Involuntary Loss of Bowel Control

Fecal incontinence (the involuntary loss of bowel control) affects more than 18 million Americans. Although it is a relatively common problem in older adults, it is not a normal part of aging. The inability to control your bowels can lead to embarrassment and cause you to avoid social situations, but fecal incontinence is often treatable with medication, lifestyle measures, or surgical repair of the damaged sphincter muscles. In addition, some people can benefit from an implanted device called an artificial sphincter.

Causes of fecal incontinence

Fecal incontinence is not a disease but a symptom of another gastrointestinal problem. The most common causes are:

  • damage to the sphincter muscles in the anus (usually due to hemorrhoid surgery or childbirth)—These muscles normally contract to prevent stool from leaving the rectum.
  • damage to nerves in the anal sphincter muscles or rectum (due to chronic constipation, stroke, diabetes, multiple sclerosis, or childbirth)—Nerve damage in the sphincter muscles leads to a loss of proper functioning of the muscles, while nerve damage in the rectum leads to loss of sensation in that area, so that you no longer recognize that stool is present.
  • loss of storage capacity in the rectum (due to rectal surgery, radiation therapy for cancer, or inflammatory bowel disease)—Normally, the rectum stretches to hold stool until you reach the toilet; with loss of elasticity, an accident is much more likely.
  • diarrhea—Loose, watery stools are much harder to control than solid stools.
  • pelvic floor dysfunction (such as rectal prolapse, in which the rectum sags)—By supporting the organs in the pelvis and lower abdomen, the muscles of the pelvic floor play a role in preventing fecal incontinence.

Symptoms of fecal incontinence

The symptoms of fecal incontinence are easily recognizable, ranging from the occasional leakage of liquid or solid stool and gas to the inability to hold a bowel movement until you reach the toilet. Other possible symptoms include diarrhea and constipation.

Diagnosis of fecal incontinence

Because self-treatment of fecal incontinence is rarely successful, you should see your doctor if you experience any of the symptoms above. The doctor will take a medical history, do a thorough physical examination, and may order one or more diagnostic tests.

These tests could include:

  • anal manometry to measure the tightness of the anal sphincter
  • anorectal ultrasonography to examine the structure of the anal sphincter
  • proctography/defecography to determine how well the rectum holds and eliminates stool
  • proctosigmoidoscopy to detect signs of diseases or other problems inside the rectum and sigmoid colon
  • anal electromyography to test for nerve damage

You should bring a list of all the medications that you take to your doctor's appointment. Some medications, such as sedatives, antacids, and muscle relaxants, can cause or increase the frequency of fecal incontinence—especially in older adults.

Publication Review By: H. Franklin Herlong, M.D.

Published: 28 Mar 2011

Last Modified: 16 Dec 2014