Introduction to Bowel Incontinence

Bowel or fecal incontinence is the loss of voluntary control of stool, or bowel movements. This condition can vary from being partial, in which a person loses only a small amount of liquid waste, to complete, in which the entire solid bowel movement cannot be controlled.

Bowel incontinence affects more than 5.5 million Americans. Both men and women suffer from this problem, though it is more common in women because of injury to the anal muscles or nerves that can occur during childbirth. Bowel incontinence becomes more common with advancing age as the muscles that control bowel movements (anal sphincter muscles) weaken.

Often, embarrassment and the stigma associated with incontinence prevent people from seeking treatment, even when incontinence affects his or her quality of life. Many people resort to altering their social and physical activities, even their employment, to cope with the problem. In addition, some people with bowel incontinence do not see a doctor because they just don't realize that their problem can be effectively treated. It's important to understand that bowel incontinence is not uncommon and can be successfully treated.

What Causes Bowel Incontinence?

Normal control of bowel movements depends on proper functioning of the colon and rectum, the muscles surrounding the anus (anal sphincter muscles), the brain and the body's nerves (the nervous system), plus the amount and consistency of waste products produced.

There are many causes of bowel incontinence, including:

• Damage or injury to the anal sphincter muscles or the nerves surrounding these muscles.
• Anal surgery for another condition.
• Certain medications, such as some antibiotics or Neurontin (an anti-seizure medication).
• Improper diet.
• Radiation treatment to the lower pelvic region.
• Chemotherapy.
• Stroke.
• Conditions associated with chronic diarrhea or constipation.
• Systemic (whole-body) diseases such as diabetes or scleroderma.
• Spinal cord damage.

What Can I Do if I Have Bowel Incontinence?

See your doctor if you have bowel incontinence. Tests to determine the cause for incontinence can be completed during an outpatient appointment and are not painful.

Once these tests have confirmed the cause of your incontinence, your doctor can make specific recommendations for treatment, many of which do not require surgery.

No matter how serious the problem seems, incontinence is a condition that can be significantly helped and, in most cases, cured.

How Is Bowel Incontinence Diagnosed?

Endosonography, also called rectal ultrasound, makes it possible to view the anal sphincter muscles and precisely identify abnormalities. Ultrasound can be used to locate the exact position of a tear in a muscle, even before bowel incontinence becomes a problem.

Other procedures to diagnose bowel incontinence that may be used include:

• Flexible sigmoidoscopy. By using a thin, flexible lighted tube called an endoscope, your doctor can examine the lining of the final third of the lower digestive tract.
• Manometry. This test measures the pressure and strength of the anal muscles and can determine if they are too weak to function properly.
• Nerve studies. These tests check for nerve damage to determine if the nerves that communicate with the sphincter muscles are working properly.
• MRI. Magnetic resonance imaging can help identify areas of weakness in the sphincter muscles.

How Is Bowel Incontinence Treated?

Once the underlying cause of bowel incontinence has been identified, most people with this condition can be cured or the condition can be significantly improved. However, the method of treatment depends on the cause of the incontinence. Sometimes simple changes in diet or eliminating certain medications can be effective in helping patients regain bowel control. More frequently, treatment involves a combination of medication, biofeedback, and exercise.

• Medication. Sometimes taking medications to change the consistency of the stool can provide relief, since a person can usually control stool better when it is firm rather than loose or liquid. Over-the-counter anti-diarrheal medications may include Imodium, and prescription medications may include Lomotil.
• Biofeedback. Biofeedback training for bowel incontinence involves putting a pressure probe in the anus or a sensing electrode on the skin. These devices are attached to a visual or sound display to tell the patient when the proper anal muscles are being used. Biofeedback helps a patient improve the strength and coordination of the anal muscles that help control bowel movements, as well as heightens the sensation related to the rectum filling with stool.
• Exercise. Muscle-strengthening exercises (called Kegel exercises or pelvic floor exercises) can be very helpful in treating bowel incontinence. To do Kegel exercises contract the muscles of the anus, buttocks, and pelvis and then hold as hard as possible for a slow count of five and then relax. Imagine you are trying to stop the flow of stool and urine or trying not to pass gas. A series of 30 of these exercises should be done three times daily. In a few weeks, the pelvic floor muscles will be stronger and often the incontinence improves or resolves.
• Surgery. Patients who continue to experience bowel incontinence despite other treatments may require surgery to regain control. Surgery may especially be needed for patients who have experienced anal muscle injuries (as can occur during childbirth).

What Surgical Procedures Are Used to Treat Bowel Incontinence?

Surgical options for bowel incontinence include:

• Sphincteroplasty. Rectal sphincter repair is the most common procedure used to correct a defect in the sphincter muscles. There are two anal muscles that control bowel movements, similar to two round doughnuts, one inside the other. If a defect exists in the complete circle of muscle, the problem can be corrected with this surgery. During the sphincteroplasty, the two ends of the muscle are cut and overlapped onto one another, then sewn in place to restore the complete circle of muscle.
• Muscle transposition. During this procedure gluteal (buttock) or gracilis (inner thigh) muscles are used to encircle and strengthen the anal canal. When the inner thigh muscle is used, pacemaker-like electrodes are implanted into the grafted muscle to train it to remain contracted. When the buttock muscle is used, the lower portion of this muscle is freed from the tailbone region and wrapped around the anus to construct a new anus. The buttock muscle transposition does not require the use of a pacemaker. This procedure is an option for the small percentage of patients whose condition cannot be successfully treated with sphincteroplasty.
• Colostomy. In rare and very difficult cases, the only alternative may be a colostomy, a surgically created opening in the abdominal wall through which the colon passes, and where a bag is fitted to collect stool.

If conservative treatment or surgical repair of the anal sphincter fails to improve a patient's situation, an artificial bowel sphincter may be an option. The Acticon Neosphincter is a circular device implanted around the anus. The device can be inflated like a balloon to prevent the passage of stool. When a person has to move the bowels, the plastic ring can be deflated for stool to pass through.

Can Bowel Incontinence Be Prevented?

Since bowel incontinence in women is often caused by anal muscle or nerve damage that occurred during childbirth, prevention is not always possible. However, if the use of forceps can be avoided during childbirth, the period of labor not prolonged and the baby not delivered too rapidly, injury to the pelvic muscles and nerves can be avoided.

Also, chronic constipation may result in incontinence. Getting sufficient water, fiber, and exercise can be effective in treating constipation.

SOURCE:

National Digestive Diseases Information Clearinghouse.

Food and Drug Administration.

Reviewed by Venkat Mohan, MD on September 13, 2008

Portions of this page © Cleveland Clinic 2008

Last Editorial Review: 9/13/2008

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