SymptomDigestive system
Bowel Leakage (Fecal Incontinence): Causes and First Steps
Fecal incontinence, also called accidental bowel leakage, means passing stool or gas when you do not mean to, from small smears on underwear to losing a whole bowel movement. It affects about 1 in 12 adults and is more common with age and after childbirth. The most common triggers are loose stool, constipation with overflow, and weak or damaged anal muscles. Most people improve with simple changes to stool consistency and pelvic floor exercises. New leakage with back pain or numbness needs emergency care.
Also called: Accidental bowel leakage, bowel incontinence, anal leakage, soiling, incontinence of stool
At a glance
- What it is
- Unintended loss of stool, liquid or gas from the back passage.
- How common
- About 1 in 12 adults; more after 65 and after vaginal childbirth.
- Common causes
- Diarrhea, constipation with overflow, childbirth injury, weak pelvic floor, hemorrhoids, nerve damage.
- Serious causes
- Spinal cord compression, rectal cancer, inflammatory bowel disease.
- First steps
- Firm up stool with fiber, treat constipation, pelvic floor exercises, see a doctor.
When to get help
Call 911 or go to the ER
- Sudden loss of bowel control with new back pain, numbness between the legs or around the anus, leg weakness, or trouble passing urine (possible cauda equina syndrome)
- Bowel leakage with a stroke-like event: face droop, arm weakness, slurred speech
See a doctor within a day or two
- Leakage with bloody diarrhea, fever or severe belly pain
- Leakage of watery stool in an older person who has been constipated (possible fecal impaction with overflow)
- New leakage after a recent injury or surgery to the anus or pelvis
Book a routine appointment
- Any ongoing leakage of stool, even small amounts, that lasts more than a few weeks
- Leakage with blood in or on the stool, a change in bowel habit or weight loss, especially over 45
- Leakage after childbirth that has not improved by 6 to 12 weeks
- A bulge from the anus that comes out with straining
Usually safe to manage at home
- A single episode of urgency or leakage during a short bout of diarrhea from a stomach bug
What the pattern of leakage tells you
| Pattern | What it suggests |
|---|---|
| Urge leakage: a sudden urge, then not reaching the toilet in time | Weak external anal sphincter, diarrhea, IBS, inflammatory bowel disease, reduced rectal storage after radiation |
| Passive leakage: stool escapes without you noticing | Weak internal sphincter, nerve damage, hemorrhoids or prolapse holding the anus open |
| Leakage after a bowel movement: smearing or seepage | Incomplete emptying, hemorrhoids, skin tags, rectocele |
| Watery leakage while constipated | Fecal impaction with overflow, common in older adults |
| Gas only | Early sphincter weakness |
Common causes of bowel leakage
Loose stool
Diarrhea is the most common trigger, because liquid stool is much harder to hold than formed stool. Causes include stomach bugs, irritable bowel syndrome, inflammatory bowel disease, celiac disease, lactose intolerance, medicines (metformin, antibiotics, magnesium) and gallbladder removal.
Constipation and overflow
Hard stool stuck in the rectum stretches and relaxes the anal muscles, and liquid stool leaks around it. This is very common in older adults, people with limited mobility and children. Treating the constipation usually stops the leakage.
Muscle damage
- Childbirth: tears or stretching of the anal sphincter during vaginal delivery, especially with forceps or a large baby. Leakage may appear soon after birth or years later, around menopause.
- Anal surgery: for hemorrhoids, fistulas or fissures.
- Pelvic floor weakness with age, chronic straining and obesity.
Nerve damage
Diabetes, multiple sclerosis, spinal cord injury, stroke, dementia and long-term straining can damage the nerves that sense stool and control the sphincters.
Structural problems
Hemorrhoids, rectal prolapse and rectocele can stop the anus closing fully or trap stool.
Reduced rectal storage
Radiation therapy to the pelvis, rectal surgery and inflammation in proctitis reduce how much stool the rectum can hold.
What to do now
- Firm up your stool. A soluble fiber supplement such as psyllium, taken daily with water, makes stool bulkier and easier to control. Reduce caffeine, alcohol, artificial sweeteners and greasy foods if they loosen stool.
- Treat constipation if you are straining or passing hard stool.
- Keep a bowel diary for 1 to 2 weeks: food, stool type, leaks and urgency. It helps you spot triggers and helps your doctor.
- Use the toilet at set times, such as 20 to 30 minutes after breakfast, when the bowel is naturally most active.
- Start pelvic floor exercises (squeezing as if stopping gas, holding for a few seconds, then relaxing, repeated several times a day).
- Protect your skin. Clean gently with water or unscented wipes, pat dry and use a barrier cream. Leakage causes soreness and anal itching.
- Carry a kit: spare underwear, wipes and disposable pads. Knowing you are prepared reduces anxiety.
Seeing a doctor
Bowel leakage is not an inevitable part of aging, and doctors are used to discussing it. Your doctor will ask about the pattern and stool consistency, childbirth history, surgery, medicines and other conditions, and will examine your anus and rectum, including a gentle internal check of muscle tone. Depending on the findings you may have blood tests, stool tests, a colonoscopy, or specialist tests of the anal muscles. See fecal incontinence for full details of testing and treatment options, including biofeedback and surgery.
Frequently asked questions
What causes accidental bowel leakage?
The most common causes are diarrhea, constipation with overflow, and weak or damaged anal sphincter muscles, often from childbirth. Nerve damage from diabetes, MS or spinal problems, hemorrhoids, rectal prolapse and pelvic radiation are other causes.
Why do I leak stool after a bowel movement?
Leakage after a bowel movement usually means some stool is left behind. Common reasons are hemorrhoids or skin tags that trap stool, a rectocele, and incomplete emptying. More fiber, not rushing on the toilet, and treating hemorrhoids often help.
Is fecal incontinence a sign of cancer?
Rarely. Most leakage has benign causes. However, leakage combined with rectal bleeding, a change in bowel habit lasting weeks, unexplained weight loss or a feeling of incomplete emptying should be checked for rectal cancer, especially over 45.
Can bowel leakage be cured?
Many people become fully continent or improve greatly. Treating diarrhea or constipation, fiber supplements and pelvic floor exercises with biofeedback help most people. Injectable treatments, nerve stimulation and surgery are options when these are not enough.
What can I take to stop bowel leakage?
Daily soluble fiber, such as psyllium, firms stool. For loose stools, loperamide can reduce urgency and leakage; follow the label dose and check with a doctor before regular use. Treat constipation-related leakage with fiber, fluids and laxatives, not loperamide.
Sources
This guide was written from current patient and clinical guidance, including:
- American Society of Colon and Rectal Surgeons: Clinical practice guidelines for the management of fecal incontinence
- NIDDK: Bowel control problems (fecal incontinence)
- MedlinePlus: Bowel incontinence
- NHS: Bowel incontinence
- American College of Gastroenterology: Fecal incontinence