Diseases & Conditions

Fecal incontinence

Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Common causes of fecal incontinence include constipation, diarrhea, and muscle or nerve damage. Fecal incontinence may be due to a weakened anal sphincter associated with aging or to injury to the nerves and muscles of the rectum and anus from giving birth.

Whatever the cause, fecal incontinence can be embarrassing. But don't shy away from talking to your doctor. Many treatments — some of them simple — are available that can improve, if not correct, fecal incontinence.

Generally, adults don't have "accidents" except perhaps during an occasional short-lived bout of severe diarrhea. But that's not the case for people with recurring, or chronic, fecal incontinence. If you have fecal incontinence, you:

• Can't control the passage of gas or stools, which may be liquid or solid, from your bowels
• May not be able to make it to the toilet in time to avoid an accident

For some people, including children, fecal incontinence is a relatively minor problem, limited to occasional soiling of their underwear. For others, the condition can be devastating due to a complete lack of bowel control.

Fecal incontinence may be accompanied by other bowel troubles, such as:

• Diarrhea
• Constipation
• Gas and bloating
• Abdominal cramping

When to see a doctor
See your doctor if you develop fecal incontinence or if your child develops fecal incontinence. Often, new mothers are reluctant to tell their doctors about their fecal incontinence problems after childbirth. But repairing a torn anal sphincter muscle soon after delivery may prevent long-term complications.

A number of tests are available to help diagnose what's causing the problem and determine the right treatment.

Emotional distress
Fecal incontinence can be a source of embarrassment and shame. It's not uncommon for someone with fecal incontinence to try to hide the problem or to avoid social engagements. The loss of dignity associated with losing control over one's bodily functions can lead to frustration, anger and depression.

Skin irritation
Besides the emotional aspects, fecal incontinence can irritate the skin. Because the skin around the anus is delicate and sensitive, repeated contact with stool can lead to pain, itching and, potentially, sores (ulcers) that require medical treatment.

If fecal incontinence is due to a problem that can't be completely corrected, you may still be able to limit the number of accidents you have by taking better control of your bowel movements. You can start by making changes in your diet:

• Watch what you eat. Keep a list of what you eat for a week. You may discover a connection between certain foods and your bouts of incontinence. Once you've identified which foods are problems for you, stop eating them and see if your incontinence improves. Foods that can cause diarrhea or gas and worsen fecal incontinence include spicy foods, fatty and greasy foods, cured or smoked meat, carbonated beverages, and dairy products (if you're lactose intolerant). Caffeine-containing beverages and alcohol also can act as laxatives, as can products such as sugar-free gum and diet soda, which contain artificial sweeteners.
• Eat smaller meals. Try to eat several small meals throughout the day, rather than three large ones, because large meals sometimes trigger bowel contractions that may cause diarrhea.
• Eat more fiber. Fiber helps makes stool soft and easier to control. Fiber is present in fruits, vegetables, and whole-grain breads and cereals. Aim for 20 to 30 grams of fiber a day, but add it to your diet slowly. Too much fiber all at once can cause bloating, gas or even diarrhea.
• Drink more water. To keep stools soft and formed, drink at least eight glasses of liquid, preferably water, a day.

In addition to managing fecal incontinence through changes to your diet, you can help avoid further discomfort by keeping the skin around your anus as clean and dry as possible. To relieve anal discomfort and eliminate any possible odor associated with fecal incontinence:

• Wash with water. Gently wash the area with water after each bowel movement — do this by using wet toilet paper, showering or, better yet, soaking in a bath. Soap can dry and irritate the skin. So can rubbing with dry toilet paper. Pre-moistened, alcohol-free towelettes or wipes may be a good alternative for cleaning the area.
• Dry thoroughly. Allow the area to air-dry after washing. If you're short on time, you can also gently pat the area dry with toilet paper or a clean washcloth.
• Apply a cream or powder. Moisture-barrier creams help keep irritated skin from having direct contact with feces. Ask your doctor to recommend a product. Be sure the area is clean and dry before you apply any cream. Nonmedicated talcum powder or cornstarch also may help relieve anal discomfort.
• Wear cotton underwear and loose clothing. Tight clothing can restrict airflow, making skin problems worse. Change soiled underwear quickly.

When medical treatments can't completely eliminate incontinence, products such as absorbent pads and disposable underwear can help you better manage the problem. You can purchase incontinence products at drugstores, supermarkets and medical supply stores. If you use pads or adult diapers, be sure they have an absorbent wicking layer on top. Products with this layer wick moisture away from your skin.