Protect Yourself from Fecal Incontinence & Bowel Movement Problems

By: Deborah Marchese PT, DPT, OCS, Cert. DN.

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Have you ever not been able to make it to the toilet in time when you have the sudden urge to go? Do you have accidents involving fecal loss that comes when you least expect it? How long can you hold on before you have a bowel movement?

We no longer need to ignore the treatment of fecal incontinence. Today we have healthcare providers who specialize in the treatment of pelvic floor disorders, with proven treatment options available to help you or a loved one with any fecal incontinence issues.

What is Fecal Incontinence?

It is the unwanted loss of stool, whether solid, liquid, or gas, from the anal opening. Fecal incontinence includes the inability to hold a bowel movement until reaching a toilet as well as passing stool into one’s underwear without being aware of it happening, sometimes referred to as anal leakage. Stool, also called feces, is solid waste that is passed as a bowel movement and includes undigested food, bacteria, mucus, and dead cells. Mucus is a clear liquid that coats and protects tissues in the digestive system. 

Fecal incontinence can be upsetting and embarrassing. Many people with fecal incontinence feel ashamed and try to hide the problem.  The problem is grossly underreported to physicians because it is a source of major embarrassment. It causes issues with self-esteem, creates social isolation, and impairs quality of life. However, people with fecal incontinence should not be afraid or embarrassed to talk with their health care provider. Fecal incontinence is often caused by a medical problem and treatment is available.

Who Suffers from Fecal Incontinence and How Many People are Affected?

Recent data has revealed that there is a much higher prevalence of fecal incontinence in North America’s adult population, around 8.3%, even when including noninstitutionalized adults. Nearly 18 million U.S. adults—about one in 12—have fecal incontinence.1 People of any age can have a bowel control problem, though fecal incontinence is more common among older adults with 16% of adults 70+ that suffer from these complications, starting from around 3% in the ages between 20 – 292. It is slightly more common among women though no significant correlation has been made with race, education, income or marital status. It is frequently associated with having urinary incontinence as well. Having any of the following symptoms can increase the risk of fecal incontinence:
  • Frequent or Chronic Diarrhea – Diarrhea composed of loose, watery stool and occurring three or more times daily. [Refer to Bristol Stool Chart Below]
  • Fecal Urgency – frequent sensation of needing to relieve themselves of a bowel movement but not having enough time to get to the toilet.
  • Nervous System Illness or Injury – A nervous system disorder or direct injury to the nervous system.
  • Poor Health – Poor health is a direct result of long-lasting or chronic illness.
  • Pregnancy Complications – Complications during childbirth that resulted in connective tissue injuries within the pelvic floor, including the bladder, rectum, vagina, and/or uterus.

Bristol Stool Chart

bristol stool chart
When referring to the Bristol Stool Chart, a healthy stool is considered to have the appearance of type 3 and type 4. These will be sausage or snake shaped with either a cracked surface, type 3, or a smooth surface, type 4. Types 1 and 2 are signs of constipation while types 5 – 7 are signs of diarrhea and could be signs of bowel movement problems.

What are the Causes of Fecal Incontinence?

Below are some of the more common reasons why fecal incontinence may occur.

  • Fecal impaction
  • Gut mobility disorders: diet, infection, anxiety, Irritable bowel syndrome
  • Medication that affects the gut-especially opioid pain medication
  • Dementia
  • Diet, alcohol
  • Pelvic floor weakness
  • Nerve injuries
  • Sphincter disruption
  • Chronic constipation
  • Impaired sensation around the rectal region
  • Rectal prolapse or rectocele
  • Scarring from surgery, radiation burns and childbirth
  • Comorbid medical diseases such as Diabetes Mellitus, Spinal Cord Injuries, and Crohn’s Disease

What are the Treatment Options for Fecal Incontinence?

Medical treatment includes education about dietary concerns, review of medication options, fecal retention devices, pelvic floor training, bowel habit training, electrical stimulation, and in some scenarios, surgery. Discuss with your doctor if pelvic floor physical therapy would be beneficial to address your specific problem. 

If pelvic floor therapy is an option, your physical therapist will begin with a detailed subjective history of your fecal incontinence and explain what the exam will involve. Together, you will review your diet, which includes your hydration levels each day and your bowel habits; your therapist will assess your muscle strength and coordination, soft tissue such as scarring, and sensory awareness in the pelvic floor region.  A treatment plan will then be devised to address your specific cause of fecal incontinence, including pelvic floor muscle contraction exercises. Below is a great example of an exercise you can try at home!

Sphincter Contraction Exercise: Position  your knees slightly apart while sitting, standing or lying down. Contract your  sphincter muscles  as tightly as you can for a minimum of 5 seconds, then rest these muscles for at least 10 seconds. This can be repeated 5 to 10 times. Make sure to start off slow and work your way up.

Want to learn more about pelvic floor exercises? Click here.

Surgical Treatment Options

Surgical procedures used to treat fecal incontinence include implanted sacral nerve stimulation, radiofrequency anal sphincter remodeling, antegrade colonic enema, anal sphincter repair (sphincteroplasty), sphincter replacement (artificial anal sphincter), surgical correction of conditions that can result in fecal incontinence (rectal prolapse, hemorrhoids, or rectocele), or colostomy when all other treatments fail.

Resources:

  1. Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in U.S. adults: epidemiology and risk factors. 
    Gastroenterology. 2009;137(2):512–517
  2. Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005-2010.
    Ditah I, Devaki P, Luma HN, Ditah C, Njei B, Jaiyeoba C, Salami A, Ditah C, Ewelukwa O, Szarka L
    Clin Gastroenterol Hepatol. 2014 Apr; 12(4):636-43.e1-2.

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