What I need to know about 

Bowel Control 

NATIONAL INSTITUTES OF HEALTH 

U.S. Department 

of Health and 

Human Services National Digestive Diseases 

Information Clearinghouse

 

What I need to know about 

Bowel Control 

U.S. Department 

of Health and
�

Human Services
�

NATIONAL INSTITUTES OF HEALTH 

National Digestive Diseases 

Information Clearinghouse

Contents

What is bowel control? ........................................... 1

Who gets bowel control problems? ....................... 2

How does bowel control work?.............................. 3
�

What causes bowel control problems?.................. 5
�

What do I tell my health care provider 

about my bowel control problem? ......................... 9
�

How will my doctor find out what is causing 

my bowel control problem?.................................. 11
�

How are bowel control problems treated? 

How do I cope with my bowel control 

......... 12
�

What should I do about anal discomfort?........... 16
�

problem? ................................................................ 18
�

Points to Remember ............................................. 20
�

Hope through Research ....................................... 21
�

Pronunciation Guide............................................. 22
�

For More Information .......................................... 23
�

Acknowledgments ................................................. 24
�

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What is bowel control? 

Bowel control means you are able to hold a bowel 

movement until you reach a bathroom. You may 

have a bowel control problem if you 

● have trouble holding a bowel movement 

●	 have solid or liquid stool leak when you don’t 

expect it 

●	 find streaks of stool on your underwear 

Bowel control problems—also called fecal 

incontinence*—can be upsetting and embarrassing. 

Most people with bowel control problems feel 

ashamed and try to hide the problem. They may 

not want to leave the house for fear of losing bowel 

control in public. They may withdraw from friends 

and family. 

Bowel control problems are 

often caused by a medical 

issue. If you have a bowel 

control problem, don’t be 

afraid to talk with your 

health care provider about 

it. Your health care provider 

may be able to help. 

*See page 22 for tips on 

how to say the words in 

bold type. 

1 
 

 

 

 

 

 

 

 

 

Who gets bowel control problems? 

People of any age can have a bowel control 

problem. Bowel control problems aren’t always a 

part of aging, but they are more common among 

older adults. Having any of the following can 

increase the risk of developing a bowel control 

problem: 

●	 diarrhea, which is passing loose, watery stools 

three or more times a day 

●	 a disease or injury that damages the nervous system 

●	 poor overall health—multiple chronic illnesses 

●	 a difficult childbirth with injuries to the pelvic 

floor—the muscles, ligaments, and tissues that 

support the uterus, vagina, bladder, and rectum 

Bowel control problems affect about 18 million 

U.S. adults—one out of every 12 people. If you 

have a bowel control problem, you are not alone. 

2 
 

 

 

 

 

 

 

 

 

How does bowel control work? 

As food moves through your digestive system, most 

of it is broken down into a form your body can use 

as energy. Some parts of the food you eat cannot 

be digested and move into the large bowel, also 

called the large intestine. By the time undigested 

food reaches the rectum—the lower end of the large 

bowel—it has formed into solid waste called stool. 

Once stool reaches the rectum, muscles and nerves 

work together to 

● hold stool in your rectum 

Esophagus 

Liver 

Appendix 

Stomach 

Pancreas 

Large 

intestine 

Small 

intestine 

Rectum 

Anus 

The digestive system 

3 
 

 

 

 

 

 

 

 

 

 

● let you know when your rectum is full 

● release stool when you’re ready 

The rectum stretches to hold stool until you are 

ready to have a bowel movement. Stool passes 

out of your body through the anus—the opening 

at the end of the rectum—when you have a bowel 

movement. Sphincter muscles—ringlike muscles 

at the end of the rectum—keep the anus closed 

to hold stool in the rectum until you are ready 

to release it. Other muscles called pelvic floor 

muscles support the rectum and a woman’s vagina 

and help maintain bowel control. 

Rectum 

External 

sphincter 

External Internal sphincter sphincter 

Internal 

sphincter 

Anus 

The external and internal anal sphincter muscles 

4 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What causes bowel control problems? 

Bowel control problems can have many causes. 

Some common causes are diarrhea, constipation, 

damage to muscles or nerves, and loss of the 

rectum’s ability to stretch. 

Diarrhea. Diarrhea causes bowel control problems 

because loose stool fills the rectum more quickly 

than the rectum can stretch to hold it. This rapid 

filling will make you feel a sense of urgency to get 

to the toilet. 

Constipation. You might be surprised to learn that 

constipation can lead to bowel control problems. 

Constipation causes large, hard stools to get stuck 

in the rectum. Then, watery stool can leak out 

around the hard stool. Constipation also causes 

muscles of the rectum to stretch and become weak 

so they can’t hold stool long enough for the person 

to get to a bathroom. 

