More so than many other digestive conditions, fecal incontinence often creates a deep sense of shame. The loss of bowel control may lead people to withdraw from social activities, avoid travel, or carry the burden of constantly worrying about having an accident. While it tends to become more common with age, fecal incontinence is not a normal or inevitable part of getting older and in many cases can be managed or treated. The good news is that many effective options are available today, ranging from simple lifestyle changes to medical treatments, all of which can make a real difference in symptoms and overall quality of life.

What Is Fecal Incontinence?

Fecal incontinence refers to the partial or complete loss of control over bowel movements, resulting in the unexpected passage of stool. It can include the occasional leakage of small amounts of stool while passing gas or a complete inability to control bowel movements. While many people think of it as simply “not making it to the bathroom in time,” the condition actually presents in several different ways.

Normal bowel control relies on a complex system working together smoothly. The rectum, which stores stool until elimination, needs to stretch properly and send signals to the brain when it’s full. The anal sphincters, rings of muscle at the end of the rectum, must contract and relax at the right times. Meanwhile, the nerves connecting these structures to the brain and spinal cord need to communicate clearly. When any part of this system doesn’t function correctly, incontinence can result.

Different people experience this condition in different ways. Some have urgency incontinence, where they feel a sudden, intense need to have a bowel movement and cannot hold it long enough to reach a bathroom. Others experience passive incontinence, where stool or liquid passes without them feeling it happening. Many notice varying levels of control depending on stool consistency, typically having more trouble with loose or liquid stool than with solid waste.1

Common Causes of Fecal Incontinence

Fecal incontinence rarely has a single cause. Often, several factors combine to weaken the normal systems of bowel control. While some causes create temporary problems that resolve with proper care, others may lead to ongoing issues that require long-term management:

  • Muscle damage: The anal sphincter muscles can be injured during childbirth, especially with difficult deliveries or the use of forceps. Hemorrhoid surgery, procedures to remove rectal cancer, or treatment for anal abscesses can also damage these muscles. Over time, these injuries can compromise the tight seal needed for bowel control.
  • Nerve damage: The nerves that sense fullness in the rectum and control the sphincter muscles can be damaged by childbirth, chronic straining during constipation, spinal cord injury, or stroke. When nerves aren’t working properly, you might not feel the need to go, or your muscles might not respond as they should.
  • Rectal prolapse and rectocele: When the rectum drops down into the anus (rectal prolapse) or bulges through the vaginal wall (rectocele), it can interfere with the normal storage of stool, leading to leakage. These structural problems often develop gradually and may be related to chronic constipation, difficult childbirth, or weakening of pelvic floor muscles with age.
  • Chronic digestive conditions: Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis often lead to inflammation and irritation in the rectum, creating urgency and making it harder to hold stool. Irritable bowel syndrome with diarrhea causes loose, frequent bowel movements that are more difficult to manage. Even chronic constipation, which might seem unrelated, can cause leakage when liquid stool seeps around impacted stool that is difficult to pass.
  • Aging: While not inevitable, age-related changes in the body can contribute to incontinence. Muscles naturally lose some strength, including the sphincter and pelvic floor muscles. The rectum may become less elastic, and nerve function can decline.
  • Medication side effects: Some medications, particularly those that cause diarrhea or constipation as side effects, can contribute to bowel control problems. Antibiotics can disrupt normal gut bacteria, while some blood pressure medications and antidepressants affect muscle tone or nerve function in ways that impact continence.

Diagnosis and Evaluation

Diagnosing fecal incontinence typically begins with a detailed medical history and physical examination, which often includes a digital rectal exam to assess sphincter strength. Your doctor may also ask you to keep a food and bowel movement diary to identify patterns that might reveal potential causes of your symptoms. For many patients, additional tests provide more specific information:

  • Anal manometry: Measures sphincter muscle strength and function using a small tube with pressure sensors
  • Anorectal ultrasound: Creates images of the anal sphincters to identify tears or muscle damage
  • Defecography: An X-ray exam that records images during bowel movements to identify structural problems like rectal prolapse
  • Colonoscopy: Allows examination of the colon to rule out inflammatory bowel disease or other conditions
  • Nerve function tests: Procedures like electromyography (EMG) assess whether nerves controlling the sphincters are working properly

Treatment Options for Fecal Incontinence

A variety of treatments are available for fecal incontinence, ranging from simple changes in diet and routine to more advanced medical procedures. Gastroenterologists often begin with conservative strategies and adjust the plan based on how well symptoms respond. The right approach depends on the underlying cause, the severity of symptoms, and a person’s overall health:

  • Dietary modifications: SSimple changes to your diet, like adding fiber, can make a significant difference. Whether through foods or supplements, fiber helps form soft, well-shaped stools that are easier to control. Avoiding foods that commonly trigger urgency or diarrhea, including caffeine, alcohol, spicy foods, and artificial sweeteners, can reduce episodes of incontinence.
  • Medication management: Medications can help regulate bowel function by addressing the underlying cause of incontinence. Anti-diarrheal drugs such as loperamide (Imodium) or diphenoxylate-atropine (Lomotil) reduce frequency and firm up stool, making accidents less likely. In some cases, prescription medications are used to slow bowel transit time or to treat inflammation related to conditions like inflammatory bowel disease.
  • Bowel training: This behavioral technique involves establishing a regular schedule for bowel movements, often timed after meals when the body’s natural gastrocolic reflex is most active. Over time, this routine can help reduce urgency and improve predictability.
  • Pelvic floor exercises: Also known as Kegel exercises, these target the muscles involved in bowel control. Strengthening these muscles through regular contraction and relaxation can improve coordination and control.
  • Biofeedback therapy: This approach uses sensors to help patients become more aware of rectal sensations and muscle activity. With visual or auditory feedback, individuals can learn to better coordinate the muscles used during bowel movements. Biofeedback is frequently combined with pelvic floor exercises for improved results.
  • Injectable bulking agents: These substances are injected into the tissue around the anus to help the sphincters close more completely. This minimally invasive approach may be helpful for patients with mild to moderate symptoms.
  • Sacral nerve stimulation: This therapy involves implanting a small device that sends mild electrical impulses to the nerves that control the bowel and sphincter muscles. The stimulation can improve coordination and muscle tone, leading to better control.
  • Sphincteroplasty: In cases where the anal sphincter has been damaged, surgical repair may be recommended. This procedure tightens the muscle and can restore control for some patients, especially after injury or childbirth.
  • Surgical interventions: In more severe or complex cases, additional surgical procedures may be considered. These include options to repair prolapse, construct a new sphincter muscle, or, in rare cases, divert stool with a colostomy.2

Contact Cary Gastro to Speak with a Gastroenterologist

Living with fecal incontinence can be challenging, but effective treatments are available. If you’re experiencing symptoms of bowel control problems, don’t let embarrassment prevent you from seeking help. The gastroenterologists at Cary Gastro have extensive experience diagnosing and treating fecal incontinence with sensitivity and respect. Contact us today to schedule a confidential consultation and take the first step toward improved bowel control and quality of life.



1https://fascrs.org/patients/diseases-and-conditions/a-z/fecal-incontinence
2https://effectivehealthcare.ahrq.gov/products/fecal-incontinence/consumer