Fecal Incontinence: Causes, Symptoms, Treatment, and Prevention

  Faecal incontinence, also referred to as bowel incontinence, can substantially affect an individual’s daily life and emotional well-being. Faecal incontinence refers to involuntary loss of control over a person’s bowel movement, causing stool (both solid and liquid) and gas to unintentionally leak. It may also range in severity from occasional leakage to total loss of bowel control. 

It is important to understand and manage faecal incontinence because it can lead to physical discomfort, social awkwardness, and emotional distress. Many individuals feel either too embarrassed or ashamed to seek medical attention, which may allow the faecal incontinence to worsen over time. However, with the correct interventions and support, most individuals will be better able to control their bowel symptoms and live comfortably.

Although faecal incontinence can affect individuals of any age, it is more prevalent in individuals who are elderly, of the female gender, postpartum, or have experienced nerve damage due to medical conditions, including diabetes, stroke, and spinal injury. Furthermore, women who have experienced difficult vaginal deliveries or undergone surgical operations to the pelvic area may have an elevated risk of faecal incontinence.

Timely diagnosis and management can improve outcomes and prevent complications for individuals with faecal incontinence. Options for faecal incontinence include lifestyle modifications, physiotherapy, medications, and/or surgery. It is time to end the stigma of bowel incontinence and recognise/acknowledge that digestive health is an integral part of holistic health and wellness. 

What is faecal incontinence?

In short, it is an inability to stop a bowel movement, resulting in the accidental leakage of stool from the rectum. This can be with or without awareness through the involuntary leaking of solid or liquid stool, and whether or not a patient has gas.

The meaning of faecal incontinence is both chronic and transient. For example, a one-time event can happen due to diarrhoea, but if a patient is experiencing chronic symptoms, they may need medical attention. Faecal incontinence majorly impacts one's self-esteem, social life, and medical health.

It is important to differentiate one-time stool leakage from a chronic disability. Most patients with chronic faecal incontinence may have underlying issues with their muscles, nerves, or other gastrointestinal illnesses that will require medical attention and intervention.

Types of Fecal Incontinence

There are different types of faecal incontinence, and understanding them can help tailor the right treatment approach:

● Urge Incontinence:

 Impulsive faecal urgency with the inability to reach the toilet quickly. This is the most frequent type and is usually a result of weak sphincter control.

● Passive Incontinence: 

 Involuntary stool leakage without the person being aware. This condition often results from nerve damage that dulls sensation in the rectum.

● Faecal seepage:  

Involves leakage of small amounts of stool after a bowel movement, often due to incomplete evacuation or weakened muscles.

What Causes Faecal Incontinence?

Let us now look at the triggers of faecal incontinence: 

● Muscle Damage: 

Damage, usually from childbirth or surgery, to the anal sphincter muscle reduces control. 

● Nerve Damage:

 Diabetes, stroke, spinal cord injuries, and other conditions can disrupt the nerve mechanism. 

● Chronic Constipation: 

Chronic constipation can cause stool accumulation and rectum stretching, and in time, the muscle can become weaker. 

● Diarrhoea: 

When there are loose and/or frequent stools, those stools are harder to control and more likely to overwhelm the bowel control reflex. 

● Haemorrhoids and Rectal Prolapse: 

Both conditions make it harder to completely close the anus and contribute to faecal incontinence. 

● Other factors: 

Other factors include age, inflammatory bowel disease (IBD), radiation therapy, and overuse of laxatives.

Symptoms of Fecal Incontinence

Identifying the symptoms of faecal incontinence is the first step in obtaining help:

● Inability to control bowel movements

● Unexpected stool leakage – solid, liquid, or mucus

● Sudden urgency to defecate

● Altered bowel habits, like persistent diarrhea or constipation

● Skin irritation around the anus due to constant moisture

These symptoms may vary in frequency and severity, but they often affect daily routines and self-confidence.

Diagnosis of Fecal Incontinence

There are multiple ways for the medical provider to diagnose faecal incontinence. A provider would take the following steps to determine both the cause and the severity of faecal incontinence: 

● Medical History Review: 

The doctor will ask you about things like your bowel habits, general lifestyle, and any medical history that may be relevant. 

● Physical Examination:

 The physical exam would involve looking at muscle tone, the function of the nerves, and any impressions of irregularity around the anus itself. 

