Here’s the truth: our bodies are incredible. So many systems work together all the time without us giving them a single thought! But sometimes, those systems malfunction or struggle to perform the tasks we’ve grown accustomed to. This can be due to aging, injury, or a wide variety of conditions. And even though facing difficulties like these is a common human experience, we can feel a lot of shame and discomfort when they happen to us. 

As a physical therapist, I want to do what I can to remove shame from the conversation – so I’m tackling these things as openly and honestly as possible. In the past, we’ve unpacked urinary incontinence (both stress and urge), and we’ve also discussed diastasis recti, a common abdominal condition many women face. Today, we’re diving into another topic that many people face: fecal incontinence. 

When you’re not able to control your bowel movements, you can experience embarrassment, not to mention a reduced quality of life or an inability to be as active as you once were. However, there is hope! If you’re struggling with this condition, I hope this blog will give you the help and answers you’re looking for. 

What is fecal incontinence? 

Fecal incontinence is also known as accidental bowel leakage. Simply put, this condition means that you’re not always able to control your bowel movements. For some people, this takes place with occasional leakage while passing gas; for others, it causes a complete lack of bowel control. No matter what degree of incontinence you’re facing, there’s no shame in seeking treatment.

Fecal incontinence can cause physical and emotional side effects, ranging from discomfort and irritation of the surrounding skin to losing your quality of life and feeling isolated, distressed, or depressed. Because of this, it’s important to have an honest conversation with your provider about the symptoms you’re experiencing. Knowing which type of fecal incontinence you’re dealing with can help you get the care you need. There are two main types of fecal incontinence:

Urge Incontinence

This is the most common type of fecal incontinence, and it mirrors urge urinary incontinence. It occurs when you feel a strong, sudden urge to have a bowel movement and cannot stop that urge before reaching the bathroom. 

Passive Incontinence

On the other hand, when you experience passive fecal incontinence, you may not be aware it’s occurring at all. You likely will not feel the urge to run to the bathroom before leakage occurs. 

What causes fecal incontinence?

Although it may feel isolating, you’re not alone if you’re currently experiencing fecal incontinence. Research suggests that this condition may affect as many as 1 in 10 people. There are many causes for bowel leakage, including: 

Constipation or Diarrhea

While these seem like opposites, both stem from bowel or digestive dysfunction. Constipation may cause dry stool to become impacted, which causes the muscles of the rectum to weaken over time and allow watery stool to pass through instead. With diarrhea, loose stool is not able to be held in by the muscles of the rectum, which can lead to leakage. Both of these can also occur as secondary symptoms of a different initial cause of incontinence. 

Nerve Damage

Nerve damage in the anal sphincter can be caused by a number of things, including:

• Repeated straining during bowel movements
• Prolonged constipation
• Childbirth
• Spinal cord injury
• Diabetes
• Stroke
• Multiple sclerosis

If you think you may have a nerve condition that’s leading to fecal incontinence, talk to your doctor. 

Muscle Damage

During childbirth, women can experience injury to the anal sphincter, since it’s in close proximity to the vagina. Fecal incontinence occurs more often in women who experienced 3rd or 4th degree perineal tearing, which involve the muscles around the anus and the anal sphincter itself. These tears can cause fecal incontinence. 

Hemorrhoids

Swollen veins in the rectum can keep the anal sphincter from being able to close fully, which causes stool to leak out. Surgery to repair hemorrhoids can also lead to nerve or muscle damage on occasion, which can prolong fecal incontinence. 

Prolapse

Rectal prolapse occurs when the rectum drops into the anus, and rectocele occurs in women when the rectum drops through the vaginal opening. Prolapse of any kind is often due to pelvic floor dysfunction or injury. I wrote extensively about prolapse, and how to treat it, in a recent blog post. 

Who does fecal incontinence affect? 

Fecal incontinence can occur in anyone, but it’s more common in older adults. As we age, our bodies can lose functionality and strength over time, leading to weakness that can cause leakage. Women are also more likely to experience fecal incontinence than men, often due to pelvic floor dysfunction that occurs as a result of childbirth. A weak pelvic floor is a leading cause of fecal incontinence across all demographics — I wrote about how to know if you’re dealing with pelvic floor weakness here. 

How to treat fecal incontinence 

If you’re experiencing symptoms of fecal incontinence, see a healthcare professional. Your primary care physician is a great place to start. They will ask about your experience with fecal incontinence and perform the appropriate tests to confirm what’s happening in your body and treat your symptoms properly. 

Treatments

Pelvic floor physical therapy 

Since pelvic floor dysfunction is often a contributing factor to all forms of incontinence, a pelvic floor PT may be able to help you reduce or eliminate your symptoms. I believe PT should serve as a first line of treatment, because it can help you without the risk of surgery or the ongoing costs and side effects of medication. Your PT treatments typically include simple exercises known as biofeedback to strengthen your muscles and repair damage.

Dietary changes

For some, making changes to food and drink habits can improve fecal incontinence. Your provider may recommend a high fiber diet, increasing your fluid intake, or keeping a food journal to see what causes an incontinence occurrence. Common culprits include caffeine, spicy foods, dairy, and greasy or fatty foods.

Medications

Depending on the cause of your fecal incontinence, your provider may recommend short-term or long-term medication to reduce or alleviate symptoms. Some of these medications attempt to lessen constipation, while others function as anti-diarrheal medicines. 

Surgery and Medical Procedures

This is often a last resort after more conservative treatments have not provided adequate symptom reduction. There are a number of surgeries available for fecal incontinence. However, just like any other medical procedure, there are risks involved. Talk to your provider about surgical options and determine which, if any, are right for you.

Prevention

In many cases, it’s possible to improve fecal incontinence significantly – or even stop it before it starts. Here’s how: 

• For women, prevent or reduce perineal tearing during labor 
• Do not strain during bowel movements – let them occur naturally
• Reduce constipation by increasing fiber intake and hydration
• Control persistent diarrhea by seeing your doctor for treatment

Need more help? 

If you’re experiencing any symptoms of fecal incontinence, seeing your primary care provider should be your first stop. They can help you determine what’s causing your symptoms. If pelvic floor dysfunction is a factor in your diagnosis, I would highly recommend an in-person, individualized exam by a pelvic floor physical therapist. In your PT appointments, you’ll learn how to strengthen your pelvic floor, perform exercises that promote healthy bowel movements, and heal damage or injury to your pelvic area. Find a provider near you to get started – and remember, there is truly no shame in seeking treatment. It could finally give you the relief you’ve been hoping for.