Normally bowel movements (stools) are stored in the rectum until the bowel sends a message to the brain that it is full, and the person finds a convenient bathroom.  This voluntary control is provided by a ring of muscular tissue called the anal sphincter which surrounds the anal opening and lower rectum.  This sphincter works together with other muscles, nerves and connective tissue that support the pelvic floor.  Sometimes, through damage to any of these tissues, voluntary control is lost, allowing leakage of stool or gas.

Fecal incontinence means difficulty controlling your bowel movements.  This includes involuntary loss of solid or liquid stool and inability to control bowel gas.  The loss may occur in association with a strong urge to defecate, or there may be no warning or sensation that an accident is occurring.  Stool loss may occur during intercourse.  Another common problem is smearing of stool on the undergarments after or in bewteen bowel movements. Still another is seepage of anal secretions and mucus.

Fecal incontinence in women is a more wide spread problem than previously thought.  As many as 10% of women over age 65 who are not living in nursing homes report troublesome loss of bowel control.  Many younger women are also troubled by fecal incontinence.

There could hardly be a more devestating problem to have to live with than the fear of losing control of your bowels.  Yet, we know that most women with this problem do not bring it up with their doctors and often do not seek treatment even when they do.  We also know that most primary care physicians do not routinely inquire about problems with stool loss.

It is important to know that while not everyone can be cured, most women with fecal incontinence can be helped substantially - often without surgery.

What causes fecal incontinence?
Anything that damages the anal sphincter, or the other muscles, nerves or connective tissue of the pelvis can cause uncontrolled loss of stool.  Examples include:

• problems with hemorroids
• irritable bowel syndrome
• damage to the pelvic floor at the time of childbirth
• pelvic surgeries and scarring
• nervous system diseases like multiple sclerosis or Parkinson’s Disease
• accidental injuries

What can be done to help with this problem?
There are several approaches that are used to decrease or stop uncontrolled loss of stool.  What works best for any one person depends on the cause of her problem.  Frequently used treatments include:

• PELVIC FLOOR REHABILITATION-including exercises, physical therapy, biofeedback, can strengthen and tone muscles.  This can help compensate for damage that has been done.  Click here for more information on pelvic floor rehabilitation .
• MANAGEMENT OF STOOL CONSISTENCY-used to keep the stool soft but formed, a combination of fiber, exercise, fluids, and constipating medications like Immodium, can limit fecal loss. Click here for more information on managing stool consistency.
• SURGERY-can repair damaged muscles of the anal sphincter.  Click here for more information on surgery for fecal incontinence. 

How do I know what will work for me ?

Generally, you must see a physician who has special training in the diagnosis and treatment of bowel incontinence.  Urogynecologists, colorectal surgeons and gastroenterologists are all appropriate specialists.  Be sure to ask if they have an interest and experience in treating bowel incontinence.  Not all do.

The evaluation to decide what types of treatment might work best includes a physical exam, and special tests designed to understand how the muscles and nerves in your bowel area are working.  These tests can include a special radiology procedure called a defecating proctogram, anal ultrasound or a test of rectal and anal function called anal manometry .  Most people report that the tests are sometimes embarassing, but not painful, and that the information they provide is can be critical to helping your doctors understand and treat the causes of your problem.

   

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