% and stop fecal incontinence in 1 out of 5 people:

• Dietary changes: This may include avoiding foods and drinks that trigger diarrhea or consuming more fiber if constipation is an issue.
• Medications: Your provider can recommend anti-diarrheal medications, fiber supplements, or laxatives.
• Bowel retraining: This method involves creating habits that familiarize your body with using the bathroom at certain times.
• Pelvic floor exercises: These are specific movements to help you strengthen your pelvic floor and anal muscles.

If your provider determines you have an underlying health condition or muscle or nerve damage, they may suggest additional treatment options, including surgical procedures and prescription medication. In these cases, they may refer you to a gastroenterologist—a specialist who treats conditions affecting the colon, anus, and rectum—or a colorectal surgeon.

How To Prevent Fecal Incontinence

While fecal incontinence is not always preventable, you may be able to lower your risk of experiencing fecal incontinence episodes or accidents.

Here are a few tips that experts suggest to help prevent these episodes from occurring:

• Be mindful of consuming potentially triggering foods and drinks, such as spicy foods, alcohol, or caffeine
• Eat smaller meals more often to help reduce the frequency of bowel movements
• Go to the bathroom at the same times each day to establish a bowel movement pattern
• Manage any chronic conditions (e.g., inflammatory bowel disease)
  

If you're worried about an accident in public, consider bringing wet wipes and a pair of clean underwear with you. You can also try wearing disposable pads or underwear to make cleanup easier.

Complications

Some complications can develop as a result of experiencing fecal incontinence. Many people report feeling emotional and mental distress along with a reduced quality of life. Symptoms of anxiety and depression may occur in social situations out of fear of having an accident.

It's also possible to experience skin irritation with fecal incontinence. Habits like frequent wiping and cleaning of the affected area and skin exposure to leaked stool can lead to irritation, sores, and possibly a bacterial or yeast infection.

A Quick Review

Fecal incontinence is the inability to control your bowel movements. With fecal incontinence, you may experience a sudden urge to go to the bathroom or notice stool streaks or stains on your underwear.

Causes include diarrhea, constipation, nerve or muscle damage in the anus or rectum, and certain underlying health conditions. Fecal incontinence is treatable with dietary changes, medications, bowel retraining, or surgery.