Fortunately, effective treatments are available for fecal incontinence. Your primary care physician may be able to assist you, or you may need to see a doctor who specializes in treating conditions that affect the colon, rectum and anus, such as a gastroenterologist, proctologist or colorectal surgeon. Treatment for fecal incontinence can usually help restore bowel control or at least substantially reduce the severity of the condition.

Depending on the cause of your incontinence, treatment may include dietary changes, medications, special exercises that help you better control your bowels, or surgery.

Dietary changes
What you eat and drink affects stool consistency. Your doctor may recommend changes to your diet to help improve your bowel movements.

For example, if chronic constipation is to blame for fecal incontinence, your doctor may recommend that you drink plenty of fluids and eat fiber-rich foods that aren’t constipating. If diarrhea is contributing to the problem, your doctor may recommend that you increase your intake of high-fiber foods to add bulk to your stools, making them less watery. In general, your doctor will recommend a diet that helps you gain good stool consistency for increased control of your bowels.

Medications
Sometimes, doctors recommend medications to treat fecal incontinence, such as:

• Anti-diarrheal drugs. Your doctor may recommend medications to reduce diarrhea and help you avoid accidents. A drug called loperamide (Imodium) may be used because it helps treat diarrhea.
• Laxatives. If chronic constipation is to blame for your incontinence, your doctor may recommend the temporary use of mild laxatives, such as milk of magnesia, to help restore normal bowel movements.
• Stool softeners. To prevent stool impaction, your doctor may recommend a stool-softening medication.
• Other medications. If diarrhea is the cause of your fecal incontinence, your doctor may recommend drugs that decrease the spontaneous motion of your bowel (bowel motility) or medications that decrease the water content of your stool.

Bowel training
If fecal incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel training program and exercise therapies aimed at helping you restore muscle strength.

In some cases, bowel training means learning to go to the toilet at a specific time of day. For example, your doctor may recommend that you make a conscious effort to have a bowel movement after eating. This helps you gain greater control by establishing with some predictability when you need to use the toilet. This technique can work well for children who have constipation and fecal incontinence because they forget to use the toilet. Children can learn to use the toilet at scheduled times.

In other cases, bowel training involves an exercise therapy called biofeedback. Biofeedback as a treatment for fecal incontinence involves inserting a pressure-sensitive probe into your anus. This probe registers muscle strength and activity of your anal sphincter as it contracts around the probe. You can practice sphincter contractions and learn to strengthen your own muscles by viewing the scale’s readout as a visual aid. These exercises can strengthen your rectal muscles.

Treatment for stool impaction
Your doctor may have to remove an impacted stool if taking laxatives or using enemas doesn’t help you pass the hardened mass. To remove an impacted stool, your doctor inserts one or two fingers into your rectum to break apart the impacted stool. These smaller pieces are easier to expel.

Surgical options
For some people, treatment of fecal incontinence requires surgery to correct an underlying problem. Surgical procedures to treat fecal incontinence aren’t necessarily easy or free of complications. But, certain causes of fecal incontinence — anal sphincter damage caused by childbirth or rectal prolapse, for example — can often be effectively treated with surgery. Surgical options include:

• Sphincteroplasty. This is surgery to repair a damaged or weakened anal sphincter. In this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscle, tightening the sphincter.
• Operations to treat rectal prolapse, a rectocele or hemorrhoids. Rectal prolapse, a condition in which a portion of your rectum protrudes through your anus, weakens the anal sphincter. In certain circumstances, such as chronic constipation and straining, the ligaments to the rectum can become stretched and lose their ability to hold the rectum in place. Surgical correction of the rectal prolapse may be needed along with sphincter muscle repair. In women, a protrusion of the rectum into the vaginal wall (rectocele) may need to be treated surgically to correct fecal incontinence. Prolapsed internal hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence. Hemorrhoids may be near the upper part or beginning of the anal canal (internal hemorrhoids) or at the lower portion or anal opening (external hemorrhoids). Hemorrhoids can be treated by conventional hemorrhoidectomy, a surgical procedure to remove the hemorrhoidal tissue.
• Sphincter replacement. An artificial anal sphincter can be used to replace a damaged anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you’re ready to defecate. To go to the toilet, you use a small external pump to deflate the device and allow stool to be released. It then reinflates itself about 10 minutes later.
• Sphincter repair. During a surgical procedure called a gracilis muscle transplant, a muscle is taken from your inner thigh and wrapped around your sphincter. This restores muscle tone to your sphincter.
• Colostomy. As a last resort, a colostomy may be the most definitive way to correct fecal incontinence. Colostomy is generally considered only after other treatments have failed. A colostomy is an operation that diverts stool through an opening in the abdomen instead of through the rectum. A special bag is attached to this opening to collect the stool.

Sacral nerve stimulation
Another possible treatment for fecal incontinence is sacral nerve stimulation. 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. Direct electrical stimulation of these nerves is a promising treatment option for fecal incontinence caused by nerve damage.

Sacral nerve stimulation is carried out in stages. First, four to six small needles are positioned in the muscles of your lower bowel, and these muscles are stimulated by an external pulse generator. The muscle response to the stimulation generally isn’t uncomfortable. After a successful response, you may have a permanent pulse generator implanted in your abdomen.

A wire from the small, battery-driven device is connected to the sacral nerves. Through the wire, the device generates electrical impulses that stimulate the nerves, helping you regain continence.

Patricia S. Goode; Kathryn L. Burgio; Anne D. Halli; Rebecca W. Jones; Holly E. Richter; David T. Redden; Patricia S. Baker; Richard M. Allman