Fecal incontinence, the accidental loss of bowel control, is a challenging but surprisingly common health issue that affects millions of people. This condition ranges from occasional leakage when passing gas to a complete loss of control over liquid or solid stool. While the topic is often surrounded by embarrassment, understanding that it is a manageable medical condition is the first step toward regaining control. This guide outlines practical, immediate, and long-term strategies for both prevention and management.
Immediate Steps for Sudden Urgency
When a sudden, intense urge to defecate strikes, the immediate response is a combination of physical and mental techniques. The first physical step is to contract the anal sphincter and pelvic floor muscles, which can temporarily activate the rectoanal inhibitory reflex and push stool away from the sensitive anal canal. This prolonged, strong squeeze should be held for 30 to 60 seconds, or until the urgency subsides.
Distraction and calm breathing prevent anxiety from worsening the urge. Remaining calm and taking slow, deliberate breaths helps avoid tensing the abdominal muscles, which increases pressure on the rectum. For practical preparedness, always pre-plan routes to include known restroom locations and consider carrying a small emergency kit with clean-up supplies and a change of underwear. Wearing absorbent pads or disposable undergarments provides security when venturing out.
Identifying the Root Causes of Incontinence
Understanding the underlying cause is paramount because fecal continence relies on the coordinated function of the rectum, anus, and nervous system. A frequent cause is damage or weakening of the anal sphincter muscles, which are two rings of muscle at the end of the rectum. This damage often results from difficult vaginal childbirth, particularly with the use of forceps or an episiotomy, or from anal surgery.
Nerve damage frequently contributes to the condition by impairing sensation or affecting muscle control. Neurological conditions such as diabetes, multiple sclerosis, Parkinson’s disease, and stroke can all affect the nerves that regulate bowel function. Chronic straining due to constipation or conditions like Crohn’s disease can cause scarring that stiffens the rectum, reducing its capacity to store stool and leading to urgency.
Gastrointestinal disorders like Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) can cause chronic diarrhea, overwhelming the sphincter muscles’ ability to contain loose stool. Severe constipation is another common cause, where a hard mass of stool becomes impacted, allowing only watery stool to leak around it uncontrollably.
Adjusting Diet and Bowel Habits
Dietary modifications are effective long-term strategies for normalizing stool consistency, which is easier for the sphincter muscles to control. The goal is to achieve a soft, formed stool, as both hard stools from constipation and loose stools from diarrhea are more difficult to contain. A well-balanced diet high in fiber is generally recommended, but the type of fiber and the underlying cause are important considerations.
Fiber adds bulk to the stool, and supplements like psyllium can help treat both diarrhea and constipation by absorbing water to firm up loose stool or softening hard stool. Adequate hydration is necessary, as increased fiber intake draws water into the stool, requiring an intake of six to eight eight-ounce cups of non-caffeinated fluid daily.
Certain foods and drinks are known to irritate the gut and should be limited or avoided, especially if diarrhea is a problem.
Common trigger substances include:
- Caffeine
- Alcohol
- Spicy foods
- High-fat or greasy items
- Artificial sweeteners like sorbitol and xylitol
Keeping a detailed food and symptom diary helps identify specific personal triggers that worsen symptoms. Establishing a regular toileting schedule, known as bowel training, can also improve predictability and control. This involves attempting a bowel movement at the same time each day, often 20 to 30 minutes after a meal, to take advantage of the body’s natural gastrocolic reflex.
Building Physical Strength and Control
The muscles responsible for maintaining continence are the pelvic floor muscles and the internal and external anal sphincters. Targeted exercises are designed to strengthen this muscular complex and improve the body’s physical response to urgency. Kegel exercises, or pelvic floor muscle training, involve tightening the muscles used to stop the flow of urine or prevent passing gas.
To perform these correctly, one must squeeze the muscles as if trying to lift the entire pelvic area up and inward, avoiding the use of the abdominal, buttock, or thigh muscles. The exercise routine involves holding the contraction for three to ten seconds, followed by an equal period of relaxation, repeated in sets three times a day. Consistent practice over several weeks is necessary before noticing improvement in muscle strength and bowel control.
Some individuals benefit from biofeedback therapy, which uses sensors inserted into the rectum or vagina to monitor muscle activity. This technique provides real-time visual or auditory feedback, helping a person correctly identify, contract, and coordinate the anal sphincter and pelvic floor muscles. Biofeedback can also include sensory training to improve the body’s ability to sense rectal fullness, which is often diminished in those with incontinence.
When Medical Intervention is Necessary
It is important to consult a healthcare professional when lifestyle changes and exercises do not provide sufficient relief. Medical attention is warranted if symptoms begin suddenly, are accompanied by blood in the stool, or include unexplained weight loss. A physical exam, including a digital rectal exam to assess muscle tone, is the first step in diagnosis.
Specialized diagnostic tests determine the exact nature of the problem. Anorectal manometry measures the strength of the anal sphincter muscles and the sensation in the rectum. An endorectal ultrasound or MRI can provide images to detect structural damage, such as tears in the anal sphincter muscles. Treatment options vary and may include prescription anti-diarrheal medications, like loperamide, or bulking agents to improve stool consistency.
For cases that do not respond to conservative management, more advanced interventions are available. Sacral nerve stimulation involves implanting a small device that sends mild electrical impulses to the sacral nerves, which influence the pelvic floor and sphincter muscles. Surgical options, such as sphincteroplasty to repair a damaged sphincter muscle, or procedures to treat underlying issues like rectal prolapse, are reserved for specific cases where muscle or structural damage is the clear cause.