Bowel/Fecal Incontinence

What is incontinence?

Fecal incontinence, also called a bowel control problem, is the accidental passing of solid or liquid stool or mucus from the rectum. Bowel continence relies on muscles and nerves of the rectum and anus working together. Control is defined as the ability to hold stool in the rectum, make us aware when the rectum is full, and release stool when the person is ready. Circular muscles called sphincters close tightly like rubber bands around the anus until stool is ready to be released. Pelvic floor muscles also help with bowel control.

Fecal incontinence ranges from the inability to hold a bowel movement at all, passing stool into one’s underwear without being aware of it happening, the need to wear protection, to minor mucous and stool staining. This condition is obviously upsetting and embarrassing. Many people with this condition feel ashamed and try to hide the problem. However, they should not be afraid or embarrassed to talk with their health care provider. Fecal incontinence is often caused by a medical problem and repairable. Treatment is available, and the condition can often be eliminated or greatly improved. It is estimated that 18 million U.S. adults have fecal incontinence. People of any age can have a bowel control problem, though fecal incontinence is more common in women and in older adults.

The physicians at Atlanta Colon and Rectal Surgery are experts in the diagnosis, management, and treatment of this life altering disability.

What causes incontinence?

Fecal incontinence has many causes, including:

  • Diarrhea
  • Loose stools fill the rectum quickly and are more difficult to hold than solid stools. Diarrhea increases the chance of not reaching a bathroom in time.

  • Constipation
  • Constipation can lead to large, hard stools that stretch the rectum and cause the internal sphincter muscles to relax by reflex. Watery stool builds up behind the hard stool and may leak out around the hard stool, leading to fecal incontinence.

    The type of constipation that is most likely to lead to fecal incontinence occurs when people are unable to relax their external sphincter and pelvic floor muscles when straining to have a bowel movement, often mistakenly squeezing these muscles instead of relaxing them. This squeezing makes it difficult to pass stool and may lead to a large amount of stool in the rectum. This type of constipation, called dyssynergic defecation or disordered defecation, is a result of faulty learning. For example, children or adults who have pain when having a bowel movement may unconsciously learn to squeeze their muscles to delay the bowel movement and avoid pain.

  • Muscle damage or weakness
  • Injury to one or both of the sphincter muscles can cause fecal incontinence. If these muscles, called the external and internal anal sphincter muscles, are damaged or weakened, they may not be strong enough to keep the anus closed and prevent stool from leaking. Trauma, childbirth injuries, cancer surgery, and hemorrhoid surgery are possible causes of injury to the sphincters.

  • Nerve damage
  • The anal sphincter muscles won’t open and close properly if the nerves that control them are damaged. Likewise, if the nerves that sense stool in the rectum are damaged, a person may not feel the urge to go to the bathroom. Both types of nerve damage can lead to fecal incontinence. Possible sources of nerve damage are childbirth; a long-term habit of straining to pass stool; spinal cord injury; and diseases, such as diabetes and multiple sclerosis, which affect the nerves that go to the sphincter muscles and rectum. Brain injuries from stroke, head trauma, or certain diseases can also cause fecal incontinence.

  • Loss of stretch in the rectum
  • Normally, the rectum stretches to hold stool until a person has a bowel movement. Rectal surgery, radiation treatment, and inflammatory bowel diseases—chronic disorders that cause irritation and sores on the lining of the digestive system—can cause the rectal walls to become stiff. The rectum then can’t stretch as much to hold stool, increasing the risk of fecal incontinence.

  • Childbirth by vaginal delivery
  • Childbirth sometimes causes injuries to muscles and nerves in the pelvic floor. The risk is greater if forceps are used to help deliver the baby or if an episiotomy—a cut in the vaginal area to prevent the baby’s head from tearing the vagina during birth—is performed. Fecal incontinence related to childbirth can appear soon after delivery or many years later

  • Hemorrhoids and rectal prolapse
  • External hemorrhoids, which develop under the skin around the anus, can prevent the anal sphincter muscles from closing completely. Rectal prolapse, a condition that causes the rectum to drop down through the anus, can also prevent the anal sphincter muscles from closing well enough to prevent leakage. Small amounts of mucus or liquid stool can then leak through the anus.

  • Rectocele
  • Rectocele is a condition that causes the rectum to protrude through the vagina. and can happen when the thin layer of muscles separating the rectum from the vagina becomes weak. For women with rectocele, straining to have a bowel movement may be less effective because it reduces the amount of downward force through the anus. The result may be retention of stool in the rectum. However, more research is needed to be sure rectocele increases the risk of fecal incontinence.

  • Inactivity
  • People who are inactive, especially those who spend many hours a day sitting or lying down, have an increased risk of retaining a large amount of stool in the rectum. Liquid stool can then leak around the more solid stool. Frail, older adults are most likely to develop constipation-related fecal incontinence for this reason.

What can be done to correct the problem?

Although quite common, fecal incontinence is a treatable condition that can significantly change the life of someone that suffers from this condition. Several new procedures such as sacral nerve stimulation and bulking agent application are now available. The physicians at Atlanta Colon and Rectal Surgery are experts in the diagnosis, management, and treatment of this life altering disability.

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