Why We Need to Talk About Fecal Incontinence

Fecal incontinence is not something people discuss every day. In fact, most people would prefer to never talk about it at all. Even your primary care physician is not likely to mention it. That’s why Devon Smith, DO, a urogynecologist with LVPG Female Pelvic Medicine and Reconstructive Surgery in Allentown, wants you to read this article.

“The issue is common enough that people should be aware of it, but no one wants to talk about it,” Dr. Smith says. She notes that even doctors rarely ask about it. “So, if you have a concern, bring it up,” she says. “After all, it could be something that’s easily addressed. Or, it could be a sign of a serious condition that needs attention.”

To be clear, suffering from fecal incontinence means you’re not able to properly control your bowels. (It’s also sometimes called “bowel incontinence.”) Stool leaks from the rectum without warning. It might happen once in a while or all the time. And it’s not just a bout of diarrhea, as troubling as that can be. The American Society of Colon and Rectal Surgeons describes fecal incontinence as “uncontrolled passage of feces for a duration of at least three months in someone who previously had control.”

Fecal incontinence can be caused by any of several different events or conditions. In some cases, there is more than one reason. The most common causes are:

• Injury to the muscles surrounding the anus, otherwise known as the anal sphincter
• Injury to nerves in the rectum or anal sphincter
• Chronic constipation, which can cause the rectum and intestines to stretch and weaken over time
• Hemorrhoids swollen to the point where they keep the anus from closing completely
• Surgery involving the rectum and anus, which can cause muscle and/or nerve damage
• Vaginal childbirth, especially if instruments are used to help in delivery or the woman has given birth multiple times

Fecal incontinence is also associated with Crohn’s disease, ulcerative colitis, celiac disease and irritable bowel syndrome. But sometimes, doctors aren’t able to find any cause for the condition.

Fecal incontinence affects women about twice as often as men. One recently published study reported that 9% of adult women experience episodes of fecal incontinence at least monthly. Although it can occur at any age, fecal incontinence is more common in adults over 65. (In nursing homes, the incidence can be as high as 50%.)

In Dr. Smith’s practice, she usually sees a couple of patients a month, but she suspects that there are many more who need help.

“Studies report that fewer than 30% of women with fecal incontinence seek care,” she says.

Urogynecologists like Dr. Smith are well qualified to treat fecal incontinence, but so are gastroenterologists and colorectal specialists. As a patient, you don’t need to worry about the overlap. “At LVHN, these physicians will work together to provide appropriate care,” Dr. Smith says. “The important thing is to talk with a doctor of your choice sooner rather than later.”

The first thing your doctor will do is ask you about your health, your medical history and all medications you are taking. Your doctor will also want to make sure that you are up to date on your colonoscopy.

“If it’s been a while or your problem has appeared just recently, we will want to have you get a colonoscopy,” Dr. Smith says.

There are other tests that can be helpful, too, including stool tests, nerve tests and imaging that can provide pictures of the organs and structures involved.

Your treatment can vary widely depending on what your doctors find, but in every case, they will start by suggesting the most conservative treatments.

“Something as simple as being sure to get enough fiber in your diet can make a difference,” Dr. Smith says. (She notes that only about 5% of American adults get enough fiber.) Studies have shown that more than half of patients with fecal incontinence report their symptoms improved after simply making changes in their diets and/or medications.

For more challenging cases, surgery is an option. And there are also other treatments to consider.

“There are some newer approaches, including sacral nerve stimulation,” Dr. Smith notes. “This procedure helps to restore proper communication between the brain, bladder and bowel.”

Often, it can take more than one type of treatment to control your symptoms, but the good news is that fecal incontinence is usually treatable. In fact, it can be cured completely in many cases.

You can reduce your odds of ever having fecal incontinence by following some simple advice:

• Include 20 to 30 grams of fiber in your diet every day.
• Avoid constipation by increasing your exercise, eating more high-fiber foods, and drinking plenty of fluids.
• Don’t strain during bowel movements as this can weaken anal sphincter muscles and/or damage nerves over time.
• Try to maintain a healthy weight.
• If you smoke, quit.

If you happen to be bothered by fecal incontinence, don’t despair. Health care professionals like Dr. Smith understand your concern and are here to help.

“We know this is an issue that can cause real distress for people, and we appreciate the opportunity to provide the care they need,” she says.