A loss of bowel control is also known as bowel or fecal incontinence.
It refers to the inability to manage the passage of stool. Some people with this condition only have occasional instances of bowel leakage, while others experience a complete lack of bowel control. While it can be an embarrassing problem to discuss, there are treatments that could improve your quality of life.
What Causes a Loss of Bowel Control?
A loss of bowel control sometimes occurs, in part, because of age-related pelvic muscle changes. Some women have fecal incontinence problems following childbirth if rings of muscle located at the end of the rectum (anal sphincter) are damaged. Rectal muscles may also be stretched due to ongoing issues with chronic constipation.
Additionally, diarrhea makes it easier for stool to unexpectedly pass. Some people also experience a loss of bowel control due to:
- Nerve damage due to a stroke, spinal cord injury, or certain chronic conditions like diabetes or multiple sclerosis
- Hemorrhoids
- Reduced rectal storage capacity
- Issues related to pelvic surgery
- Slippage of the rectum out of the anus (rectal prolapse)
- Rectal protrusion through the vagina (rectocele)
Some individuals only have a temporary loss of bowel control when they have diarrhea. Others experience an urge to pass stool that comes on so suddenly they don’t have time to make it to the bathroom (urge incontinence). Related symptoms could include gas and bloating and constipation.
How Is a Diagnosis Made?
Diagnosis usually involves a discussion of your symptoms and a review of your medical history, especially if you have recent issues with constipation or diarrhea. A probe may be used as well to check for signs of nerve damage. Additional testing may involve:
- A digital rectal exam (DRE)
- A “balloon test” to measure the tightness of the anal sphincter (anal manometry or balloon expulsion test)
- X-rays taken as you make a bowel movement (proctography) on a specially designed toilet
- A visual examination of your colon with a flexible tube (colonoscopy)
- An MRI scan
What Are Non-Surgical Treatments?
If fecal incontinence is mild or moderate, you may benefit from the use of bulk laxatives or anti-diarrheal medication. Some people also notice improvements with dietary changes or exercises that target muscles in the anal/rectal area. Other non-surgical treatments for a loss of bowel control include:
- Bowel training – e.g., scheduling bowel movements as much as possible
- Biofeedback
- Bulking agent injections to thicken anal walls
- Sacral nerve stimulation (SNS)
- Indirect stimulation of pelvic/bowel nerves (posterior tibial nerve stimulation)
How Might a Loss of Bowel Control Be Treated Surgically?
With more severe issues with a loss of bowel control, surgery may be performed to strengthen the anal sphincter (sphincteroplasty) or repair it (dynamic graciloplasty). Another option is the insertion of an artificial anal sphincter. Surgery may also involve:
- Surgical correction of prolapse issues
- Removal of hemorrhoids
- Bowel diversion (colostomy) if a loss of bowel control is severe and associated with structural problems that cannot be sufficiently corrected
- An implant (InterStim system) to stimulate the sacral nerves with low-level pulses of electricity in order to improve communication between the brain and the bowels
Reducing constipation by drinking more water, eating more high-fiber foods, and avoiding excessive straining when going to the bathroom are among the possible ways to reduce your risk of developing issues with a loss of bowel control. It can also be beneficial to deal with intestinal infections as early as possible to avoid problems with diarrhea that could contribute to fecal incontinence.