Chronic Constipation and Diarrhea
The two most common forms of fecal incontinence.
Most adults who experience fecal incontinence do so only during an occasional bout of diarrhea. But some people have recurring or chronic fecal incontinence. They may be unable to resist the urge to defecate, which comes on so suddenly that they don't make it to the toilet in time. This is called urge incontinence.
Another type of fecal incontinence occurs in people are not aware of the need to pass stool. This is called
passive incontinence.:
- Constipation. Chronic constipation may lead to a mass of dry, hard stool in the rectum (impacted
stool) that is too large to pass. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool from farther up the digestive tract to move around the impacted stool and leak out. Chronic constipation may also cause nerve damage that leads to fecal incontinence.
- Diarrhea. Solid stool is easier to retain in the rectum than is loose stool, so the loose stools of diarrhea can cause or worsen fecal incontinence.
Medications
Depending on the cause of fecal incontinence, options include:
- Anti-diarrheal drugs such as loperamide hydrochloride (Imodium) and diphenoxylate and atropine
sulfate (Lomotil)
- Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil), if chronic constipation
is causing your incontinence
- Injectable bulking agents such as Dextranomer Microspheres/Hyaluronate Sodium in 0.9 % Nacl (Solesta) are injected directly into the anal canal
Dietary changes
What you eat and drink affects the consistency of your stools. If constipation is causing fecal incontinence, your doctor may recommend drinking plenty of fluids and eating fiber-rich foods. If diarrhea is contributing to the problem, high-fiber foods can also add bulk to your stools and make them less watery.
Exercise and other therapies
If muscle damage is causing fecal incontinence, your doctor may recommend a program of exercise and other therapies to restore muscle strength. These treatments can improve anal sphincter control and the awareness of the urge to defecate. Options include:
- Biofeedback. Specially trained physical therapists teach simple exercises that can increase anal muscle strength. People learn how to strengthen pelvic floor muscles, sense when stool is ready to be released and contract the muscles if having a bowel movement at a certain time is inconvenient.Sometimes the training is done with the help of anal manometry and a rectal balloon.
- Bowel training. Your doctor may recommend making a conscious effort to have a bowel movement at a specific time of day: for example, after eating. Establishing when you need to use the toilet can help you gain greater control.
- Sacral nerve stimulation (SNS). The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can strengthen muscles in the bowel. This treatment is usually done only after other treatments are tried.
- Posterior tibial nerve stimulation (PTNS/TENS). This minimally invasive treatment may be helpful for some people with fecal incontinence, but more studies are needed.
- Vaginal balloon (Eclipse System).
This is a pump-type device inserted in the vagina. The inflated balloon results in pressure on the rectal area, leading to a decrease in the number of episodes of fecal incontinence. Results for women have been promising, but more data are needed.
Surgery
Treating fecal incontinence may require surgery to correct an underlying problem, such as rectal prolapse or sphincter damage caused by childbirth.
