Fecal incontinence—the urgent or unexpected passage of stool through the anus—can be an uncomfortable and embarrassing condition. Identifying the cause of your symptoms is the first step toward diagnosis and an effective treatment plan.
Diagnosing Fecal Incontinence
Before your doctor chooses the best therapy for you, they need to know what is causing your fecal incontinence symptoms. Your doctor will meet with you to perform a physical exam and discuss your medical history, your symptoms, and how your life is affected by fecal incontinence.
Tests and procedures
We offer the following tests to diagnose fecal incontinence:
- Anal manometry measures 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 empty
- 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
Treatment Options for Fecal Incontinence
Fecal incontinence treatment depends on what is causing your symptoms and how severe they you’re your healthcare team may use one or more therapies to manage your symptoms, from medication and exercises to dietary changes and surgery.
Medication to help control diarrhea or, conversely, bulk laxatives to help develop more regular bowel movements may be helpful in treating fecal incontinence. Examples include:
- Anti-diarrheal drugs such as loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol, Kaopetate)
- Laxatives, stool softeners, or fiber supplements—such as psyllium (Metamucil) or methylcellulose (Citrucel)—if you have constipation
- Prescription medications for irritable bowel syndrome, Crohn's disease, and ulcerative colitis to help reduce fecal incontinence episodes
- Bulking agents that are injected into the wall of the anus to bulk up the anal tissue, narrowing the opening so the sphincter can close more effectively
If muscle damage or weakness is triggering your fecal incontinence, you may benefit from exercises and other techniques to strengthen those muscles and train your body to regain control of your bowel movements.
- Kegel exercises - Tightening and relaxing the muscles of your pelvic floor several times a day—can reduce fecal incontinence symptoms by strengthening the muscles of your pelvic floor, anus, and rectum
- Biofeedback - We offer biofeedback techniques to help control and strengthen your anal muscles. A computer measures muscle contraction while you perform Kegel exercises, 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.
- Bowel training - If you train yourself to have bowel movements at certain times of day for weeks or months, you may improve fecal incontinence by introducing regularity to your bowel movement schedule
- Vaginal balloon - A device that inflates a balloon inside the vagina can place pressure on the wall of the rectum and keep stool from passing
A registered dietitian can work with you to adopt a diet that will help reduce incontinence episodes. The dietitian may ask you to keep a food diary and also recommend eating smaller meals more frequently or drinking before or after (but not with) meals. Avoiding or reducing intake of the following foods may help:
- Dairy products
- Cured or smoked meat
- Spicy foods
- Fatty foods
- Dietary sweeteners such as sorbitol, xylitol, mannitol, and fructose
To manage irritation, itching, or pain around your anus, you should develop a skincare routine to relieve discomfort and control possible odor. Become familiar with the following kinds of practices:
- Gently wash the area around the anus after each bowel movement and then keep it dry
- Change soiled underwear as soon as you can
- Use moisture-barrier creams and nonmedicated powders to help soothe the anal area. Your doctor or nurse can let you know which ones are best for you.
- Wear clothes and underwear made of fabrics that "breathe" and let air pass through easily. They will help keep the anal area dry.
- Wear absorbent pads inside your underwear to wick away moisture and control odor
- Always carry clean underwear and, if needed, a change of clothes for those moments when you have fecal incontinence away from home. Disposable underwear can be useful in certain settings, such as when you are traveling.
If medications, exercises, and dietary changes are not enough to control or treat fecal incontinence, we may recommend sacral nerve stimulation or surgery.
- Sacral nerve stimulation - 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.
- Fecal incontinence surgery - Our colorectal surgeons use minimally invasive approaches to repair damage to the anal sphincter, anal canal, and pelvic floor 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. We often use robotic technology to see inside the pelvis and perform very delicate procedures, such as "ventral mesh rectopexy"—the surgical insertion of a mesh to improve the suspension and support of the rectum.
- Colostomy - This fecal incontinence treatment is reserved for people whose condition 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.
Get Fecal Incontinence Treatment at NewYork-Presbyterian
At NewYork-Presbyterian, we take a nonsurgical approach first to see if we can reduce or eliminate your fecal incontinence symptoms. Your team includes all the experts you need to achieve relief.
We'll carefully assess your health and match you with the most effective therapies according to your needs and preferences. All the support you need is here, through one medical center. Make an appointment today so you can start feeling better and living the life you want.