What is fecal incontinence?

Fecal incontinence – also called anal incontinence – is the term used when bowel movements cannot be controlled. Stool (feces/waste) leaks out of the rectum at unwanted times – not at planned bathroom breaks. This leakage occurs with or without your knowledge. Fecal incontinence happens more often in women than in men and also happens often among older people.

The term fecal incontinence is used if any of these situations occur:

  • Stool leaks out when passing gas
  • Stool leaks out due to physical activity/daily life exertions
  • A person may "feel like he/she has to go" and not be able to make it to the bathroom in time
  • Stool is seen in the underwear after a normal bowel movement
  • There is complete loss of bowel control

Why does fecal incontinence happen?

Several factors affect continence of stool or the ability to control bowel movement:

  • Muscles in the rectum and anus (the very last two sections of the intestines) must be working properly.
  • The rectum must be able to stretch to hold the stool. A "rectal sensation" has to be present to provide warning of the need to move bowels. When properly working, this means a person gets a feeling that it is time to go to the bathroom.
  • The anal muscles (sphincters) must have the ability to squeeze the anus shut. If these muscles are not working properly, stool can leave the body unexpectedly.
  • The person lacks the physical and mental abilities to "recognize the signal" that it is time to go to the bathroom to move bowels, or the physical quickness to reach the bathroom.
  • Stools are very watery or explosive or both.

If any of these body functions are not working properly, fecal incontinence may occur.

What causes changes in these body functions?

  • Frequent diarrhea or constipation. These conditions cause the muscles in the rectum and anus to weaken. When these muscles weaken, the ability to hold stool within the body also weakens.
  • Muscle damage. Muscle damage can occur during a difficult vaginal childbirth, when doctors have to use forceps or make a small cut (an episiotomy) to make a larger opening. Muscle damage can also result from anal or rectal surgery.
  • Older age. Muscles in the rectum and anus naturally weaken with age. Other nearby structures in the pelvis area also loosen with age. This adds to the general weakness seen in that area of the body, leading to problems with stool control. Loose stool is more difficult to control than solid stool. When a large amount of loose stool arrives rapidly in the rectum, there may not be enough warning to reach the bathroom in time.
  • Damage to nerves. If the nerves that control the ability of the rectum and anus muscles to contract are damaged, incontinence can result. Nerves that control "rectal sensation" can also lead to incontinence if they are damaged. Nerve damage occurs due to a difficult vaginal delivery, anal surgery, constipation (resulting in bouts of frequent and severe straining), or the presence of certain health conditions (eg, diabetes, multiple sclerosis, stroke, spinal tumor).
  • Inability of the rectum to stretch. If the muscles of the rectum are not as elastic as they should be, excess stool that builds up can leak out. Inflammatory bowel disease (such as Crohn's disease) can also affect the rectum's ability to stretch. The scars resulting from surgery and radiation therapy can also stiffen the muscles of the rectum.
  • Other medical conditions. Certain medical conditions, such as rectal prolapse (the rectum falls down into the anus) or rectocele (the rectum pushes into the vagina), or chronic constipation where stool leaks around a large stool ball, can lead to fecal incontinence.
  • Other causes: Laxative abuse, radiation treatments, certain nervous system and congenital (inherited) defects, inflammation (swelling), and inflammatory bowel disease may affect the ability to control stool.

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