Muscle damage or weakness. If the sphincter 

muscles are damaged, they won’t be strong enough 

to keep the anus closed and stool can leak out. 

Weak pelvic floor muscles also make holding stool 

in the rectum harder to do. 

5 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nerve damage. If the nerves that control the 

sphincters are damaged, the muscles can’t work the 

way they should. Damage to the nerves that sense 

stool in the rectum can make knowing when you 

need to use the bathroom difficult. 

Muscles and nerves can be damaged by 

●	 surgery to remove hemorrhoids, which are 

swollen blood vessels in and around the anus and 

lower rectum 

●	 a long-term habit of straining to pass stool 

●	 childbirth 

●	 stroke 

●	 diseases that affect the nerves, such as diabetes 

and multiple sclerosis 

●	 spinal cord injury 

Loss of stretch. If the rectum is scarred or 

inflamed, it becomes stiff and can’t stretch as much 

to hold stool. Then, if the rectum gets too full, 

stool can leak out. Radiation treatment for rectal 

cancer or other pelvic cancers can cause scarring 

of the rectum. Inflammatory bowel diseases— 

long-lasting disorders such as ulcerative colitis and 

Crohn’s disease—can cause swelling and irritation 

that make the rectal wall stiff. 

6 
 

 

 

 

 

 

 

 

 

 

Hemorrhoids. External hemorrhoids, which 

develop under the skin around the anus, can 

prevent the anal sphincter muscles from closing 

completely. Small amounts of mucus or liquid 

stool can then leak through the anus. 

Aging and Bowel Control Problems 

Bowel control problems are more likely to affect 

older adults than younger people because as you 

age 

● muscles lose some of their strength 

● tissues lose some ability to stretch 

For older people, physical disabilities and poor 

health may also make reaching a bathroom in time 

hard to do. 

7 
 

 

 

 

 

 

Childbirth and Bowel Control Problems 

Bowel control problems sometimes start right after 

giving birth if damage to the pelvic floor muscles 

happens during delivery. For some women, 

however, bowel control problems may not appear 

until many years later. 

Childbirth-related bowel control problems may be 

caused by 

●	 injuries to nerves during labor and delivery 

●	 tearing of the sphincter muscles during delivery 

●	 damage to the sphincter muscles caused by 

forceps used to help deliver the baby 

●	 episiotomy—a cut doctors sometimes make in 

the vaginal area to make a larger opening for the 

baby to come out 

8 
 

 

 

 

What do I tell my health care provider 

about my bowel control problem? 

You may be embarrassed to talk about your bowel 

control problem, but your health care provider 

will not be shocked or surprised. Your health care 

provider will probably ask you questions like these: 

●	 How often do you have a bowel control 

problem? 

●	 Do you leak a little bit of stool or do you lose 

complete control of your bowels? 

●	 Do you feel a strong urge to have a bowel 

movement or do you lose control without 

warning? 

●	 Is your bowel control worse when you have 

diarrhea or constipation? 

●	 How is your bowel control problem affecting 

your daily life? 

9 
 

 

 

 

The more details and examples you can give about 

your problem, the better your health care provider 

will be able to help you. Be prepared to tell your 

health care provider 

●	 when your bowel control problem started 

●	 how often you have a loss of bowel control 

●	 whether you leak liquid or solid stool or only 

stain your underwear 

●	 if you have hemorrhoids that bulge through your 

anus when you lift things or at other times 

●	 if any foods seem to make the problem worse 

●	 if you aren’t able to control passing gas 

10 
 

 

 

 

 

 

How will my doctor find out what is 

causing my bowel control problem? 

Your doctor will take your medical history and 

probably do a physical exam. Your doctor may 

also do one or more medical tests or send you to a 

specialist for tests. Different tests can 

●	 check how well the sphincter muscles are 

working 

●	 show how much stool the rectum can hold, 

how well the rectum holds it, and how well the 

rectum passes it out of the body 

●	 show the inside of the rectum so the doctor 

can look for signs of disease or other problems, 

such as swelling and irritation, scar tissue, or 

tumors 

●	 check for nerve damage 

Once the cause of your bowel control problem is 

found, you and your doctor can choose the best 

treatment. 

11 
 

 

 

 

 

How are bowel control problems 

treated?
�

Diet 

Different foods affect how hard or soft your stool 

is and how fast it travels through your digestive 

system. You can make changes in what and 

how you eat to help manage your bowel control 

problem. 

●	 Keep a food diary. Write down what you eat, 

how much you eat, and when you lose bowel 

control. Keep a record of whether foods that 

contain lactose—a sugar found in milk and foods 

made with milk—or drinks that contain artificial 

sweeteners tend to cause diarrhea. After a few 

days, you may begin to see a link between certain 

foods and loss of bowel control. Discuss your 

food diary with your health care provider. 

