Summary

Fecal incontinence is the inability to control the passage of bowel movements, causing stool and gas to be unexpectedly released from the rectum. It is a symptom of an underlying medical condition, not a disease in itself.

More than 5.5 million Americans experience fecal incontinence, according to the National Institutes of Health (NIH).

It is more common in women and older adults, but is not considered a normal part of the aging process. Conditions that may cause fecal incontinence include constipation, diarrhea, muscle damage, nerve damage and pelvic floor dysfunction. When it occurs in children under age 4, it is most commonly the result of constipation caused by withholding stool, and is known as encopresis.

To determine the cause of fecal incontinence, a physician will perform a physical examination, which may include a digital rectal examination (DRE) or an anal wink test. Other diagnostic tests that may be performed include anal manometry (evaluates anal sensation, pressure and elasticity), anorectal ultrasonography (evaluates the structure of the anal sphincter) and defecography (determines how much stool the rectum can hold).

Treatment varies according to the cause and severity of the fecal incontinence. It may consist of making dietary modifications or performing special exercises to strengthen the rectum. In some cases, medications or surgery may be needed.

Fecal incontinence may sometimes be prevented when its cause (e.g., constipation, diarrhea) can be prevented. Although many people who experience fecal incontinence may be embarrassed to seek help, treatment often provides some relief from symptoms. In cases where the incontinence is not completely relieved through treatment, various actions can be taken to improve the quality of life for patients with fecal incontinence.

Carlo Di Lorenzo and Marc A. Benninga
Division of Pediatric Gastroenterology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands