3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 1/9

Anatomy of the rectum and anus.

The Wayback Machine - https://web.archive.org/web/20041023185056/http://www.digestive.niddk.nih.gov/ddiseases/pubs/feca...

Email To A Friend

Home : Digestive Diseases A-Z List of Topics and Titles : Fecal Incontinence

Fecal Incontinence

On this page:

Causes

Diagnosis

Treatment

Emotional Considerations

Fecal Incontinence in Children

Hope Through Research

For More Information

Fecal incontinence is the

inability to control your bowels.

When you feel the urge to have

a bowel movement, you may not

be able to hold it until you can

get to a toilet. Or stool may leak

from the rectum unexpectedly.

More than 5.5 million Americans

have fecal incontinence. It

affects people of all ages--

children as well as adults. Fecal

incontinence is more common in

women than in men and more

common in older adults than in

younger ones. It is not, however,

a normal part of aging.

Loss of bowel control can be

devastating. People who have

fecal incontinence may feel

ashamed, embarrassed, or

humiliated. Some don't want to leave the house out of fear they might have an

accident in public. Most try to hide the problem as long as possible, so they

withdraw from friends and family. The social isolation is unfortunate but may be

reduced because treatment can improve bowel control and make incontinence

easier to manage.

[Top]

Causes

Fecal incontinence can have several causes:

Constipation

damage to the anal sphincter muscles

damage to the nerves of the anal sphincter muscles or the rectum
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 2/9

loss of storage capacity in the rectum

diarrhea

pelvic floor dysfunction

Constipation

Constipation is one of the most common causes of fecal incontinence.

Constipation causes large, hard stools to become lodged in the rectum. Watery

stool can then leak out around the hardened stool. Constipation also causes the

muscles of the rectum to stretch, which weakens the muscles so they can't hold

stool in the rectum long enough for a person to reach a bathroom.

Muscle Damage

Fecal incontinence can be caused by injury to one or both of the ring-like muscles

at the end of the rectum called the anal internal and/or external sphincters. The

sphincters keep stool inside. When damaged, the muscles aren't strong enough to

do their job, and stool can leak out. In women, the damage often happens when

giving birth. The risk of injury is greatest if the doctor uses forceps to help deliver

the baby or does an episiotomy, which is a cut in the vaginal area to prevent it

from tearing during birth. Hemorrhoid surgery can damage the sphincters as well.

Nerve Damage

Fecal incontinence can also be caused by damage to the nerves that control the

anal sphincters or to the nerves that sense stool in the rectum. If the nerves that

control the sphincters are injured, the muscle doesn't work properly and

incontinence can occur. If the sensory nerves are damaged, they don't sense that

stool is in the rectum. You then won't feel the need to use the bathroom until stool

has leaked out. Nerve damage can be caused by childbirth, a long-term habit of

straining to pass stool, stroke, and diseases that affect the nerves, such as

diabetes and multiple sclerosis.

Loss of Storage Capacity

Normally, the rectum stretches to hold stool until you can get to a bathroom. But

rectal surgery, radiation treatment, and inflammatory bowel disease can cause

scarring that makes the walls of the rectum stiff and less elastic. The rectum then

can't stretch as much and can't hold stool, and fecal incontinence results.

Inflammatory bowel disease also can make rectal walls very irritated and thereby

unable to contain stool.

Diarrhea

Diarrhea, or loose stool, is more difficult to control than solid stool that is formed.

Even people who don't have fecal incontinence can have an accident when they

have diarrhea.

Pelvic Floor Dysfunction

Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some

abnormalities are decreased perception of rectal sensation, decreased anal canal

pressures, decreased squeeze pressure of the anal canal, impaired anal

sensation, a dropping down of the rectum (rectal prolapse), protrusion of the

rectum through the vagina (rectocele), and/or generalized weakness and sagging

of the pelvic floor. Often the cause of pelvic floor dysfunction is childbirth, and

incontinence doesn't show up until the midforties or later.

[Top]

Diagnosis
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 3/9

The doctor will ask health-related questions and do a physical exam and possibly

other medical tests.

Anal manometry checks the tightness of the anal sphincter and its ability to

respond to signals, as well as the sensitivity and function of the rectum. 

Anorectal ultrasonography evaluates the structure of the anal sphincters. 

Proctography, also known as defecography, shows how much stool the

rectum can hold, how well the rectum holds it, and how well the rectum can

evacuate the stool. 

Proctosigmoidoscopy allows doctors to look inside the rectum for signs of

disease or other problems that could cause fecal incontinence, such as

inflammation, tumors, or scar tissue. 

