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Patient education: Fecal incontinence (The Basics)

Patient education: Fecal incontinence (The Basics)

What is fecal incontinence? — Fecal incontinence is the medical term for when a person loses control of their bowels. A person with fecal incontinence might leak solid or liquid bowel movements. The term "anal incontinence" includes these issues as well as the leaking of gas.

Fecal incontinence is most common in people who gave birth to 1 or more babies when they were younger. It happens because the muscles that control bowel movements can get damaged in childbirth. People can also have fecal incontinence for other reasons.

Having fecal incontinence can be embarrassing and stressful. People who have it sometimes stay at home instead of going out, because they are afraid of having "an accident." If you have trouble controlling your bowels, you should know that the problem is not a normal part of aging. It can often be treated and fixed, or at least improved.

Is there a test for fecal incontinence? — Yes. Your doctor or nurse will look at your anus and do a "digital rectal exam." During a digital rectal exam, your doctor or nurse will put a gloved finger into your anus and rectum to feel for lumps or anything abnormal. Doctors can also do a few different tests to find out what might be causing fecal incontinence. Your doctor might order 1 or more of these tests:

Lab tests – Doctors can check a sample of bowel movement for infections that could cause diarrhea.

Colonoscopy or sigmoidoscopy – During a colonoscopy, the doctor puts a thin tube into your rectum and advances it up into your colon (figure 1). The tube has a camera attached to it, so the doctor can look inside your colon (also called large intestine) and take tissue samples (called biopsies). A sigmoidoscopy is very similar, but the tube does not go in as far (figure 2).

Anorectal manometry – This test allows the doctor to measure the pressure inside the rectum at different points. A very thin tube is inserted into your rectum. For this test, the tube has a balloon on the end. The balloon is inflated once it is in the rectum. Then you are asked to try to squeeze and relax the muscles in the area. A machine attached to the tube measures how well these muscles are working.

Manometry can help the doctor find out if the muscles that control bowel movements are working right. The test also shows whether the person's rectum can feel normally.

Ultrasound or MRI – Ultrasound and MRI are imaging tests. They can also help the doctor check whether the parts involved in controlling bowel movements are normal. These parts include the pelvic and "anal sphincter" muscles, as well as the inner wall of the colon.

Is there anything I can do on my own to feel better? — Yes. Some people have fewer problems with fecal incontinence if they:

Avoid foods and drinks that cause loose or frequent bowel movements. Examples include:

Dairy foods (for people who have trouble with dairy)

Fatty or greasy foods

Drinks with caffeine, such as coffee

Diet foods or drinks

Sugar-free gum or candy

Alcohol

Eat more fiber. Fiber makes bowel movements bulkier and sturdier. This can make bowel movements easier to control. Foods that have a lot of fiber include fruits, vegetables, and whole grains (table 1). You can also get more fiber by taking fiber supplements, such as Metamucil, Citrucel, or Benefiber.

Should I see a doctor or nurse? — Yes. If you have fecal incontinence, tell your doctor or nurse. People are sometimes too shy to bring it up. But fecal incontinence is a real medical problem that can be treated.

How is fecal incontinence treated? — Treatments your doctor might suggest include:

Fiber pills, powders, or wafers – Fiber supplements make bowel movements bulkier and sturdier. This can make bowel movements easier to control.

Medicines to reduce the number of bowel movements – These medicines are often used to treat diarrhea. They can decrease the number of "accidents" a person has. Examples of these medicines include loperamide (sample brand name: Imodium) and diphenoxylate-atropine (brand name: Lomotil).

Medicines to slow the movement of food through the intestines – These medicines are called "anti-cholinergics."

Treatment to empty the bowels – Some people with fecal incontinence have bowels that are full and that they cannot empty completely. These people need treatment to flush the bowels. Then, once the bowels are cleaned out, they can take medicines to keep bowel movements regular.

Scheduled bathroom visits – Some people have fewer accidents if they visit the bathroom on a schedule. They try to go even when they don't "feel" like they need to go.

Biofeedback – Biofeedback is a way to retrain the muscles that control bowel movements (figure 3). It is done at the doctor's office and involves using devices called sensors that measure muscle activity. These sensors tell you if you are using the muscles the right way.

Electrical nerve stimulation – Doctors can implant devices that send a mild electrical current to the nerves that control the muscles in the anus. These devices sometimes help improve bowel control.

Surgery – Doctors can sometimes do surgery to repair the muscles that control bowel movements. This is often helpful in people whose muscles were damaged during childbirth. There are also other types of surgery to treat fecal incontinence.

More on this topic

Patient education: Constipation in adults (The Basics)

Patient education: Diarrhea in adolescents and adults (The Basics)
Patient education: High-fiber diet (The Basics)

Patient education: Fecal incontinence (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)

This topic retrieved from UpToDate on: Mar 03, 2022.
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