Fecal incontinence (FI) is when you lose liquid or solid stool by accident. When it is bad enough, it can become a social and/or hygienic problem, causing social and emotional anxiety as well as embarrassment for women of any age.
How often this can happen depends on your age. Overall, about seven percent of people report having FI for longer than one month.
There are three types of FI:
- Passive incontinence – passing gas or stool without knowing it;
- Urge incontinence – passing gas or stool even if you try to stop it; and
- Fecal seepage – leaking of stool after a bowel movement when you usually have control.
There can often be an overlap between the types. You can have more than one type at the same time, but, typically one type is more dominant. The treatments that you will be offered depend on the type of FI you have.
Being able to control the passage of stool is complex, particularly with FI. It involves three factors:
- Several muscles and nerves working together;
- How much stool you have and how hard or soft it is; and
- Your senses and reflexes.
Here is what happens when you need to move your bowels:
- Stool fills your rectum, and the rectum expands.
- The feeling then travels to your brain.
- A reflex controls the urge to pass the stool until it is the right time to do so.
- To pass stool, muscles in your anus relax, and muscles in your stomach tighten.
Because they are embarrassed about FI, often women do not want to talk to their doctor. This leads to a delay in treatment for months or even years, and that can result in more anxiety and embarrassment. FI can and often does have a negative impact on your life. Some women are often so embarrassed they isolate themselves from family and friends. That is why it is so important to talk to your doctor.
There are many risk factors for developing FI, and some of the risk factors you’re able to change, and others you can’t. Some risk factors include:
- Being unable to hold your urine
- Poor general health
- Physical limitations
- Obstetrical factors, especially in younger women
Although advanced age is a risk factor for developing FI, one of the most important things you need to know is that it is not part of the normal aging process.
You might ask, “What causes fecal incontinence?” There are many reasons, and often, more than one cause is to blame. Some of the causes can be reversed, such as:
- Watery stool
- Not being able to pass your stool
- Medicines you take
And other causes can’t be reversed, such as:
- Irritable bowel syndrome (IBS)
- Injuries to the anus, such as might happen during the vaginal delivery of a baby.
There are several steps to evaluate if you have FI. Your doctor will ask you some questions about:
- The symptoms you are having
- Prior treatment
- Surgical history
- Bowel habits
- What you eat and drink
- Medicines you take
- The impact on your quality of life
In order to help your doctor better understand your symptoms, you may be asked to keep a bowel diary. This means writing down things like the type of leakage (gas, liquid stool, solid stool) and how this affects your life. Different tests can be used to define the type of FI to help your doctor find where the problem lies. These tests look at the muscles and nerves that control the passage of gas and stool.
The main goal of treating your FI is to improve your quality of life by improving your control of the passage of gas and stool. Some of the first changes you can make on your own are:
- Avoid food that in the past caused your symptoms to get worse;
- Reduce your caffeine intake;
- Increase the amount of fiber in your diet; and
- Use the toilet at a scheduled time.
Your doctor may prescribe medicine for your FI, or you may be asked to do muscle training exercises. Surgery is a last resort if nothing else works at controlling your FI. The type of surgery chosen by your doctor will depend on the symptoms you’re having.
But, remember if you’re having any symptoms of FI, call your doctor.
If you suffer from FI, why not share with others via our comments section how you’ve managed your condition. Let them know they aren’t alone.
Elise Schrop, M.D.
Obstetrics & Gynecology
Summa Akron City Hospital
Summa Health System