Fecal leakage is when the person is not able to control bowel movements. Thus from the rectum the stool leaks out at unexpected times. In women it is more common and also in elderly in both male and female it is common. Many people who experience this feel embarrassed and reluctant to talk about it. They feel that nobody can help them with the problem. However, for fecal leakage many effective treatments are available.
Three things control the bowel function: the pressure by the anal sphincter, rectal sensation and storage capacity of rectum. Anal sphincter is a muscle and in order to prevent stool from leaking out it contracts. In maintaining continence this muscle is very critical. The sensation that a person feels to go to the bathroom is given by the rectal sensation. After the person becomes aware that the stool is there the rectum can stretch and hold the stool for some time. This is the storage capacity of rectum. To notice the rectal sensation, the person must be alert enough and once the person gets the sensation he or she should do something about it such as moving towards the toilet. If any of these factors are having a problem, then the person may experience fecal leakage.
Fecal leakage is also known as fecal incontinence. Out of the rectum the stool can leak out unexpectedly. This can be as mild as small leakage of stool along flatulence to as severe as entire loss of control of bowel movement. Several different factors can cause this condition.
Causes of fecal leakage
Fecal leakage can be caused by several factors. Damage to one or both of the anal sphincters is the most common cause of fecal leakage. During childbirth tears to the anal sphincter can cause damage to the anal sphincter. Once the rectum is full and the sensation to empty the bowel is felt then bowel emptying can get delayed because of external anal sphincter. Some people can typically experience urgency if the external sphincter muscle is weak or damaged. In such cases if they are not able to reach the toilet in time then fecal leakage can occur. Usually people complain of passive soiling when their internal anal sphincter is damaged. Without even realizing in such people there can be leakage of stool or small pellets.
Other causes that are common are:
- Constipation- it can be responsible for causing fecal leakage whereas it can also be a symptom of fecal leakage. If you have difficulty emptying your bowel, then you can become constipated. This may seem contradictory but fecal leakage can be caused by chronic constipation. The walls of the rectum can become weak due to impacted stool in which the feces become hard and dry. It becomes too large to pass the feces since the feces is too large or the nerves that control defecation may get damaged. Moreover, around the blockage there can be leakage of looser waterier stool.
Stool becomes hard in case of constipation and the stool gets lodged in the rectum. This is one of the most common causes. Around the hard stool the watery stool that is present may leak out. Also the rectum walls may weaken due to constipation. Thus bowel movement becomes hard to control. Finally, to the presence of feces the nerves of the rectum become less responsive thus causing chronic constipation which allows the feces to leak out.
- Diarrhea- fecal leakage can be caused by diarrhea. This diarrhea can be ongoing and a reoccurring one. It can be chronic or it can be sudden and unexpected one that is it can be acute. Compared to formed stools diarrhea is more difficult to control thus fecal leakage is caused by added stress. Hence fecal leakage is most likely to occur in those who experience bouts of diarrhea. Diarrhea can be caused and symptoms can get aggravated by certain foods or infections. The feces become loose and watery when a person gets affected by diarrhea. To compensate for the change in consistency the rectum muscles are unable to compensate. This can cause fecal leakage. Also the rectum fills with stool faster when a person ahs diarrhea. When the rectum is out of space it causes fecal leakage.
- Medical disorders- people with certain disorders such as spinal cord injury, multiple sclerosis, stroke, Alzheimer’s, Parkinson’s disease can cause fecal leakage. This is associated with certain illness.
- Medications- loose stools, diarrhea are caused by medications such as antibiotics which may worsen the symptoms.
- IBD- inflammatory bowel disease causes diarrhea and the urgency to go to the toilet.
- During childbirth- In most cases of fecal leakage muscle damage is involved. During childbirth in women most commonly this damage occurs. In a difficult delivery it especially occurs due to use of forceps or an episiotomy. Before delivery to enlarge the opening to the vagina a cut is made. This is called episotomy.
- Surgery - Also during rectal surgery such as for hemorrhoids when surgery is done muscle damage can occur.
- Muscle damage- a frequent cause of fecal leakage is damage to the external or internal sphincters. Muscle damage can occur during vaginal childbirth. Sometimes for years the symptoms do not show and later in life the symptoms arise. As the persons ages the pelvic floor muscles tend to become weak or the anal sphincter becomes weak. This too can cause fecal leakage.
- Age- For muscle weakness people can often compensate. When muscles become weak later in life people develop fecal leakage. In such cases the in the pelvis the supporting structures become loose.
- Nerve injury- A common cause of fecal leakage is damage to the nerves that control anal muscles or it can also be caused by damage to the regulation of rectal sensation. In the following cases nerve injury can occur:
- During delivery that is childbirth
- For stool if the person has to strain for longer time and if the straining is severe
- Certain diseases such as multiple sclerosis, spinal cord tumors and diabetes
- Stiff rectum- Reduction in the elasticity of the rectum may also cause fecal leakage. Hence the time gap during which the sensation is felt and the urgent need to have a bowel movement is shortened. The rectum can become stiff due to radiation injury or surgery since they can make the rectum scar. The rectum can become less elastic due to inflammatory bowel disease. The lining of the rectal wall may get irritated due to inflammatory bowel disease such as Crohn’s disease. The ability to hold the stool is interfered.
