Fecal incontinence (FI) is the inability to control bowel movements, leading to the involuntary passage or leakage of stool. FI is similar to urinary incontinence from overactive bladder, it is often due to damage to the nerves, muscles, or both. Because it often goes hand-in-hand with urinary incontinence, it is sometimes addressed by a urologist or urogynecologist as a part of a treatment plan for overactive bladder.
Fecal Incontinence can range from occasional leakage when passing gas to the urge to have a bowel movement that comes on suddenly and may be hard to control to the complete loss of bowel control. It can affect people of all ages, but it is more common among older adults and the prevalence varies depending on factors such as age, gender, and underlying health conditions. Nerve involvement can disrupt either the sensory or motor aspects of bowel control. Injury to the nerves, often due to trauma, surgery, or childbirth-related injuries, can result in impaired nerve function, sphincter function and sensory deficits, leading to fecal incontinence.
People who experience bowel control problems, often try dietary modification or biofeedback to improve bowel sensation and strength. When these things are not effective, often people give up and live with their condition. Untreated, fecal incontinence can have a significant effect on the quality-of-life leading to a loss of confidence and participation in regular day to day activities.
Facts About Fecal Incontinence
- Fecal incontinence affects about 2% to 15% of adults in the general population, with many cases going unreported due to embarrassment or stigma.
- The prevalence increases with age, especially those over 65. In fact, the percentage of people with fecal incontinence can rise to 15% to 20%, and among those in nursing homes or long-term care facilities, it can be as high as 50% or more.
- Women tend to be affected more than men. This is often due to factors like pregnancy, childbirth, and the weakening of pelvic floor muscles that can occur with age. It’s estimated that up to 25% of women experience fecal incontinence at some point in their lives.
- Fecal incontinence is less common in men but still affects around 1% to 10% of the male population, with higher rates in those who have had prostate surgery or other pelvic surgeries.
What Causes Fecal Incontinence?
People with conditions like diabetes, multiple sclerosis, stroke, or spinal cord injuries are at a higher risk of developing fecal incontinence due to nerve damage or other underlying health issues. Women who have had difficult or multiple childbirths (vaginal deliveries) are also at increased risk due to potential injury to the anal sphincter or pelvic floor muscles. Individuals with chronic bowel issues, such as chronic constipation or irritable bowel syndrome (IBS) can also have an increased risk of fecal incontinence, particularly if these conditions lead to damage or weakening of the muscles involved in bowel control. Age-related changes can also play a role in the development of FI. As people age, the muscles and nerves involved in bowel control may weaken, increasing the risk of incontinence.
Treatment Options
There are many ways to manage bowel control problems. Your doctor will recommend the conservative treatments first, but if conservative treatments don’t deliver the results you need, you have more options.
- Lifestyle Changes: Simple dietary changes like eating a fiber-rich diet or adjusting food intake to manage diarrhea or constipation can be a first line treatment.
- Pelvic floor exercises: Working with a physical therapist to strengthen the muscles involved in bowel control can improve symptoms.
- Medications: Anti-diarrheal or anti-laxative medications may help control bowel movements.
- InterStim™ Therapy: This therapy, also known as sacral neuromodulation, involves the use of a small device called a neurostimulator, which is placed under the skin near the sacral nerves in the lower back. This procedure aims to restore normal function to the sacral nerves and improve bowel control in individuals with fecal incontinence.
How does InterStim Therapy work?
InterStim therapy can be an effective treatment option for those who have not found relief from other conservative treatments and are seeking a long-term solution. This therapy implants a small device in the lower back or buttocks area that is used to deliver electrical pulses to the sacral nerve. Before the actual implantation of the device, patients have the opportunity for a trial to see if it helps to improve or restore normal function. During the trial phase a temporary thin, flexible wire is placed externally near the sacral nerves to see if the therapy improves symptoms. The lead is connected to an external device that sends electrical pulses. If the trial phase is successful, a small permanent device is implanted under the skin. The device can be programmed and adjusted from an app on a smart phone to deliver the therapy in the most effective way.
Treatment depends on the underlying cause and severity of the condition. If you or someone you know is experiencing fecal incontinence, it is important to consult a healthcare provider for an accurate diagnosis and appropriate management. Conrad Pearson Clinic is a center of excellence for InterStim Therapy and Dr. Adam Stewart and Dr. Val Vogt, have experience helping patients with overactive bladder and fecal incontinence find relief.
Learn more about InterStim for Fecal Incontinence
