Fecal incontinence can be defined as complete loss of bowel or leaking of liquid or small formed stool. Some complaints with fecal incontinence is associated with a strong urge that comes on suddenly with little time before needing to defecate, often not making it to the toilet before an accident occurs.
Fecal incontinence or staining can be the resultant of constipation, not having the correct stool consistency, not fully emptying during defecation, and/or pelvic floor muscle weakness. Diet is key and the first place to start when treating fecal incontinence in order to ensure normal stool consistency (Type 4 on Bristol Stool Chart). Second is ensuring proper bowel habits are in place in order to fully empty the rectum. This can be accomplished with Bowel Retraining). The main part of bowel retraining is sitting on the toilet after each meal whether an urge to have a bowel movement is present or not in order to facilitate the natural reflex and give the rectum a chance to empty before it’s full (this will also allow the rectum to return back to normal size and restore normal signals between the bowel, brain, and pelvic floor muscles). Watch this video for a further explanation on fecal incontinence due to constipation titled “The Poo in You“. It is also important to note that stool consistency that is liquid will increase likelihood of fecal incontinence as our anal sphincter muscles are not designed to hold back liquid stool and will result in a sudden strong urge to defecate. Therefore, once again, getting your diet right to improve stool consistency is where you need to start.
Often times people are unaware that they had stool in their rectum until it ends up in their underwear or when they sit on the toilet. This is likely due to a desensitized and overstretched rectum. Returning the rectum to normal size is key and can be accomplished with bowel retraining. Sometimes the use of Mirilax is necessary to keep the stool a little softer than we typically want in order to not allow the rectum to fill up to its overstretched size, therefore, allowing it to return to normal size. However, this is not usually the case and should be discussed with your Physician first.
Often patients will complain about having to wipe several times and still have fecal matter present on toilet paper or subsequently stain their underwear and ‘never feeling clean’. Again this comes down to stool consistency. If the stool is too soft, then it is difficult for the anal sphincter muscle to ‘pinch it off’ for a clean evacuation, leaving fecal matter to smear in the perianal creases. Another reason for this could be a weakness of the pelvic floor muscles. During defecation the pelvic floor muscles should be relaxed in order to allow the stool to pass. However, at the end of the bowel movement there will be a final pelvic floor muscle contraction that occurs, expelling the last bit and closing the sphincter. When the pelvic floor muscles are too weak for this to occur, there can be slight anal gapping that occurs while sitting on the toilet allowing you to continue to wipe into the anus. It is best to stand up and clean off in the shower if possible, to avoid prolonged sitting and risk of hemorrhoids and skin irritation.