- Loss of capacity- to accommodate the presence of stool the rectum will normally stretch. But it is possible that the rectum will not stretch enough if the walls have stiffened due to surgery or if the scar tissue is present. Also the stretching capacity of the rectum is restricted due to existing conditions such as Crohn’s disease or ulcerative colitis.
- Cancer- fecal leakage can be caused by colorectal cancer. In this in the rectal walls the cancer begins to enter. Thus the muscles and nerves in the rectum may begin to get damaged which makes them less sensitive to the presence of feces.
- Other condition- a condition in which the rectum drops and protrudes into the anus is termed as rectal prolapsed and a condition in which the rectum protrudes through the vagina is called rectocele. Both these conditions can cause fecal leakage. The anal sphincter can be prevented from closing properly due to hemorrhoids which can cause fecal leakage.
Treatment of fecal leakage
There are options available to treat fecal leakage hence about it talk to your doctor. Usually the results are unsuccessful in cases of attempts of self treatment. The treatment varies and on the cause of the problem it depends. One or more of the following treatment is recommended by the doctor:
- Dietary changes- usually to control fecal leakage, it is helpful to prevent diarrhea and constipation. Diarrhea and constipation can be prevented by making changes in the diet such as the amount of fiber should be adjusted, drink plenty fluids, change the quantity of food. You can prevent or relieve your fecal leakage by changing what you eat. In order to prevent diarrhea from becoming worse your doctor will recommend to avoid certain foods and drinks. To keep a track of which foods and drinks can make the condition better or worse maintain a food diary in which you can keep a record of:
- Each day what you eat
- Quantity of food that you eat
- The time that you eat
- Symptoms that you experience
- Types of bowel movement
- When does fecal leakage occur?
- Which foods or drinks make the condition better or worse
Discuss about these things with the doctor.
- Medicine- laxatives, anti-diarrhea drugs and stool softeners can be prescribed by the doctor to treat fecal leakage. Before you take any over the counter medicines for fecal leakage talk to your doctor. To reduce or relieve fecal leakage over the counter medicines can help. Your doctor may recommend medicines such as bismuth subsalicyclate or loperamide if a person has diarrhea. If constipation is causing fecal leakage, then doctor may recommend psyllium or methylcellulose.
- Biofeedback therapy- to help you learn how to do certain exercises biofeedback therapy uses a device to help you. These exercises help to strengthen the muscles of pelvic floor. If you have passive incontinence you can learn how to sense when rectum is full. If you have urge incontinence you can control the sensation of urgency with the help of this therapy.
- Sacral nerve stimulation- the anal sphincter, colon and rectum are controlled by the sacral nerves. When the nerves are not working properly the doctor uses sacral nerve stimulation. For this just above the tailbone, near the sacral nerves under the skin the doctor places thin wires. Mild electrical pulses are sent through battery operated device through the wires to the sacral nerves. The nerves are able to work properly due to electrical stimulation of sacral nerves.
Prescription medicines- these are prescribed when over the counter medications do not help. They help to treat the underlying cause of fecal leakage such as Crohn’s disease, irritable bowel syndrome and ulcerative colitis.
- Vaginal balloons- the doctor may prescribe a device for women with fecal leakage. This device inside the vagina inflates a balloon. Through the vaginal wall on the wall of the rectum this balloon exerts pressure. This keeps the stool away from passing due to the pressure on the walls. You can add or remove the air from the device once the doctor has fitted it properly.
- Nonabsorbable bulking agents- to bulk up the tissue around the anus these agents are injected into the wall of the anus. The opening of the anus is made narrower by these bulkier tissues. This enables better closing of the sphincters.
- Bowel training- it can be very helpful to develop a regular bowel movement pattern. This involves specific time of the day you visit the washroom such as after you eat or anorectal biofeedback which is a treatment. While you do special exercises called kegal exercise this procedure measures the sphincter contractions. Your sphincter muscles can get strengthened by biofeedback training and the control over bowel movement will also increase.
- Surgery- fecal leakage can be treated by several different surgical procedures. Often these surgeries can help to repair sphincter muscle or replace them.
- Sphincteroplasty- the separated ends of the anal sphincter are reconnected
- Artificial anal sphincter- around the anus a cuff is placed and to inflate or deflate the cuff under the skin a small pump is implanted. The passage of the stool is controlled by this cuff.
- Colostomy- through an opening in the abdominal wall the colon is brought such so that in a bag on the outside of the abdomen the stools are collected. This surgery is the last resort.
- Wearing absorbent pads- the most frequently used treatment for fecal leakage is wearing absorbent pads inside the underwear. In your quality of life this can make a large difference in cases of milder forms of fecal leakage such as small volume of stool, few bowel leakages and staining of underwear. With other treatments this can be combined with.
Your doctor can help you with the problem such as first he will do physical exam and may suggest other tests such as anorectal manometry. The cause can be pinpointed by these tests. These tests help to measure rectal elasticity, rectal sensation and anal pressure thus proper treatment is suggested by the doctor.