Fecal incontinence is the inability to control your bowels.
When you feel the urge to have a bowel movement, you may not be
able to hold it until you can get to a toilet. Or stool may
leak from the rectum unexpectedly.
Fecal incontinence can have several causes:
- damage to the anal sphincter muscles
- damage to the nerves of the anal sphincter muscles or
- loss of storage capacity in the rectum
- pelvic floor dysfunction
Constipation is one of the most common causes of fecal
incontinence. Constipation causes large, hard stools to become
lodged in the rectum. Watery stool can then leak out around the
hardened stool. Constipation also causes the muscles of the
rectum to stretch, which weakens the muscles so they can't hold
stool in the rectum long enough for a person to reach a
Fecal incontinence can be caused by injury to one or both of
the ring-like muscles at the end of the rectum called the anal
internal and/or external sphincters. The sphincters keep stool
inside. When damaged, the muscles aren't strong enough to do
their job, and stool can leak out. In women, the damage often
happens when giving birth. The risk of injury is greatest if
the doctor uses forceps to help deliver the baby or does an
episiotomy, which is a cut in the vaginal area to prevent it
from tearing during birth. Hemorrhoid surgery can damage the
sphincters as well.
Fecal incontinence can also be caused by damage to the
nerves that control the anal sphincters or to the nerves that
sense stool in the rectum. If the nerves that control the
sphincters are injured, the muscle doesn't work properly and
incontinence can occur. If the sensory nerves are damaged, they
don't sense that stool is in the rectum. You then won't feel
the need to use the bathroom until stool has leaked out. Nerve
damage can be caused by childbirth, a long-term habit of
straining to pass stool, stroke, and diseases that affect the
nerves, such as diabetes and ms.
Loss of Storage Capacity
Normally, the rectum stretches to hold stool until you can
get to a bathroom. But rectal surgery, radiation treatment, and
inflammatory bowel disease can cause scarring that makes the
walls of the rectum stiff and less elastic. The rectum then
can't stretch as much and can't hold stool, and fecal
incontinence results. Inflammatory bowel disease also can make
rectal walls very irritated and thereby unable to contain
Diarrhea, or loose stool, is more difficult to control than
solid stool that is formed. Even people who don't have fecal
incontinence can have an accident when they have diarrhea.
The doctor will ask health-related questions and do a
physical exam and possibly other medical tests.
- Anal manometry checks the tightness of the anal
sphincter and its ability to respond to signals, as well as
the sensitivity and function of the rectum.
- Anorectal ultrasonography evaluates the structure of
the anal sphincters.
- Proctography, also known as defecography, shows how
much stool the rectum can hold, how well the rectum holds
it, and how well the rectum can evacuate the stool.
- Proctosigmoidoscopy allows doctors to look inside the
rectum for signs of disease or other problems that could
cause fecal incontinence, such as inflammation, tumors, or
- Anal electromyography tests for nerve damage, which is
often associated with obstetric injury.
Treatment depends on the cause and severity of fecal
incontinence; it may include dietary changes, medication, bowel
training, or surgery. More than one treatment may be necessary
for successful control since continence is a complicated chain
Food affects the consistency of stool and how quickly it
passes through the digestive system. If your stools are hard to
control because they are watery, you may find that eating high
fiber foods adds bulk and makes stool easier to control. But
people with well-formed stools may find that high fiber foods
act as a laxative and contribute to the problem.
Other foods that may make the problem worse are drinks
containing caffeine, like coffee, tea, and chocolate, which
relax the internal anal sphincter muscle.
You can adjust what and how you eat to help manage fecal
Keep a food diary. List what you eat, how much you eat, and
when you have an incontinent episode. After a few days, you may
begin to see a pattern involving certain foods and
incontinence. After you identify foods that seem to cause
problems, cut back on them and see whether incontinence
improves. Foods that typically cause diarrhea, and so should
probably be avoided, include:
- cured or smoked meat like sausage, ham, or turkey
- spicy foods
- dairy products like milk, cheese, and ice cream
- fruits like apples, peaches, or pears
- fatty and greasy foods
- sweeteners, like sorbitol, xylitol, mannitol, and
fructose, which are found in diet drinks, sugarless gum and
candy, chocolate, and fruit juices
If diarrhea is causing the incontinence, medication may
help. Sometimes doctors recommend using bulk laxatives to help
people develop a more regular bowel pattern. Or the doctor may
prescribe antidiarrheal medicines such as loperamide or
diphenoxylate to slow down the bowel and help control the
The skin around the anus is delicate and sensitive.
Constipation and diarrhea or contact between skin and stool can
cause pain or itching. Here's what you can do to relieve
- Wash the area with water, but not soap, after a bowel
movement. Soap can dry out the skin, making discomfort
worse. If possible, wash in the shower with lukewarm water
or use a sitz bath. Or try a no-rinse skin cleanser. Try
not to use toilet paper to clean up—rubbing with dry toilet
paper will only irritate the skin more. Premoistened,
alcohol-free towelettes are a better choice.
- Let the area air dry after washing. If you don't have
time, gently pat yourself dry with a lint-free cloth.
- Use a moisture barrier cream, which is a protective
cream to help prevent skin irritation from direct contact
with stool. However, talk to your health care professional
before you try anal ointments and creams because some have
ingredients that can be irritating. Also, you should clean
the area well first to avoid trapping bacteria that could
cause further problems. Your health care professional can
recommend an appropriate cream or ointment.
Reference for Fecal Incontinence
National Institutes of Health
The National Cancer
The National Eye Institute
The National Heart, Lung, and Blood
National Institute on Aging
National Institute of Allergy and
National Institute of Arthritis and
Musculoskeletal and Skin Diseases
National Institute of Diabetes and
Digestive and Kidney Diseases
National Institute on Drug
National Institute of Mental
National Institute of Neurological
Disorders and Stroke