Fecal Incontinence
Also known as: Bowel incontinence, Accidental bowel leakage, Faecal incontinence
Fecal incontinence is the inability to control bowel movements, resulting in leakage of stool or gas without meaning to. It ranges from occasional minor staining when passing wind to complete loss of control. The problem is far more common than most people realize, especially in older adults and women who have had childbirth injuries, yet embarrassment stops many from seeking help. Causes include damage to the anal sphincter muscles or the nerves controlling them, chronic diarrhea or constipation with overflow, and conditions such as diabetes or neurological disease. The encouraging news is that a wide range of treatments, from simple dietary changes and pelvic floor training to medications and procedures, help most people regain control or greatly reduce accidents.
At a Glance
- Common symptoms
- Leakage of liquid or solid stool without warning, Urgency with an inability to reach the toilet in time, Passive leakage or staining of underwear without awareness
- Main treatments
- Treating the underlying cause, such as managing diarrhea, clearing constipation, or controlling diabetes, Bulking agents (fiber supplements) and antidiarrheal medication such as loperamide to firm the stool, Pelvic floor muscle training and biofeedback with a specialist physiotherapist
- Category
- Digestive · Common but underreported, particularly in older adults and women after childbirth injury
- See a doctor if
- Any bowel leakage that is happening regularly, even if it seems minor
Symptoms
Causes
- Injury to the anal sphincter muscles during childbirth, especially with forceps delivery or severe tearing
- Nerve damage from diabetes, multiple sclerosis, stroke, spinal cord injury, or chronic straining
- Chronic diarrhea from inflammatory bowel disease, irritable bowel syndrome, or infections
- Severe constipation causing a hard mass of stool with liquid leaking around it (overflow)
- Surgery or radiation involving the rectum or anus, including hemorrhoid or fissure operations
- Loss of rectal storage capacity or rectal prolapse, and reduced mobility or dementia in older adults
Risk Factors
- Older age
- Female sex, particularly after vaginal deliveries with tearing or instrumental help
- Chronic diarrhea or constipation
- Diabetes, neurological disease, or dementia
- Previous anal or rectal surgery
- Physical disability that makes reaching the toilet difficult
Diagnosis
- A frank discussion of symptoms, bowel habits, obstetric and surgical history, and a bowel diary
- Physical examination including a rectal exam to assess muscle tone and look for impaction or prolapse
- Anorectal manometry to measure sphincter pressure and rectal sensation
- Endoanal ultrasound or MRI to look for sphincter tears
- Colonoscopy or stool tests if diarrhea, bleeding, or other symptoms suggest an underlying bowel disease
Treatment
- Treating the underlying cause, such as managing diarrhea, clearing constipation, or controlling diabetes
- Bulking agents (fiber supplements) and antidiarrheal medication such as loperamide to firm the stool
- Pelvic floor muscle training and biofeedback with a specialist physiotherapist
- Sacral nerve stimulation, a small implanted device that improves sphincter and bowel control
- Surgical repair of a torn sphincter, injectable bulking agents, or, rarely, a colostomy for severe cases
- Supportive: scheduled toileting, skin care with barrier creams, and absorbent products or anal plugs for confidence
- Supportive: identifying food triggers such as caffeine, alcohol, artificial sweeteners, and very spicy or fatty foods that loosen stool
Prevention
- Treat constipation and diarrhea promptly rather than letting them persist
- Avoid chronic straining on the toilet
- Practise pelvic floor exercises, particularly during and after pregnancy
- Keep diabetes well controlled to protect nerve function
- Stay active and maintain a healthy weight
- Seek early assessment after a significant childbirth tear
When to See a Doctor
- Any bowel leakage that is happening regularly, even if it seems minor
- Incontinence accompanied by blood in the stool, weight loss, or a change in bowel habit
- Sudden loss of bowel control with numbness in the saddle area, leg weakness, or new bladder problems (emergency, possible nerve compression)
- Leakage that started after childbirth or surgery
- Skin breakdown or infection around the anus
Frequently Asked Questions
Related Conditions
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