Treatment Options for Involuntary Loss of Bowel Control
Treatment depends on the cause and severity of fecal incontinence and may include changes in diet, bowel training, medication, or surgery.
Dietary changes. Because it is difficult for the anal sphincter to handle large amounts of waste material, changes in your diet may be necessary to make the stool firmer and more compact. Foods that thicken the stool include rice, bananas, yogurt, and cheese. Increasing fiber intake—to 22 g daily if you're a woman over age 50 and to 28 g daily if you're a man over age 50—by consuming more whole grains, fruits, and vegetables also may help.
Alcohol and caffeine may cause diarrhea and should be eliminated. Some people are unable to digest lactose (a sugar found in dairy products) or food additives and flavorings like sorbitol and nutmeg. Because improper digestion of these substances could contribute to diarrhea and fecal incontinence, they should be avoided as well.
Bowel training. Some people with fecal incontinence need to relearn how to control their bowels. One way to retrain the bowels is through biofeedback, which uses a computer to monitor muscle contractions as you learn exercises to strengthen the rectum and pelvic muscles. Stronger muscles can help retain stool. If fecal incontinence is caused by constipation, your doctor may recommend starting a routine of having a bowel movement at the same time every day.
Medication. Drugs may be used if fecal incontinence is caused by diarrhea. Imodium A-D is an antidiarrheal medication that thickens the stool and also increases the strength of the rectal muscles.
Other medications help treat fecal incontinence in other ways, for example, by decreasing intestinal secretions, contracting the muscle that closes the rectum, or slowing the movement of stool through the bowel.
External incontinence devices. If you're unable to regain fecal continence, you can wear an external device to collect any leaking stool. These prescription devices, available at medical supply stores and some pharmacies, typically consist of a drainable pouch attached to an adhesive wafer. The hole in the center of the wafer is placed over the rectum to allow stool to pass through. These devices can remain in place for 24 hours, but they must be changed if any stool leakage occurs.
Surgical repair. If fecal incontinence is caused by injury to the pelvic floor, anal canal, or anal sphincter, surgery may be performed to repair the problem. For example, damaged muscles in the anus may be replaced with muscle from the leg or arm.
Artificial sphincter. If your anal sphincter muscles are not capable of holding in stool, an artificial anal sphincter can be surgically implanted. This sphincter consists of a fluid-filled cuff that surrounds the anal canal, a pressure-regulating balloon in the anal canal, and a control pump located just under the skin.
Normally, the cuff is full of fluid, which squeezes the anal canal closed. When you need to have a bowel movement, you squeeze the pump several times; the fluid then drains from the cuff into the balloon, and stool can pass through the open anal canal. After the bowel movement, the cuff automatically refills with fluid from the balloon.
Colostomy. Severe fecal incontinence that does not respond to treatment may require a colostomy, a procedure in which the large intestine is connected to the abdominal wall. Instead of entering the rectum, stool goes directly from the intestine into a special bag outside the body.