12
�
 

Foods That May Cause Diarrhea 

Some foods that may cause diarrhea include 

●	 dairy products, such as milk or ice cream 

●	 artificial sweeteners 

●	 drinks and foods with caffeine, such as 

coffee, tea, or chocolate 

●	 prunes or figs 

●	 fatty or greasy foods 

●	 spicy foods 

●	 alcoholic drinks 

●	 Eat the right amount of fiber. For many people, 

fiber makes stool soft, adds bulk, and makes 

stool easier to control. It can help whether you 

tend to have diarrhea or constipation. Fiber 

is found in fruits, vegetables, whole grains, 

and beans. Fiber supplements purchased in 

a pharmacy or health food store are another 

common source of fiber to treat bowel problems. 

Add fiber to your diet slowly so your body can 

adjust. Too much fiber all at once can cause 

bloating. 

13 
 

 

 

 

●	 Get plenty to drink. Drink eight 8-ounce glasses 

of liquid a day to help prevent constipation. 

Water is a good choice. Avoid drinks with 

caffeine, alcohol, milk, artificial sweeteners, or 

carbonation if they give you diarrhea. 

Medicines 

If you have constipation, your doctor may have 

you take laxatives to help soften stool and make 

it easier to pass. If your problems are caused by 

diarrhea, your doctor may suggest medicines to 

control it. 

14 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pelvic Floor Exercises 

Exercises that strengthen your pelvic floor muscles 

can help with bowel control. To do pelvic floor 

exercises, you squeeze and relax these muscles 

50 to 100 times a day. The trick is finding the 

right muscles to squeeze. Your doctor, nurse, 

or a specially trained therapist can help make 

sure you’re doing the exercises the right way. 

Biofeedback therapy may help. Biofeedback 

therapy is painless and uses a machine to let you 

know when you are squeezing the right muscles. 

Improved Toileting Habits 

Training yourself to have bowel movements at certain 

times during the day—such as after meals—may help. 

It may take a while to develop a regular pattern, so 

don’t give up if it doesn’t work right away. 

Surgery 

Depending on the reason for your bowel control 

problem or how severe it is, your doctor may 

recommend surgery. The most common type of 

surgery is called sphincteroplasty, which involves 

sewing back together the separated ends of a 

sphincter muscle torn by childbirth or another 

injury. Other types of surgery include placing 

an artificial sphincter, which is an inflatable cuff, 

around the anus and implanting a small pump 

beneath the skin to inflate or deflate the cuff. 

15 
 

 

 

 

discomfort? 

What should I do about anal 

The skin around the anus is delicate and sensitive. 

Constipation and diarrhea or contact between skin 

and stool can cause pain or itching. Here are some 

things you can do to relieve discomfort: 

●	 Wash with water. Gently wash the area with 

water, but not soap, after a bowel movement. 

Soap can dry out and irritate the skin, and so 

can rubbing with dry toilet paper. Alcohol-free 

wipes are a better choice. 

●	 Air dry. Let the area air dry after washing. If 

you don’t have time, gently pat yourself dry with 

a clean cloth. 

●	 Use a moisture-barrier cream. Use a cream that 

contains ingredients such as dimethicone—a 

type of silicone—that form a barrier between 

your skin and stool. Clean and dry the area 

before you apply the cream. Ask your health 

care provider what kind of cream to use. 

16
�
●	 Try nonmedicated powders. Plain talcum 

powder or cornstarch may help relieve pain or 

itching. 

●	 Use products with a wicking layer. If you use 

pads or disposable underwear worn in close 

contact with your skin, make sure they have a 

wicking layer. The wicking layer protects the 

skin by pulling moisture away from the skin and 

into the pad. 

●	 Wear clothes and underwear that allow air 

to flow. Tight clothes and plastic or rubber 

underwear that block air can make skin 

problems worse. Clothes and underwear that 

allow air to flow help keep skin dry. Change 

soiled underwear as soon as you can. 

17 
 

 

 

 

How do I cope with my bowel control 

problem? 

Living with a bowel control problem can be 

upsetting. You may feel ashamed and alone. But 

there are things you can do to improve your life 

and feel better about yourself. 

● Try these everyday tips: 

• Take a bag with cleanup supplies and a change 

of clothes with you everywhere. 

• Find public restrooms before you need them. 

• Use the toilet before leaving home. 

• If you think you might have a loss of bowel 

control, wear disposable underwear. 

• If you lose bowel control frequently, use a 

fecal deodorant—a pill that you chew or 

swallow to reduce the smell of stool and 

gas. These pills are available without a 

prescription. Your doctor can help you choose 

which type is best for you. 

18
�
 

• When you have to travel or attend business 

or social gatherings, use medicines that help 

control diarrhea. 

• While you are undergoing medical treatment, 

wear absorbent pads or disposable underwear. 