Anal electromyography tests for nerve damage, which is often associated

with obstetric injury.

[Top]

Treatment

Treatment depends on the cause and severity of fecal incontinence; it may include

dietary changes, medication, bowel training, or surgery. More than one treatment

may be necessary for successful control since continence is a complicated chain

of events.

Dietary Changes

Food affects the consistency of stool and how quickly it passes through the

digestive system. If your stools are hard to control because they are watery, you

may find that eating high fiber foods adds bulk and makes stool easier to control.

But people with well-formed stools may find that high fiber foods act as a laxative

and contribute to the problem. Other foods that may make the problem worse are

drinks containing caffeine, like coffee, tea, and chocolate, which relax the internal

anal sphincter muscle.

You can adjust what and how you eat to help manage fecal incontinence.

Keep a food diary. List what you eat, how much you eat, and when you

have an incontinent episode. After a few days, you may begin to see a

pattern involving certain foods and incontinence. After you identify foods

that seem to cause problems, cut back on them and see whether

incontinence improves. Foods that typically cause diarrhea, and so should

probably be avoided, include

caffeine

cured or smoked meat like sausage, ham, or turkey

spicy foods

alcohol

dairy products like milk, cheese, and ice cream

fruits like apples, peaches, or pears

fatty and greasy foods

sweeteners, like sorbitol, xylitol, mannitol, and fructose, which are

found in diet drinks, sugarless gum and candy, chocolate, and fruit

juices

Eat smaller meals more frequently. In some people, large meals cause

bowel contractions that lead to diarrhea. You can still eat the same amount

of food in a day, but space it out by eating several small meals. 
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 4/9

Eat and drink at different times. Liquid helps move food through the

digestive system. So if you want to slow things down, drink something half

an hour before or after meals, but not with the meals. 

Eat the right amounts of fiber. For many people, fiber makes stool soft,

formed, and easier to control. Fiber is found in fruits, vegetables, and

grains, like those listed below. You'll need to eat 20 to 30 grams of fiber a

day, but add it to your diet slowly so your body can adjust. Too much fiber

all at once can cause bloating, gas, or even diarrhea. Also, too much

insoluble, or undigestible, fiber can contribute to diarrhea. So if you find

that eating more fiber makes your diarrhea worse, try cutting back to two

servings each of fruits and vegetables and removing skins and seeds from

your food. 

Eat foods that make stool bulkier. Foods that contain soluble, or

digestible, fiber slow the emptying of the bowels. Examples are bananas,

rice, tapioca, bread, potatoes, applesauce, cheese, smooth peanut butter,

yogurt, pasta, and oatmeal. 

Get plenty to drink. You need to drink eight 8-ounce glasses of liquid a

day to help prevent dehydration and to keep stool soft and formed. Water

is a good choice, but avoid drinks with caffeine, alcohol, milk, or

carbonation if you find that they trigger diarrhea.

Over time, diarrhea can rob you of vitamins and minerals. Ask your doctor if you

need a vitamin supplement.

[Top]

What Foods Have Fiber?

Examples of foods that have fiber include

Breads, cereals, and beans fiber

1/2 cup of black-eyed peas, cooked 4 grams

1/2 cup of kidney beans, cooked 5.7 grams

1/2 cup of lima beans, cooked 4.5 grams

Whole-grain cereal, cold

1/2 cup of All-Bran

3/4 cup of Total

3/4 cup of Post Bran Flakes

9.6 grams

2.4 grams

5.3 grams

1 packet of whole-grain cereal, hot

(oatmeal, Wheatena)

3 grams

1 slice of whole-wheat or multigrain bread 1.7 grams

Fruits

1 medium apple 3.3 grams

1 medium peach 1.8 grams

1/2 cup of raspberries 4 grams

1 medium tangerine 1.9 grams

Vegetables

1 cup of acorn squash, raw 2.1 grams

1 medium stalk of broccoli, raw 3.9 grams
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 5/9

5 brussels sprouts, raw 3.6 grams

1 cup of cabbage, raw 2 grams

1 medium carrot, raw 1.8 grams

1 cup of cauliflower, raw 2.5 grams

1 cup of spinach, cooked 4.3 grams

1 cup of zucchini, raw 1.4 grams

Source: USDA/ARS Nutrient Data Laboratory

[Top]

Medication

If diarrhea is causing the incontinence, medication may help. Sometimes doctors

recommend using bulk laxatives to help people develop a more regular bowel

pattern. Or the doctor may prescribe antidiarrheal medicines such as loperamide

or diphenoxylate to slow down the bowel and help control the problem.

