Fecal incontinence is characterized by an inability to control bowel movements. Over 5.5 million adults and children in the United States Americans have fecal incontinence, which may be caused by an abscess or inflammation, anal sphincter damage, complications of childbirth, prior surgery in or radiation therapy to the area, a nervous system injury or disorder, chronic constipation, inflammatory bowel disease, or age. At NewYork-Presbyterian, we understand how uncomfortable and embarrassing fecal incontinence is for you, and how it impairs your quality of life. We have comprehensive programs to assess and treat fecal incontinence so you can begin feeling better and return to the activities you enjoy.
A Team of Specialists
Your healthcare team includes gastroenterologists, colorectal surgeons, dietitians, nurses, and others with experience diagnosing and treating fecal incontinence, with a shared goal: restoring your bowel control and quality of life. Together they put together a plan of care that meets your personal needs.
Accurately Diagnosing Fecal Incontinence
Before we choose the best therapy for you, we need to know what is causing your symptoms. Your doctor meets with you to discuss your medical history, your symptoms, and how your life is affected by fecal incontinence. We offer the following tests to make an accurate diagnosis of the cause of your symptoms:
- Anal manometry to measure the strength of the anal sphincter muscles and their ability to respond to signals.
- MRI and/or an anorectal ultrasound to visualize the structure of the sphincter.
- Proctography (defecography) to measure how much stool the rectum can hold, how effectively it holds it, and how effectively the rectum can evacuate.
- Proctosigmoidoscopy to view the inside of the rectum and lower colon to detect disease or other problems such as inflammation, scar tissue, or tumors, which can cause fecal incontinence.
- Anal electromyography to measure nerve damage.
Nonsurgical Treatments for Fecal Incontinence
Your treatment depends on what is causing your incontinence and how severe it is. We may use one or more therapies to manage your symptoms. At NewYork-Presbyterian, we try nonsurgical treatments first to see if we can reduce or eliminate your fecal incontinence.
- Dietary changes. Our registered dietitian can work with you to adopt a diet that will help reduce episodes of incontinence. Avoiding caffeine, alcohol, dairy products, cured or smoked meat, spicy foods, fruit, fatty foods, and dietary sweeteners such as sorbitol, xylitol, mannitol, and fructose may help. The dietitian may also recommend eating smaller meals more frequently or drinking before or after (but not with) meals.
- Medication. Medication to help control diarrhea or, conversely, bulk laxatives to help develop more regular bowel movements may be helpful.
- Biofeedback. We offer biofeedback techniques to help control and strengthen your anal muscles. A computer measures muscle contraction while you perform muscle exercises (called Kegel exercises) for the pelvic floor, with the goal of strengthening rectal muscles and improving sensation. The computer provides feedback on whether you are performing the exercises correctly and whether the muscles are getting stronger.
Surgical Procedures for Fecal Incontinence
If dietary changes, medications, and biofeedback are not enough to control fecal incontinence, we may recommend sacral nerve stimulation or surgery.
- Sacral nerve stimulation. One of the latest technological advances for treating bowel incontinence, sacral nerve stimulation is a reversible treatment for people with bowel control problems in whom other treatments have not been successful. A small pacemaker-like device is implanted under the skin and stimulates the sacral nerve in the lower back to restore bowel control.
- Surgery. Our colorectal surgeons use minimally invasive approaches to treat anal sphincter, anal canal, and pelvic floor injuries as well as rectal prolapse (protrusion of the rectum from the anus). These techniques are associated with less postoperative pain and a faster recovery than traditional open surgery.
- Colostomy. This treatment is reserved for people whose fecal incontinence cannot be treated well using other therapies. During colostomy, the surgeon disconnects the colon and brings one end through an opening in the abdomen. Stool exits the body through this opening and is collected in a pouch (ostomy bag) attached to the outside of the abdomen. Our ostomy nurses have the compassion and experience to support you as you adapt to life with a colostomy, which may be temporary or permanent.