Fecal Incontinence - Diagnosis and Treatment

Diagnosis

When a person has symptoms of fecal incontinence, the healthcare provider gathers information through questions and a physical exam.

The provider checks the function of the rectum, anus, and the muscles called anal sphincters that help control bowel movements. Sometimes, the provider finds problems such as rectal prolapse, fecal impaction, or nerve damage during this process.

Checking How the Rectum and Anus Work

List of Main Function Tests:

Test Name	What It Checks
Anorectal manometry	Measures the pressure and coordination of internal and external sphincters. Also checks rectal compliance (ability to stretch).
Balloon expulsion test	Finds out if a person can push out stool by having them expel a filled balloon.

Anorectal manometry uses a slim, flexible tube with sensors. This test shows if the anal sphincters and nerves work well or if a problem causes stool leakage or passive incontinence.

The test also checks rectal sensation, which is important for knowing when the rectum is full.

Balloon expulsion tests involve placing a small balloon inside the rectum. After filling it with water, the patient tries to push it out as if having a bowel movement.

Difficulty in expelling the balloon may suggest problems with how well the muscles empty the rectum.

Imaging Methods for Seeing Inside

Imaging finds the cause of symptoms by showing detailed pictures of the anus, rectum, and sometimes the colon.

Providers often use imaging for people with accidental bowel leakage, unexplained anal incontinence, or suspicious findings during exams.

Common Imaging Tests:

Endoscopy: A flexible tube with a camera examines the lining of the rectum and colon for inflammation, polyps, tumors, and other problems.
Endoscopic Ultrasound: This combines sound waves with an endoscope to visualize deeper layers and check the health of the anal sphincter muscles and rectal wall.
Defecography: Special X-rays or MRI scans are taken while the person tries to pass stool. This can reveal issues like rectal prolapse, problems emptying the rectum, or abnormal muscle movement.
Anorectal MRI: This scan creates clear images of the anal sphincter muscles and other soft tissues, helping check for injuries or weakness.

These tools provide a full picture of any problems affecting bowel control and help guide treatment.

Treatment

Changes to Eating Habits and Daily Life

Making changes in everyday habits is a key first step. Eating more foods rich in fiber, like vegetables, nuts, fruits, beans, and whole grains, can make stools bulkier and easier to manage.

People should slowly add fiber to their meals to avoid gas and bloating. Fiber helps both diarrhea and constipation, which are two common causes of bowel control problems.

Some foods and drinks can make symptoms worse. These usually include caffeine, alcohol, spicy foods, fatty meals, dairy, and artificial sweeteners. Certain fruits, such as apples and peaches, can also cause loose stools for some people.

Cutting back on these may help. Drinking plenty of water and keeping a healthy weight are also important. Regular exercise and not smoking further support gut health.

A table can help show foods to choose and avoid:

Choose More Often	Limit or Avoid
Whole grains	Alcohol
Vegetables and fruits	Caffeinated drinks
Beans and legumes	Spicy foods
Water	Fatty and fried foods
	Dairy products

Drug Treatments and Supplements

Sometimes, medicine treats diarrhea, constipation, or both. For diarrhea, anti-diarrheal drugs like loperamide slow bowel movements and help prevent accidents.

If constipation is the problem, stool softeners, fiber supplements, and gentle laxatives help keep stools regular without causing loose bowels. Providers select medicines based on what causes the loss of bowel control and adjust the dosage as needed.

Some people may also need medication for conditions like diabetes or nerve disorders that make bowel control difficult.

Strengthening Muscles and Training the Body

Doing regular exercises to strengthen the pelvic floor and anus muscles can improve bowel control. Kegel exercises are a popular method.

They involve squeezing the muscles that stop the flow of urine or gas, holding for several seconds, then relaxing. Over time, doing sets of these exercises daily strengthens pelvic muscles.

Biofeedback training is another helpful option. It uses sensors to show signals from the body, helping people learn how to use their muscles correctly. A physical therapist who specializes in bowel control teaches these techniques.

This approach helps people sense when stool is present and contract the right muscles at the right time.

Bowel training involves picking a set time each day to try and empty the bowels, such as after breakfast. Following a daily pattern helps the body get used to a schedule, which can lower the chances of accidents.

Here’s a list of training techniques:

Kegel exercises for pelvic muscles.
Biofeedback with devices and a therapist.
Timed trips to the bathroom (bowel training).

Additional Approaches

When changes in lifestyle, diet, and exercise do not give enough relief, providers may suggest other options. One option is an injection of bulking agents around the anus. These agents thicken the area and can help hold stool in more effectively.

Another advanced choice is electrical stimulation of the nerves that control the rectum and anus. A device placed under the skin sends small pulses to the sacral nerves. This can improve nerve signals and muscle strength, helping stop unwanted leaks.

Some people use medical devices such as anal plugs, which block the passage and are worn when needed. There are also vaginal inserts for women, which apply gentle pressure to the rectum to help prevent leakage.

A quick overview of these options:

Bulking injections for the anus.
Sacral nerve stimulation using electrical pulses.
Anal plugs or vaginal inserts to physically block stool passage.

