Shedding Light on Fecal Incontinence

For many women, fecal incontinence is embarrassing, but the rare issue that may occur when you have the stomach flu that’s producing diarrhea or as a reaction to last night’s dinner party. Sometimes, however, the unexpected loss of stool becomes an ongoing issue that’s difficult to hide and just as difficult to discuss.

Fortunately, many treatments exist that can effectively resolve the issue and the underlying conditions responsible for the unexpected loss of stool. Dr. Kohli has extensive experience in diagnosing the reasons for fecal incontinence and developing treatment strategies that offer welcome solutions.

What is fecal incontinence?

Also known as bowel incontinence, fecal incontinence occurs when you can’t control your bowels and are unable to hold your stool (feces) until you reach the toilet. You may notice stool leakage when you pass gas or during physical exertion. It’s sometimes a small amount of stool, but can also be a full bowel movement.

You may experience:

• Urge incontinence, during which you feel the need to have a bowel movement, but the stool seems to come so quickly you can’t get to the bathroom in time
• Passive incontinence, when you pass stool without experiencing the sensation that typically precedes a bowel movement

What causes fecal incontinence?

Fecal incontinence is more common in women than men and occurs much more frequently in middle-aged and older adults.

Other conditions associated with fecal incontinence include:

• Diarrhea or watery stools, which are much more difficult to retain than firm stool and caused by various bowel disorders, including irritable bowel syndrome or inflammatory bowel disease such as Crohn's
• Nerve damage related to diabetes, multiple sclerosis, and other medical conditions that affect the nerves that help control your anal sphincter, which releases so you can have a bowel movement and otherwise remains closed to retain stool
• Chronic constipation, which may cause muscle or nerve damage that leads to fecal incontinence

Another factor that is often linked to fecal incontinence is pelvic organ prolapse, specifically rectocele. This occurs when the structural tissue or wall separating the rectum from the vagina becomes weak and the rectum bulges into the vagina.

Excess weight, chronic cough, and chronic constipation or straining with bowel movements all increase your risk of developing a rectocele and subsequent fecal incontinence.

Vaginal childbirth can also cause fecal incontinence if the muscles or nerves are damaged during delivery.

What are the treatments for fecal incontinence?   

Because fecal incontinence is not a condition but a symptom of a problem, treatment starts with discovering the underlying cause. You can expect a detailed discussion of your symptoms, a thorough examination, and any necessary diagnostic studies.

These studies might include testing to measure the strength of your anal and rectal muscles (anorectal manometry) and/or endoscopy via a camera attached to a small tube that’s inserted into your rectum. An endoscopy helps identify structural abnormalities or other issues that may be causing the incontinence.

Depending on the cause, treatment for bowel incontinence may include:

• Dietary changes, such as increasing fiber to help make stools bulkier and easier to control or increased water intake to help prevent constipation
• Medications to decrease the number of bowel movements you have each day (Imodium, Lomotil)
• Kegel exercises to strengthen the pelvic muscles and potentially reduce bowel incontinence

If rectocele or other issues linked to pelvic organ prolapse are causing fecal incontinence, Dr. Kohli may recommend treatment with:

• A pessary, which is a small, removable, rubber or plastic device inserted into the vagina to help support the prolapsing structures
• Surgery, typically via a vaginal approach, to remove excess, stretched skin and restore vaginal wall support that helps keep the rectum in place

If unexpected loss of stool has become more than a rare occurrence in your life, schedule an appointment at Boston Urogyn for solutions you can count on.