Tests:

●  Anal Manometry –

 To measure the pressure and strength of the sphincter

● Endorectal Ultrasound – 

Imaging that will show damage to the muscles

● MRI Defecography –

 Looks at you moving bowels in real-time  

● Nerve Function Assessments – 

Tests damage to the nerves innervating the rectum and anus.

With an early diagnosis, things are likely going to turn out better for you, and it can also lead to the prevention of complications such as skin infections or chronic irritation.

Treatment Options for Fecal Incontinence

Although there is not a single treatment for faecal incontinence that can work for everyone, some of the best options are listed below! 

1. Lifestyle and Dietary Modifications: 

● Come up with a dietary plan that increases fiber (i.e., fruits, whole grains, legumes) to get your bowel movements on a schedule 

● Avoid foods that may cause you trouble, like caffeine, alcohol, dairy, and spicy foods, as well as others that may be specific to you!

● Drink lots of fluids to prevent constipation (remember, keeping hydrated is important for other parts of your body as well!)

2. Medications: 

● Consider anti-diarrhoeals like loperamide after loose stools. 

● Consider a stool softener or a laxative if you are constipated.

3. Pelvic Floor Exercises (Kegels): 

● Pelvic Floor Exercises can help you regain control of your anal sphincter and pelvic muscles. 

4. Biofeedback Therapy: 

● Biofeedback therapy using sensors and monitors was designed specifically to help people learn to control their muscles with their bowels. 

5. Surgical Options: 

There are surgical options for severe cases or those cases that have been refractory to conservative treatments. These might include:

● Sphincteroplasty, which would repair your damaged sphincter muscles. 

● Sacral Nerve Stimulation (SNS)—which sends small electrical impulses to improve your bowel control. 

● A colostomy involves diverting solid stools through an opening in the abdomen and should be a last resort. 

Fecal Incontinence Coping Strategies and Lifestyle Adjustments

Coping with fecal incontinence can be very difficult, but here are some tips to help alleviate some of the burden or anxiety around the daily activities you may face: 

● Wear protective underwear or have absorbent pads to feel secure and protected 

● Plan outings with the ability to reach a restroom in mind 

● Get connected with support groups – means meeting adults dealing with a similar situation to help reduce isolation 

● Maintain good hygiene – gently wash and apply barrier creams to the area as needed to limit any skin irritation 

Working on your pelvic floor, maintaining a healthy diet, and maintaining a regular scheduled bowel routine can help to manage your symptoms and build your confidence to allow you back into society.

Prevention of Fecal Incontinence

While you can't prevent every instance of faecal incontinence, you can reduce your risk by adopting the following lifestyle habits: 

● Eat a high-fibre diet and drink enough water— your bowel habits will thank you!

● Exercise regularly to make your core and pelvic muscles strong; your overall well-being will benefit.

● Addressing constipation and diarrhea early can prevent long-term consequences

● Take action so you don't have to get surgery.

Regularly check your intestinal and digestive health because you deserve to maintain optimal gut health.

Conclusion

Faecal incontinence is a manageable condition that no one should feel embarrassed about. Knowing the symptoms of faecal incontinence, what causes it, and addressing it early can help enhance one's quality of life. There are many faecal incontinence treatment options. Depending on severity, it may involve fragments of pelvic floor therapy, changes in your diet, or, needless to say, surgery. If you are experiencing any indications of faecal incontinence or if there is a loved one who is, apply yourself to a provider. The sooner, the better.

FAQs

1. What is faecal incontinence?

Faecal incontinence is the loss of control over bowel movements, leading to accidental leakage of stool or gas.

2. What causes faecal incontinence?

It can be caused by muscle damage, nerve injuries, constipation, diarrhoea, or medical conditions like diabetes and IBD.

3. Who is most at risk for faecal incontinence?

The elderly, women after childbirth, and those with neurological disorders are most commonly affected.

4. Can faecal incontinence be cured?

Yes, depending on the cause. Many cases improve with dietary changes, pelvic exercises, medications, or surgery.

5. What are the early symptoms of faecal incontinence?

The patient is experiencing urgency, occasional leakage of stool or gas, and skin irritation around the anus.

6. What foods should I avoid if I have faecal incontinence?

Avoid caffeine, dairy products, fatty foods, and spicy meals, especially if they trigger diarrhoea.

7. When should I see a doctor for faecal incontinence?

If you experience repeated stool leakage, sudden urgency, or changes in your bowel habits, consult your doctor for evaluation.