Fecal Incontinence (Bowel Incontinence)

What is Fecal Incontinence?

Fecal incontinence, or bowel incontinence, occurs when you’re not able to hold in gas or bowel movements.

Why Choose University of Utah Health?

U of U Health General Surgery Services has advanced fellowship training and experience in colon and rectal surgery, as well as gastrointestinal surgery. Our general surgeons are nationally recognized for outstanding clinical care, research, and innovation for conditions like fecal incontinence.

We offer extensive treatment options for fecal incontinence and other gastrointestinal, colon, and rectal conditions:

Access to the newest medications
Emerging surgical techniques
Clinical trials

Our physicians also work with other specialists from urology, urogynecology, and physical therapy to address overlapping issues with fecal incontinence:

Causes of Fecal Incontinence

There are several causes of fecal incontinence:

Age—As you get older, you are more likely to experience structural or functional problems in your pelvic floor that can lead to incontinence.
Anatomy—Physical changes or abnormalities that affect the gastrointestinal (GI) tract, such as your rectum or colon, can affect your body’s ability to hold in bowel movements.
Diet—Sensitivity to certain foods, such as gluten or dairy, may cause loose or difficult-to-control stool.
Illness—Short-term illnesses can cause temporary incontinence because of loose stool or diarrhea. Long-term or chronic illnesses, such as colorectal cancer, can also cause fecal incontinence.
Injuries—Damage to the pelvic floor, rectum, or perineum can lead to fecal incontinence. Women may injure the sphincter muscle (a ring of muscles around the anus that tightens to hold in bowel movements) during childbirth. Other injuries that cause fecal incontinence include prior surgery or trauma, or injuries to the spinal cord or nerves.
Medications—Some medications cause diarrhea or weaken the sphincter muscle so it’s harder to control bowel movements.

A specialist can diagnose the underlying cause of your fecal incontinence, which can help predict whether it might get worse over time. If your bowel incontinence doesn’t negatively affect your quality of life, you may not need treatment.

Symptoms of Bowel Incontinence

A provider who specializes in treating fecal incontinence can help you understand your symptoms and get the correct diagnosis. Most people seek care from a provider after they start having bowel movement accidents, especially in public. There are several symptoms of bowel incontinence:

Feeling of urgently needing to have a bowel movement
Frequent diarrhea, constipation, or gas and bloating
Inability to stop yourself from defecating (pooping), even when you are not on a toilet

Going to the bathroom and needing to wipe a lot or noticing discharge a couple hours after a bowel movement might seem like fecal incontinence; however, it’s often a sign of other conditions, such as hemorrhoids or obstructive defecation.

What to Expect at Your First Appointment

At your first appointment, your provider will go through your medical history and ask about symptoms to determine the cause of your incontinence. They will conduct a physical exam by inserting a finger, covered with a glove and lubricant, into your rectum. They will check the sphincter muscle and rectal tissues for anything out of the ordinary.

Your provider may order diagnostic tests to confirm the diagnosis or rule out certain conditions, such as colorectal cancer:

Anal manometry—A small, flexible tube that goes inside your anus and rectum. A balloon at the tip of the tube can help providers measure tightness in your anal sphincter.
Anorectal ultrasonography—A narrow wand that uses sound waves to create a video image on a computer of the tissues inside your sphincter.
Balloon expulsion test—Your provider will insert a small balloon full of water inside your rectum. You will then go to the bathroom to see how long it takes to expel the balloon.
Colonoscopy—A flexible tube with a camera at the end that is inserted through your anus to look at your colon (intestine).
Magnetic resonance imaging (MRI)—An MRI can help doctors see soft tissues, organs, and muscles around the anus and sphincter that might contribute to fecal incontinence.
Pelvic floor defcography—This test takes MRI images of the structure and function of your rectum and pelvic floor while you pass a bowel movement on a special toilet.

Fecal Incontinence Treatment

Treatment depends on the underlying cause and the severity of fecal incontinence:

Pelvic floor physical therapy to teach you exercises to strengthen your pelvic floor muscles
Dietary changes, such as eating more fiber
Over-the-counter medications or prescriptions
Sacral nerve stimulation

Sacral Nerve Stimulation

Your sacral nerve goes from your spinal cord to the pelvic muscles, which controls sensations and strength in your anal and sphincter muscles. A sacral nerve stimulator (SNS) is a small device implanted under your skin that sends electrical impulses to the nerve. The impulses strengthen the muscles and improve your bowel movement control.

The Procedure

During the procedure, your surgeon will implant an electrode into your sacrum (the lower part of your spine). For the first two weeks, you will have an electrode coming out of your skin that connects to a trial device. If your fecal incontinence responds well to the trial, your surgeon will implant the permanent nerve generator under your skin in a second surgical procedure. You are under full anesthesia for both procedures, which take about 90 minutes each.

What to Expect After Implantation

Most people do not have much pain and only need over-the-counter pain medication after surgery. After the surgery you cannot get in a hot tub, go swimming, or take a bath for two weeks to prevent infection.

There are potential complications and risks of sacral nerve stimulators:

Device malfunctions
Electrodes that migrate (move) inside your body
Erosion of the skin near the device
Infection

Newer devices are rechargeable, so you will not need surgery to replace the device when the battery dies. They are also compatible with MRI tests.

Colorectal Surgery for Fecal Incontinence

A final option for people who do not get relief from less invasive treatments is colorectal surgery for fecal incontinence. Depending on your case, your surgeon may suggest a colostomy (bowel diversion). This surgery is typically a last resort for patients who do not benefit from other treatments. During the procedure, your stool will be diverted from your colon (intestine) into an opening in your abdomen. As a result, stool will collect in a small pouch outside of your body that you replace as needed.

Bowel Incontinence Home Remedies

Some people don’t need medical treatment for bowel incontinence. There are successful home remedies for bowel incontinence:

Eat more fiber or taking a fiber supplement.
Take over-the-counter medications for diarrhea (Imodium).
Do regular pelvic floor exercises to strengthen pelvic floor muscles.
Use bowel training to gain more control by consciously having bowel movements at the same time each day.

Find a Fecal Incontinence Specialist

Schedule An Appointment for Fecal Incontinence

Schedule an appointment to meet with one of our specialists if your inability to control bowel movements is affecting your health or quality of life. Our fecal incontinence specialists can help you find the underlying cause, and provide treatment to help relieve your symptoms.

Prior to your appointment, we may request tests, such as a colonoscopy. Call 801-587-5854 to speak to a member of our scheduling team, or request an appointment online.