Most adults experience fecal incontinence only during an occasional bout of diarrhea. But some people have recurring or chronic fecal incontinence. They:
- Can't control the passage of gas or stools, which may be liquid or solid, from their bowels
- May not be able to make it to the toilet in time
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 problems, such as:
- Gas and bloating
When to see a doctor
See your doctor if you or your child develops fecal incontinence. Often, new mothers and other adults are reluctant to tell their doctors about fecal incontinence. But treatments are available, and the sooner you are evaluated, the sooner you may find some relief from your symptoms.
The causes of fecal incontinence include:
- Muscle damage. Injury to the rings of muscle at the end of the rectum (anal sphincter) may make it difficult to hold stool back properly. This kind of damage can occur during childbirth, especially if you have an episiotomy or forceps are used during delivery.
- Nerve damage. Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to fecal incontinence. The nerve damage can be caused by childbirth, constant straining during bowel movements, spinal cord injury or stroke. Some diseases, such as diabetes and multiple sclerosis, also can affect these nerves and cause damage that leads to fecal incontinence.
- Constipation. Chronic constipation may lead to a mass of dry, hard stool in the rectum (impacted stool) that is too large to pass. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool from farther up the digestive tract to move around the impacted stool and leak out. Chronic constipation may also cause nerve damage that leads to fecal incontinence.
- Diarrhea. Solid stool is easier to retain in the rectum than is loose stool, so the loose stools of diarrhea can cause or worsen fecal incontinence.
- Loss of storage capacity in the rectum. Normally, the rectum stretches to accommodate stool. If your rectum is scarred or your rectal walls have stiffened from surgery, radiation treatment or inflammatory bowel disease, the rectum can't stretch as much as it needs to, and excess stool can leak out.
- Surgery. Surgery to treat enlarged veins in the rectum or anus (hemorrhoids), as well as more complex operations involving the rectum and anus, can cause muscle and nerve damage that leads to fecal incontinence.
- Other conditions. Fecal incontinence can result if the rectum drops down into the anus (rectal prolapse) or, in women, if the rectum protrudes through the vagina (rectocele).
A number of factors may increase your risk of developing fecal incontinence, including:
- Age. Although fecal incontinence can occur at any age, it's more common in middle-aged and older adults. Approximately 1 in 10 women older than age 40 has fecal incontinence.
- Being female. Fecal incontinence is slightly more common in women than in men. One reason may be that fecal incontinence can be a complication of childbirth. But most women with fecal incontinence develop it after age 40, so other factors may be involved.
- Nerve damage. People who have long-standing diabetes or multiple sclerosis — conditions that can damage nerves that help control defecation — may be at risk of fecal incontinence.
- Dementia. Fecal incontinence is often present in late-stage Alzheimer's disease and dementia.
- Physical disability. Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage leading to fecal incontinence.
Complications of fecal incontinence may include:
- Emotional distress. The loss of dignity associated with losing control over one's bodily functions can lead to embarrassment, shame, frustration, anger and depression. It's common for people with fecal incontinence to try to hide the problem or to avoid social engagements.
- Skin irritation. The skin around the anus is delicate and sensitive. Repeated contact with stool can lead to pain and itching, and potentially to sores (ulcers) that require medical treatment.
Depending on the cause, it may be possible to prevent fecal incontinence. These actions may help:
- Reduce constipation. Increase your exercise, eat more high-fiber foods and drink plenty of fluids.
- Control diarrhea. Treating or eliminating the cause of the diarrhea, such as an intestinal infection, may help you avoid fecal incontinence.
- Avoid straining. Straining during bowel movements can eventually weaken anal sphincter muscles or damage nerves, possibly leading to fecal incontinence.