Fecal Incontinence
Loss of control over bowel movements
Quick Facts
- Type: Symptom (sign)
- Common causes: Muscle or nerve damage, diarrhea, constipation
- Often treatable: Diet, exercises, and other therapies help
- Note: Common but under-reported; help is available
Overview
Fecal incontinence is the loss of normal control over bowel movements, causing stool to leak unexpectedly from the rectum. It ranges from occasional leakage of a small amount of stool while passing gas, to a complete loss of bowel control. Some people feel a sudden, urgent need to pass stool and cannot reach a toilet in time, while others leak without realizing it.
Fecal incontinence is more common than many people think, but it is often not discussed because of embarrassment. It is not a normal part of aging and is not something you simply have to live with. Many causes are treatable, and a range of strategies, from dietary changes to exercises and procedures, can greatly improve or resolve the problem. Talking openly with a clinician is the first step.
Common Causes
Normal bowel control depends on healthy rectal and anal muscles, intact nerves, and a normal stool consistency. Problems with any of these can cause incontinence:
- Muscle damage: Injury to the anal sphincter muscles, often from childbirth (especially with tearing or forceps), or from surgery in the anal area.
- Nerve damage: From childbirth, long-term straining, diabetes, spinal cord injury, stroke, or conditions such as multiple sclerosis.
- Diarrhea: Loose stool is harder to control and is a very common contributor.
- Severe constipation: A large, hard stool can stretch the rectum and let watery stool leak around it (overflow).
- Reduced rectal storage: From surgery, radiation, or inflammation that stiffens the rectum.
- Rectal prolapse or hemorrhoids: Which can interfere with the seal of the anus.
Associated Symptoms
Fecal incontinence may occur with other bowel and pelvic symptoms, which help point to the cause:
- Sudden, hard-to-control urges to pass stool
- Leakage of gas or stool without awareness
- Diarrhea or constipation
- Bloating, gas, and abdominal discomfort
- Bladder control problems (urinary incontinence)
- A feeling of incomplete emptying after a bowel movement
If incontinence is new and comes with back pain, leg weakness, or numbness around the buttocks and genitals, it can signal a nerve emergency and needs urgent care.
Diagnosis & Evaluation
A clinician will ask how often leakage happens, whether it involves gas, liquid, or solid stool, and about childbirth, surgeries, and bowel habits. The exam usually includes inspecting the anal area and a gentle internal exam to assess muscle tone. Further tests may include:
- Anal manometry to measure the strength of the sphincter muscles
- An ultrasound of the anal muscles to look for damage
- Tests of the nerves serving the rectum and anus
- A colonoscopy or other studies if there is bleeding or a change in bowel habits
These help identify whether the problem is mainly muscular, nerve-related, or due to stool consistency.
Treatment & Management
Most people improve with a combination of approaches:
- Diet and bowel habits: Adjusting fiber, fluids, and trigger foods to firm up stool and establish regular, complete bowel movements.
- Medications: Anti-diarrheal medicines to reduce leakage, or treatment of constipation when overflow is the cause.
- Pelvic floor exercises and biofeedback: Strengthening and retraining the muscles that control the bowel.
- Bowel training: Setting a routine to empty the bowel at predictable times.
- Procedures and surgery: Such as nerve stimulation or sphincter repair, considered when simpler measures are not enough.
Skin care and absorbent products can protect the skin and add confidence while treatment takes effect. A continence specialist can tailor the plan to the cause.
When to See a Doctor
See a doctor for any ongoing loss of bowel control. It is common and treatable, and there is no need to feel embarrassed. Seek care sooner if you also have:
- Blood in the stool or black, tarry stools
- Unexplained weight loss or a marked change in bowel habits
- Severe abdominal pain
Seek urgent care if new bowel incontinence comes with sudden leg weakness, numbness around the buttocks or genitals, or difficulty urinating, as this can indicate serious nerve compression that needs emergency treatment.
Self-Care & Prevention
Several everyday measures can reduce leakage and protect your skin and confidence while treatment takes effect:
- Aim for well-formed stool by adjusting fiber and fluids; both loose stool and constipation make control harder
- Keep a food and symptom diary to spot triggers such as caffeine, alcohol, spicy or greasy foods, and artificial sweeteners
- Try to empty your bowel at regular, unhurried times, for example after a meal
- Do pelvic floor exercises regularly to strengthen the muscles that control the bowel
- Use barrier creams to protect the skin, and carry a change of clothing and wipes for reassurance
- Plan ahead by noting where toilets are when you go out
These steps work best alongside a treatment plan from your clinician, who can identify and address the underlying cause.
Frequently Asked Questions
Is fecal incontinence a normal part of getting older?
No. Although it becomes more common with age, fecal incontinence is not a normal or unavoidable part of aging. It usually has a treatable cause, so it is always worth discussing with a doctor.
Can fecal incontinence be cured?
Many people are cured or greatly improved with treatment. Approaches like dietary changes, anti-diarrheal medicines, pelvic floor exercises with biofeedback, and sometimes procedures address the underlying cause.
What foods make bowel leakage worse?
Common triggers include caffeine, alcohol, spicy or greasy foods, artificial sweeteners, and very large amounts of fiber for some people. Keeping a food diary can help identify your own triggers.
Does childbirth cause fecal incontinence?
Childbirth can injure the muscles or nerves that control the bowel, especially with a difficult delivery, tearing, or forceps. Symptoms may appear soon after birth or years later, and treatment is available.
When is fecal incontinence an emergency?
Seek urgent care if new bowel incontinence comes with sudden leg weakness, numbness around the buttocks or genitals, or trouble urinating. This combination can signal serious nerve compression that needs immediate treatment.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Fecal Incontinence.
- Mayo Clinic. Fecal incontinence — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Bowel incontinence.
- Centers for Disease Control and Prevention (CDC).