The best pads and underwear are those that 

aren’t bulky and don’t make noise when you 

walk. 

●	 Talk with your health care provider. 

●	 Contact professional or patient-advocacy groups 

for information and support (see page 23). 

19 
Points to Remember 

● Bowel control means you are able to hold a 

bowel movement until you reach a bathroom. 

● People of any age can have a bowel control 

problem. You are not alone. 

●	 Bowel control problems don’t have to be a part 

of aging, but they are more common among 

older adults. 

●	 Bowel control problems are often caused by a 

medical issue that can be treated. 

●	 Don’t be afraid to talk with your health care 

provider about your bowel control problem. 

●	 Diet changes, medicines, bowel training, or 

surgery may help. 

●	 You can take steps to cope with your bowel 

control problem. 

20
�
 

 

 

 

 

 

 

 

 

 

 

Hope through Research 

The National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK) conducts and 

supports research into bowel control problems. 

Researchers are working to better understand the 

causes of bowel control problems and explore new 

treatment options. 

Participants in clinical trials can play a more 

active role in their own health care, gain access to 

new research treatments before they are widely 

available, and help others by contributing to 

medical research. For information about current 

studies, visit www.ClinicalTrials.gov.

21 
 

 

Pronunciation Guide 

anus (AY-nuhss)

biofeedback (BY-oh-FEED-bak)

constipation (KON-stih-PAY-shuhn)

diabetes (DY-uh-BEE-teez) 

diarrhea (DY-uh-REE-uh)

episiotomy (eh-PIZ-ee-OT-uh-mee) 

fecal incontinence (FEE-kuhl) (in-KON-tih-nenss)

hemorrhoids (HEM-uh-roydz)

inflammatory (in-FLAM-uh-toh-ree) 

intestine (in-TESS-tin)

laxatives (LAK-suh-tivz)

multiple sclerosis (MUHL-tih-puhl) 

(sklee-ROH-siss) 

radiation (RAY-dee-AY-shuhn) 

rectum (REK-tuhm) 

sphincter (SFINGK-tur) 

sphincteroplasty (SFINGK-tur-oh-PLASS-tee) 

vagina (vuh-JY-nuh) 

22
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For More Information 

American Academy of Family Physicians 

P.O. Box 11210 

Shawnee Mission, KS 66207–1210 

Phone: 1–800–274–2237 or 913–906–6000 

Email: fp@aafp.org 

Internet: www.aafp.org 

American College of Gastroenterology 

P.O. Box 342260 

Bethesda, MD 20827–2260 

Phone: 301–263–9000 

Internet: www.acg.gi.org 

American Neurogastroenterology and 

Motility Society 

45685 Harmony Lane 

Belleville, MI 48111 

Phone: 734–699–1130 

Fax: 734–699–1136 

Email: admin@motilitysociety.org 

Internet: www.motilitysociety.org 

International Foundation for Functional 

Gastrointestinal Disorders 

P.O. Box 170864 

Milwaukee, WI 53217–8076 

Phone: 1–888–964–2001 or 414–964–1799 

Fax: 414–964–7176 

Email: iffgd@iffgd.org 

Internet: www.iffgd.org 

23 
24 

 

 

 

 

 

 

 

 

 

 

 

Acknowledgments 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists and 

outside experts. The National Digestive Diseases 

Information Clearinghouse would like to thank 

the following individuals for assisting with the 

scientific and editorial review of this publication: 

Satish Rao, M.D., University of Iowa College of 

Medicine; William Whitehead, M.D., University 

of North Carolina School of Medicine; and Nancy 

Norton, International Foundation for Functional 

Gastrointestinal Disorders. 
 

 

 

 

 

 

 

 

 

 

National Digestive Diseases 

Information Clearinghouse 

2 Information Way 

Bethesda, MD 20892–3570 

Phone: 1–800–891–5389 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information Clearinghouse 

(NDDIC) is a service of the National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK). The NIDDK is part of 

the National Institutes of Health of the U.S. Department of Health 

and Human Services. Established in 1980, the Clearinghouse 

provides information about digestive diseases to people with 

digestive disorders and to their families, health care professionals, 

and the public. The NDDIC answers inquiries, develops and 

distributes publications, and works closely with professional and 

patient organizations and Government agencies to coordinate 

resources about digestive diseases. 

This publication is not copyrighted. The Clearinghouse 

encourages users of this publication to duplicate and distribute 

as many copies as desired. 

This publication is available at www.digestive.niddk.nih.gov.

This publication may contain information about medications. 

When prepared, this publication included the most current 

information available. For updates or for questions about any 

medications, contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit 

www.fda.gov. Consult your health care provider for more 

information. 
U.S. Department of HealtH

anD HUman ServiceS

national institutes of Health

NIH Publication No. 11–6513

November 2010

The NIDDK prints on recycled paper with bio-based ink.