Fecal Incontinence

What Is It?

When stool is released from the bowel unintentionally, it is known as fecal incontinence. Under normal circumstances, the stool enters the end portion of the colon, called the rectum, and is stored there until it is released intentionally. The rectum distends as it fills with stool. This triggers receptors in the surrounding muscles to tighten the anal sphincter muscle, which prevents feces from leaving the rectum until it is time to have a bowel movement.

Various conditions can cause stool to escape. The rectum may have a diminished capacity to store the stool, the person may be unable to perceive sensation of fullness in the rectum, or anal sphincter may fail to withstand the pressure of the stool in the rectum. A person also must be alert to the need to empty the bowels, and be mobile enough to reach the bathroom in time.

The problem can be caused by several conditions. Muscle or nerve damage usually is involved in chronic cases of fecal incontinence. Women can experience fecal incontinence after childbirth, especially if tissues in the area between the anus and vaginal opening were injured during delivery. Muscle damage also can occur as a result of rectal surgery or from inflammatory bowel disease. Sources of nerve damage that can lead to fecal incontinence include complications from diabetes, spinal-cord injury and multiple sclerosis.

Symptoms

Symptoms of fecal incontinence can range in severity from mild soiling with the passage of gas to the complete inability to contain solid stool.

Diagnosis

Several tests are used to determine the cause of fecal incontinence. The first step is a digital rectal exam in which the doctor inserts a gloved finger into the rectum. The doctor feels for anatomical abnormalities or impacted stool. In the latter condition, a mass of hard, dry feces becomes lodged in the bowel and liquid material can leak out around it.

Nerve damage that could affect rectal reflexes can be identified with the "wink" test, in which the doctor touches the anus to see if it contracts normally. The next test is often a sigmoidoscopy. This test involves inserting a thin, lighted tube fitted with a video camera into the rectum to look for inflammation, tumors, fissures or other problems. Your doctor also may suggest a barium enema or colonoscopy to look for problems in the intestine. Sometimes, abdominal X-rays are needed to spot fecal impaction higher up in the intestine. Another diagnostic test, anorectal manometry, measures the sensation and elasticity of the rectum and anal pressures.

Expected Duration