Bowel Leakage / Incontinence

Bowel leakage or fecal incontinence is the accidental passing of fecal material (bowel movement). This can happen to anyone if they  have bad diarrhea, but it is considered abnormal in anyone over the age of four who has it repeatedly.There are different degrees of fecal incontinence, from “skid-marks” in your underwear to accidental passage of solid stool. Underwear staining is a milder form of incontinence, which typically has different causes than losing fecal matter and can usually be resolved by medical treatments.

Flatus (gas) is not bowel leakage. Most people pass rectal gas every day, up to 20 times per day. While this can be very embarrassing it is not bowel leakage or fecal incontinence. Your doctor can sometimes help you reduce the odor or the amount of gas you pass.

Who has Fecal Incontinence?

1.  It is more common in children and in the elderly than in young and middle aged people.
2. It affects adult men and women equally.
3. Approximately 8% of persons living at home may have bowel leakage; while 45% of patients admitted to nursing homes have the problem.

How is Bowel Leakage diagnosed?

Your doctor can often tell if your bowel leakage is related to constipation during your consultation and exam. If the examination suggests that there is a different cause, two tests can help your doctor choose the best treatment:

1. 3D Anorectal Manometry is a test which measures the strength and symmetry of the anal sphincter muscles. It also tests the elasticity of your rectum and your ability to feel when your rectum is full.
2. Pelvic Floor Electromyographic (EMG) is a test where small electrical  sensors are placed in the anal canal to record the electrical activity of your sphincter muscles when they squeeze (contract) and relax.

What causes bowel leakage?

1. Hemorrhoids or rectal prolapse (bulging of the rectal lining through the anus) may cause minor incontinence by making it hard to clean up or by blocking the sphincter muscle from closing completely.
2. Diarrhea, especially when there is a strong urge, can cause bowel leakage. This is more likely if the patient has ulcerative colitis, Crohn’s disease or infectious diarrhea. About 20% of patients with Irritable Bowel Syndrome have occasional bowel leakage because of diarrhea.
3. Constipation can cause bowel leakage. A large amount of hard bowel movement in the rectum can prevent the sphincter from closing and liquid or soft bowel movement can leak out.
4. Childbirth injuries can result in tremendous stretching of the muscles in the pelvic floor which can damage the nerves and tear the sphincter muscles.
5. Diabetes mellitus; Bowel leakage can result from injuries to the sensory nerves, which tell us when the rectum is filling up and when we need to squeeze the sphincter muscle. This may happen after you have had diabetes a long time or it can be caused by spinal cord injury or stroke.
6. Colitis involves the rectum making it rigid. This makes the stool shoot our quicker and sphincter cannot close quickly enough to prevent leakage.
7. Dementia and disorders which affect walking or disrobing may contribute to bowel leakage.

How is Fecal Incontinence treated?

1. Diarrhea related incontinence can be treated with over the counter anti-diarrheal drugs and increase in fiber intake.
2. Constipation related incontinence can be treated with laxatives combined with a daily schedule to try to have bowel movements which is effective in about 60% of patients.
3. Pelvic floor exercises can be used to strengthen weak sphincter muscles.
4. Biofeedback therapy helps patients learn how to squeeze their sphincter muscles or improve their rectal sensation while using machines to monitor how well they are doing.
5. Surgery is often a last resort and may include sphincter repair, sphincter injection and electrical stimulator implant in the spine.

For more information, visit our Center of Excellence in Motility & Constipation.