Bowel Training

Bowel training helps some people relearn how to control their bowels. In some

cases, it involves strengthening muscles; in others, it means training the bowels to

empty at a specific time of day.

Use biofeedback. Biofeedback is a way to strengthen and coordinate the

muscles and has helped some people. Special computer equipment

measures muscle contractions as you do exercises--called Kegel

exercises--to strengthen the rectum. These exercises work muscles in the

pelvic floor, including those involved in controlling stool. Computer

feedback about how the muscles are working shows whether you're doing

the exercises correctly and whether the muscles are getting stronger.

Whether biofeedback will work for you depends on the cause of your fecal

incontinence, how severe the muscle damage is, and your ability to do the

exercises.

Develop a regular pattern of bowel movements. Some people--

particularly those whose fecal incontinence is caused by constipation--

achieve bowel control by training themselves to have bowel movements at

specific times during the day, such as after every meal. The key to this

approach is persistence--it may take a while to develop a regular pattern.

Try not to get frustrated or give up if it doesn't work right away.

Surgery

Surgery may be an option for people whose fecal incontinence is caused by injury

to the pelvic floor, anal canal, or anal sphincter. Various procedures can be done,

from simple ones like repairing damaged areas, to complex ones like attaching an

artificial anal sphincter or replacing anal muscle with muscle from the leg or

forearm. People who have severe fecal incontinence that doesn't respond to other

treatments may decide to have a colostomy, which involves removing a portion of

the bowel. The remaining part is then either attached to the anus if it still works

properly, or to a hole in the abdomen called a stoma, through which stool leaves

the body and is collected in a pouch.

What to Do About Anal Discomfort

The skin around the anus is delicate and sensitive. Constipation and diarrhea

or contact between skin and stool can cause pain or itching. Here's what you
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 6/9

can do to relieve discomfort:

Wash the area with water, but not soap, after a bowel movement. Soap

can dry out the skin, making discomfort worse. If possible, wash in the

shower with lukewarm water or use a sitz bath. Or try a no-rinse skin

cleanser. Try not to use toilet paper to clean up--rubbing with dry toilet

paper will only irritate the skin more. Premoistened, alcohol-free

towelettes are a better choice. 

Let the area air dry after washing. If you don't have time, gently pat

yourself dry with a lint-free cloth.

Use a moisture barrier cream, which is a protective cream to help

prevent skin irritation from direct contact with stool. However, talk to

your health care professional before you try anal ointments and creams

because some have ingredients that can be irritating. Also, you should

clean the area well first to avoid trapping bacteria that could cause

further problems. Your health care professional can recommend an

appropriate cream or ointment.

Try using nonmedicated talcum powder or corn starch to relieve anal

discomfort.

Wear cotton underwear and loose clothes that "breathe." Tight clothes

that block air can worsen anal problems. Change soiled underwear as

soon as possible.

If you use pads or disposable undergarments, make sure they have an

absorbent wicking layer on top. Products with a wicking layer protect

the skin by pulling stool and moisture away from the skin and into the

pad.

[Top]

Emotional Considerations

Because fecal incontinence can cause distress in the form of embarrassment,

fear, and loneliness, taking steps to deal with it is important. Treatment can help

improve your life and help you feel better about yourself. If you haven't been to a

doctor yet, make an appointment. Also, consider contacting the organizations

listed at the end of this fact sheet. Such groups can help you find information and

support and, in some cases, referrals to doctors who specialize in treating fecal

incontinence.

Everyday Practical Tips

Take a backpack or tote bag containing cleanup supplies and a change

of clothing with you everywhere.

Locate public restrooms before you need them so you know where to

go.

Use the toilet before heading out.

If you think an episode is likely, wear disposable undergarments or

sanitary pads.

If episodes are frequent, use oral fecal deodorants to add to your

comfort level.
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 7/9

[Top]

Fecal Incontinence in Children

If your child has fecal incontinence, you need to see a doctor to determine the

cause and treatment. Fecal incontinence can occur in children because of a birth

defect or disease, but in most cases it's because of chronic constipation.

Potty-trained children often get constipated simply because they refuse to go to

the bathroom. The problem might stem from embarrassment over using a public

toilet or unwillingness to stop playing and go to the bathroom. But if the child

continues to hold in stool, the feces will accumulate and harden in the rectum. The

child might have a stomachache and not eat much, despite being hungry. And

when he or she eventually does pass the stool, it can be painful, which can lead to

fear of having a bowel movement.

