Fecal Incontinence

Fecal incontinence, or encopresis, is the inability to control bowel movements, which can cause stool to leak from the body. In mild cases, this may involve just a small amount of stool when passing gas. In severe cases, it can result in a complete loss of bowel control.

While a fairly common condition in older adults, fecal incontinence can have a significant impact on a patient’s quality of life. WakeMed’s gastroenterologists and colorectal surgeons use their expertise and experience to find the underlying cause of the fecal incontinence — and provide effective treatment.

What Are the Symptoms and Causes of Fecal Incontinence?

Symptoms of fecal incontinence can include:

• Being unable to reach the toilet in time
• Leakage of stool
• Inability to hold in gas or stool
• Diarrhea
• Constipation
• Abdominal pain

Often, the cause can simply be aging (which leads to muscle or nerve damage in the anal sphincter), or a prolonged childbirth. Chronic diarrhea and constipation can also lead to fecal incontinence. 

Rectal prolapse and rectovaginal fistulae can also make a person more susceptible to fecal incontinence.

Besides the emotional component that fecal incontinence can cause, it can also create sores on the skin around the anus. Because of this, it’s important to diagnose and treat quickly.

How Is Fecal Incontinence Diagnosed?

Our doctors will start by taking a full medical history and performing a physical examination. It’s a good idea to track your bowel habits for a few weeks before seeing your doctor, and to bring that information to your appointment. 

Diagnostic tests to help us diagnose fecal incontinence and its underlying cause may include:

• Digital rectal examination, in which the doctor inserts a lubricated, gloved finger into the rectum to feel for any abnormalities
• Anal manometry, in which a tube with an expandable balloon is inserted into the rectum, and then measures the tightness and functioning of the anal sphincter and rectum
• Balloon expulsion exam, in which a water-filled balloon is placed in the rectum, and then expelled
• Proctoscopy, which uses a thin tube to look at the inside of the anus and rectum
• Ultrasound, in which sounds waves are used to take detailed pictures of the anus and rectum
• Colonoscopy, in which a lighted, flexible tube looks at the inner lining of the colon to check for inflammation
• Magnetic resonance imaging (MRI) scans

How Is Fecal Incontinence Treated?

It’s possible to restore or improve bowel control. Our doctors work with each patient to provide an individualized treatment plan, based on the cause of the incontinence.

Dietary changes can help — including avoiding spicy, fatty, and greasy foods; as well as dairy and caffeine. For patients who also suffer from constipation, the doctor may recommend eating high-fiber foods or using fiber supplements. 

Bowel retraining therapies — including biofeedback — can also help patients regain control of their muscles and lessen the frequency and severity of fecal incontinence.

At WakeMed, we are experts at performing sacral nerve stimulation. Sacral nerves are the nerves that regulate the anal sphincter muscles. Small needles are placed in the sacral nerves, and are then stimulated with an electrical current. Occasionally, a permanent stimulator may be implanted.

When Is Surgery Needed for Fecal Incontinence?

When these treatments don’t work, our colorectal surgeons have surgical options.

In cases where a patient has a damaged anal sphincter, we can perform a surgery, called a sphincteroplasty, to repair it. In some patients, we may need to replace the sphincter with an artificial anal sphincter.

If a patient has an underlying condition like rectal prolapse or rectovaginal fistulae, surgically treating those conditions may eliminate fecal incontinence.

In very rare situations, a colostomy may be performed as a last resort.

Learn more about what to expect from colorectal surgery. 

Make an Appointment

If you or someone you care for is experiencing worrisome symptoms, we encourage you to make an appointment with one of our pediatric gastroenterologists, adult gastroenterologists or colorectal surgeons.