Procedures and Surgical Solutions

Surgeons consider surgery for those who do not improve with other interventions, or when they find physical damage.

Some surgeries fix problems like a dropped rectum or bulging tissue in the vaginal wall (rectocele) that can make bowel control worse. Fixing these issues can improve symptoms.

Surgeons use sphincter repair (sphincteroplasty) if the anal muscle was injured, such as during childbirth. In this procedure, they find and stitch together the damaged muscles, making them tighter and improving control.

However, not everyone finds long-term success with this operation.

As a last resort, surgeons may perform a colostomy. In this operation, they reroute the bowels through an opening in the belly, where waste leaves the body into an attached bag.

This major step is usually chosen only if all other treatments have failed.

Everyday Tips and At-Home Strategies

Keeping Track with Journals

Keeping daily journals can help manage bowel changes and spot any patterns. Using a food log helps track what is eaten and drunk at each meal and snack.

By doing this, people can notice if certain foods or drinks are linked to symptoms.

If problem foods are identified, removing or reducing them could reduce episodes of incontinence. Keeping a bowel movement journal is also helpful. Record the time, texture, and frequency of stools, as well as any accidents.

These records help doctors suggest personalized advice and serve as a useful reference during appointments.

Sample Bowel Journal Table:

Time	Food/Drink	Bowel Movement (Y/N)	Stool Type	Accident (Y/N)
7 AM	Oatmeal, water	Yes	Soft	No
12 PM	Sandwich, coffee	No	–	No
2 PM	Apple, juice	Yes	Loose	Yes

Protecting and Caring for the Skin

Good skin care is important for people who deal with fecal incontinence. After each bowel movement, gently cleaning the area helps maintain skin health.

Use unscented, alcohol-free wipes instead of rough toilet paper. Washing with mild, scent-free soap and water is also helpful.

Let the area dry naturally, if possible, to avoid irritation. If needed, pat gently with a soft cloth. Applying a moisture barrier cream before putting on absorbent products can protect the skin from irritation caused by moisture.

Some may prefer using nonmedicated powders like talcum or cornstarch.

Wear cotton underwear and loose clothing to allow the skin to breathe. Change soiled garments or incontinence products as soon as possible to lower the chance of skin breakdown.

Products such as absorbent pads or disposable underwear with a wicking layer keep skin dry and comfortable.

Managing Daily Life and Emotional Well-being

Tips for Living with Bowel Control Issues

People with fecal incontinence, including both adults and children, may experience anything from light soiling to more frequent accidents. Simple daily steps can make life easier:

Use the restroom before going out to help reduce risk.
Wear protective pads or disposable underwear if accidents are likely.
Carry cleanup wipes and a change of clothes for quick handling of any surprises.
Plan ahead by noting toilet locations in public places.
Some use over-the-counter products made to help reduce odor from stool and gas.

Dealing with bowel control problems can take a toll on confidence and self-esteem. Building these coping habits can help someone feel more ready to leave the house and keep life as normal as possible.

Potential Complications: Repeated accidents may lead to skin irritation, hygiene issues, or even damage to the muscles used for bowel control, especially in those with chronic problems.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Before seeing a healthcare provider, it’s a good idea to be well-prepared. Here are some helpful actions:

Ask About Preparation: Call ahead to find out if you need to follow any instructions, such as fasting before tests.
Write Down Your Symptoms: List all symptoms, even if they do not seem related.
Note Your Medical Details: Include any recent stresses, changes in your life, and family health history.
Record All Medicines: Make a list of all medications, supplements, or vitamins you take, including the amounts.
Bring Someone with You: If possible, have a friend or family member come along to help remember the information you get.
Prepare Your Questions: Keep a written list of things you want to ask. This can include questions like:
- What could be causing these symptoms?
- Are there other possible reasons for my symptoms?
- What tests might I need?
- Will the condition last or go away?
- What are my options for treating this?
- Should I visit a specialist?
- How does this impact my other health conditions?
- Are there helpful resources you recommend?

Tip: Organizing your questions and information in a table or written list can help you during the appointment.

Questions Your Healthcare Provider May Ask

The provider will likely have a series of questions. Being ready to answer can help them make a better plan:

When did the symptoms begin?
Do the symptoms stay the same or come and go?
How much do these symptoms affect daily life?
Does anything help or worsen the symptoms?
Have you stopped doing any activities because of your symptoms?
Do you have other illnesses, such as diabetes or neurological conditions?
Do you experience diarrhea?
Were you treated for other bowel problems before?
Have you had radiation treatments to the pelvic area?
Have you had certain childbirth experiences, such as forceps deliveries?
Do you have urinary incontinence as well?

You might want to jot down some of your answers ahead of time for these topics.

What You Can Do While You Wait

Until the appointment, avoid eating or doing things that make your symptoms worse. This could include skipping foods like caffeine, greasy foods, spicy foods, dairy, or anything else that triggers your symptoms.

Keep track of what you eat and how you feel to discuss with your healthcare provider. Making small changes now may give you more comfort and helpful information for your visit.

Fecal Incontinence – Diagnosis and Treatment