Fecal Incontinence

Fecal incontinence, also known as accidental bowel leakage (Fecal Incontinence), is a condition where a person is unable to control their bowel movements. It’s more common than you may think, affecting about 6% of younger women and up to 15% of older women. While it can be difficult to talk about, there are effective ways to manage and treat Fecal Incontinence.

About Fecal Incontinence

Women with Fecal Incontinence are not always able to control their bowel movements and may experience passage of stool into their underwear or clothing. Some women have difficulty controlling gas, while others may have trouble controlling loss of liquid or solid stool. Many different factors can contribute to Fecal Incontinence. Normally, the nerves and muscles in the rectum and anus, the intestines, and mental alertness work together to make sure you do not leak stool. Fecal Incontinence can be due to problems with the muscles and nerves in the rectum and anus as well as abnormalities in bowel movement consistency like constipation and loose stools. These problems can result from many different causes, such as damage to the anal sphincters during childbirth or surgery, nerve disorders like multiple sclerosis, stroke, and spinal cord injury, diabetes that is not under good control, bowel problems such as irritable bowel syndrome and inflammatory bowel disease, and weakening of the pelvic muscles that occurs with aging. Other factors that increase your risk of Fecal Incontinence include:

Rectal prolapse
Hemorrhoids and Associated constipation
Radiation therapy to the pelvic area
Medication and Nutritional Supplements

DIAGNOSIS

Proper bowel control relies on a complex system of nerves and muscles and good Gl health. A careful review of your health history including all medications and supplements you take is needed to find the best treatment for you. Your health care provider will also ask about your vaginal childbirth experience, including how many babies you had, whether a forceps or vacuum was used, and any episiotomies or perineal tears you experienced as well as any surgery in the anus or rectum. The provider will examine your anal area and look for any injury. This starts with an examination of the skin surrounding the anus and a rectal exam. Your provider will look for signs of a fistula, which is a connection between the bowel and the vagina or the perineal skin

Anorectal manometry

The strength of your anal sphincter is tested by having you squeeze on a pressure-sensing probe.

Ultrasound

This exam takes a picture from inside your rectum of the anal sphincter muscles. The doctor looks for any defects or weak areas in these muscles.

Anoscopy or proctoscopy

A camera is used to look inside your anus or rectum.

Defecography

This imaging test is used to study your rectum and anal canal during a bowel movement using x-rays or MRI.

Nerve tests

These tests check if the nerves to your rectum and anus are working as they should.

TREATMENTS

There are many treatment options. It may take a period of trial and error to find the one or combination of treatments that work best for you. Be honest with your provider and keep working to find a solution.

EMFEMME 360 (FDA-Cleared)

Non-Surgical Radiofrequency Treatment
EMFEMME 360 is an FDA-cleared, non-invasive treatment that uses radiofrequency to deliver gentle heat to the vaginal and pelvic tissues. This process promotes collagen remodelling, enhances circulation, and supports tissue tone, improving both pelvic floor strength and overall vaginal health. EMFEMME 360 is ideal for women looking to address pelvic discomfort and urinary control without surgery or downtime.

EMSELLA (FDA-Cleared)

Non-Invasive Pelvic Floor Treatment
Emsella is an FDA-cleared treatment that uses high-intensity focused electromagnetic energy to stimulate deep pelvic floor muscle contractions. Each session is equivalent to doing thousands of Kegel exercises in just 30 minutes. It’s an effective, non-invasive solution for stress urinary incontinence (SUI), helping to restore muscle strength and improve bladder control. Many women experience improvement after a series of treatments, with no downtime and comfortable, fully clothed sessions.

Dietary changes

What you drink and eat affects your bowel movements. Drink enough water to make your urine a pale yellow color—but, not completely clear like water. Limit caffeinated coffees, teas, and sodas, as well as alcohol and artificial sweeteners. For those with leakage of liquid stool, using fiber to bulk stool can minimize leakage episodes. Avoid constipation and keep stools the consistency of toothpaste. Some women find it helpful to keep a food diary to identify which foods are most bothersome. If you need help figuring out what to eat, ask for a referral to a dietitian.

Timed Bowel movements

Eating food stimulates the colon to release stool. Reserve time for a bowel movement after each meal and ensure you can get safely to a bathroom. You also want to have plenty of time to go without having to strain to force a bowel movement out.

Skin care

Women with Fecal Incontinence often have sore skin around the anus. Sometimes, this area can become inflamed. Contact your doctor if open sores form. After you go, gently wipe with soft toilet paper, avoiding excessive cleaning. Even better, clean the area with warm water and pat dry. Do not wipe aggressively as this can stimulate stool seepage from the anus. Wearing cotton underwear and loose-fitting clothing is helpful, too. Use cotton pads rather than menstrual pads, if you need a pad. Do not use perfumed or scented soaps, lotions, powders or deodorants—they can worsen the soreness. Other products to avoid include antiseptics, disinfectants, and wipes with alcohol.

PeLVic FLOOr mUscLe eXercises (PFme)

PFME can help manage Fecal Incontinence episodes. For some, strengthening the pelvic floor can stop bowel leakage. Ask your doctor for a referral to a specialized physical therapist (PT) to learn how to best perform PFME. The PT can also teach you exercises to help strengthen your anal muscles.

meDicines

The drug loperamide may be taken to help reduce the frequency of diarrhea. Some women with Fecal Incontinence are not able to completely empty their bowels or pass small and hard stools. A laxative may help resolve this symptom. To avoid worsening your problem, talk with your provider before you start using these medicines.

BULKing PrOceDUres

Bulking procedures involve the injection of a biocompatible gel or material just beneath the lining of the anal canal. This added volume helps narrow the anal opening, allowing the sphincter muscles to close more effectively and improve stool control. These minimally invasive treatments are typically recommended for patients with mild to moderate fecal incontinence. While results vary, some patients may require repeat treatments over time for sustained benefit.

Surgery

When fecal incontinence is caused by significant damage to the anal sphincter muscles or the surrounding nerves, surgery may be recommended as a treatment option. Surgical procedures aim to restore muscle function, improve control, and reduce accidental bowel leakage. Common operations for fecal incontinence include sphincteroplasty (to repair a damaged anal sphincter), sacral nerve stimulation (to enhance nerve signals to the bowel), and, in more severe cases, a colostomy.

THREE TAKEAWAYS

Fecal Incontinence can be upsetting and embarrassing. You are not alone. There are treatments to help manage and, for some women, cure Fecal Incontinence.
There are many lifestyle treatments that help women manage Fecal Incontinence, including dietary changes, timed bowel movements, skin care, pelvic floor muscle exercises, and anal sphincter muscle exercises.
Other treatments for Fecal Incontinence include medicines, sacral nerve stimulation, bulking procedures, and surgery.

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