A child who is constipated may soil his or her underpants. Soiling happens when

liquid stool from farther up in the bowel seeps past the hard stool in the rectum

and leaks out. Soiling is a sign of fecal incontinence. Try to remember that your

child did not do this on purpose. He or she cannot control the liquid stool and may

not even know it has passed.

The first step in treating the problem is passing the built-up stool. The doctor may

prescribe one or more enemas or a drink that helps clean out the bowel, like

magnesium citrate, mineral oil, or polyethylene glycol.

The next step is preventing future constipation. You will play a big role in this part

of your child's treatment. You may need to teach your child bowel habits, which

means training your child to have regular bowel movements. Experts recommend

that parents of children with poor bowel habits encourage their child to sit on the

toilet four times each day (after meals and at bedtime) for 5 minutes. Give

rewards for bowel movements and remember that it is important not to punish

your child for incontinent episodes.

Some changes in eating habits may be necessary too. Your child should eat more

high-fiber foods to soften stool, avoid dairy products if they cause constipation,

and drink plenty of fluids every day, including water and juices like prune, grape,

or apricot, which help prevent constipation. If necessary, the doctor may prescribe

laxatives.

It may take several months to break the pattern of withholding stool and

constipation. And episodes may occur again in the future. The key is to pay close

attention to your child's bowel habits. Some warning signs to watch for include

pain with bowel movements

hard stool

constipation

refusal to go to the bathroom

soiled underpants

signs of holding back a bowel movement, like squatting, crossing the legs,

or rocking back and forth

Why Children Get Constipated

They were potty-trained too early.

They refuse to have a bowel movement (because of painful ones in the

past, embarrassment, stubbornness, or even a dislike of public
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 8/9

bathrooms).

They are in an unfamiliar place.

They are reacting to family stress like a new sibling or their parents'

divorce.

They can't get to a bathroom when they need to go so they hold it. As

the rectum fills with stool, the child may lose the urge to go and become

constipated as the stool dries and hardens.

[Top]

Hope Through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

conducts and supports research into many kinds of digestive disorders, including

fecal incontinence. In addition, researchers throughout the country are working

hard to find possible solutions to the problem of fecal incontinence. Some studies

address fecal incontinence due to anal sphincter damage and combine surgical

procedures with electrical stimulation.

[Top]

For More Information

You can get information about fecal incontinence, as well as support, from

American Academy of Family Physicians

11400 Tomahawk Creek Parkway

Leawood, KS 66211-2672

Phone: 1-800-274-2237 or (913) 906-6000

Email: fp@aafp.org

Internet: www.aafp.org

International Foundation for Functional Gastrointestinal Disorders

P.O. Box 170864

Milwaukee, WI 53217

Phone: 1-888-964-2001 or (414) 964-1799

Fax: (414) 964-7176

Email: iffgd@iffgd.org

Internet: www.iffgd.org

[Top]

The U.S. Government does not endorse or favor any specific commercial product

or company. Trade, proprietary, or company names appearing in this document

are used only because they are considered necessary in the context of the

information provided. If a product is not mentioned, this does not mean or imply

that the product is unsatisfactory.

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892-3570

Email: nddic@info.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 under the U.S. Department

of Health and Human Services. Established in 1980, the clearinghouse provides
3/31/22, 7:24 AM Fecal Incontinence

https://web.archive.org/web/20041023185056/http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm 9/9

information about digestive diseases to people with digestive disorders and to

their families, health care professionals, and the public. NDDIC answers inquiries,

develops and distributes publications, and works closely with professional and

patient organizations and Government agencies to coordinate resources about

digestive diseases.

Publications produced by the clearinghouse are carefully reviewed by both NIDDK

scientists and outside experts. This fact sheet was reviewed by Arnold Wald,

M.D., University of Pittsburgh Medical Center; Paul Hyman, M.D., University of

Kansas Medical Center; and Diane Darrell, A.P.R.N., B.C., Research College of

Nursing, Kansas City, MO.

This e-text is not copyrighted. The clearinghouse encourages users of this e-pub

to duplicate and distribute as many copies as desired.

NIH Publication No. 04-4866

March 2004

[Top]

Digestive Diseases Home | Digestive Diseases A-Z | Statistics | Clinical Trials | in Spanish | Additional Resources | Order Publications |

About Us |

Contact Us | Satisfaction Survey | NIDDK Health Information

The NDDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892-3570

Phone: 1-800-891-5389

Fax: (703) 738-4929

Email: nddic@info.niddk.nih.gov

Privacy | Disclaimer | Accessibility