Fecal Incontinence: Causes, Diagnosis, and Treatment Options to Improve Quality of Life

Fecal incontinence can have various underlying causes.

For example, a change in the consistency of bowel movements can lead to continence problems. These changes in stool consistency are particularly common in chronic inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease, but can also result from an overdose of laxatives. 

Fecal incontinence often occurs temporarily in cases of stomach and intestinal infections caused by bacterial or viral pathogens.

Malabsorption can also cause pathological changes in stool. People with malabsorption are unable to adequately break down and absorb nutrients. This leads to increased episodes of diarrhea. Impaired bowel capacity can also result in involuntary stool leakage.

Furthermore, the colon’s absorptive capacity may be limited by rectal tumors or collagenoses. Collagenoses are systemic chronic diseases characterized by changes in connective tissue and musculature.

Many patients also suffer from fecal incontinence following surgeries that affect the lower colon.

Furthermore, the pelvic floor influences bowel movements: pelvic floor prolapse or a dysfunction of the pudendal nerve can lead to nerve disorders. In such cases, the affected person can no longer consciously control bowel movements.

Possible causes of fecal incontinence also include disorders of the sphincter and the pelvic floor muscles. Such disorders can be caused by:

• trauma during childbirth (perineal tear)
• local inflammation (for example, in Crohn’s disease)
• complications from surgery
• Cancer of the anus and rectum
• Injuries
• Hemorrhoids

Impaired sensation, such as that seen in people with

• dementia or
• stroke
• nervous system disorders (e.g., multiple sclerosis)
• trauma, or
• cancer

is another cause of anorectal incontinence.

Medically, fecal incontinence is classified into three degrees of severity.

Grade I fecal incontinence: This involves the uncontrolled passage of flatus. Occasionally, “fecal smearing” may also occur. In this case, small amounts of stool are passed after the actual bowel movement, appearing as smear marks on the underwear.

Fecal incontinence, Grade II: In addition, there is a loss of control over the passage of liquid stool.

Fecal incontinence, Grade III: Total loss of control over bowel movements. Those affected can no longer voluntarily hold back bowel contents, regardless of consistency, resulting in the uncontrolled loss of even solid stool. Grade III fecal incontinence is also associated with constant soiling from intestinal mucus or stool.

The condition has a major impact on the quality of life of those affected, particularly in Grade III cases. They report

• shame,
• insecurity, and
• fears,

which often lead to family and social isolation, and in some cases even to job loss.

First, the doctor conducts a detailed interview with the patient. During this interview, the doctor asks specific questions about the symptoms. The doctor inquires about bathroom habits as well as the consistency and color of the stool. It is also important to determine whether the patient can consciously delay a bowel movement and whether they are even aware that their bowel is filled with stool.

This medical history is followed by a digital rectal exam, and the doctor uses a stethoscope to listen to the bowel. Bowel sounds can provide clues to a motility disorder. Hardened areas may indicate inflammation or fecal impaction.

By palpating the rectum, the doctor assesses the tone of the sphincter muscle. The doctor can also detect or rule out polyps or tumors of the rectum.

Colonoscopy and rectoscopy are used to determine the cause. Like proctoscopy, which involves examining the anal canal, these procedures are part of the basic diagnostic workup for anorectal incontinence. For the endoscopy, the doctor inserts a thin tube with a camera into the anus. This allows the doctor to assess the condition of the intestine and detect inflammation, tumors, or polyps.

Another diagnostic procedure used for people with fecal incontinence is endosonography. In this type of ultrasound examination, a small probe is inserted into the anal canal. This procedure is particularly effective for detecting injuries to the sphincter muscle.

The function of the sphincter muscle can also be assessed using painless anal sphincter manometry. In contrast, the contraction and relaxation of the rectal muscles are measured using anal manometry.

Functional processes during bowel movements can be analyzed using defecography. In this procedure, the rectum is filled with an X-ray contrast agent. During a bowel movement, an X-ray video can then be recorded, which can also detect protrusions and invaginations of the intestinal wall.

If a neurological disorder is suspected, the doctor will also perform an electromyogram.

The treatment of fecal incontinence depends on the cause.

If the incontinence is due to a change in stool consistency, simple dietary adjustments often help. A balanced intake of fiber and fluids is crucial here. Wheat bran or psyllium seeds can also improve stool consistency.

Specialized toilet training can also help those affected with bowel movements.

If the incontinence is caused by a bowel disease, that condition should be treated. Patients with Crohn’s disease or ulcerative colitis are prescribed medications to reduce inflammation in the bowel.

Medications that slow intestinal transit can improve stool consistency. This helps people with anorectal incontinence better control their bowel movements.

Depending on the cause, surgical procedures may also be necessary for treatment.

The prognosis varies significantly from patient to patient. Factors such as the underlying cause and the patient’s age play a role.

However, appropriate treatment measures can often alleviate symptoms and improve the quality of life for those affected.