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Fecal incontinence

Last updated: November 10, 2021

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Fecal incontinence is a condition characterized by the involuntary loss of solid or liquid feces. Causes and presentations are variable. Fecal incontinence remains a grossly underreported condition in the US and affects approximately 8% of adults older than 65 years of age. Prevalence is similar in women and men. Diagnosis involves a detailed medical history, physical examination, and diagnostic testing such as the evaluation of the neuromuscular function of the anorectum (anorectal manometry). Treatment is determined based on the etiology, and usually involves supportive measures such as dietary changes, pelvic floor physiotherapy, and medical therapy aimed at reducing stool frequency and improving stool consistency. Complications include perianal dermatitis and psychological distress.

  • Fecal incontinence (FI): the involuntary loss of feces
  • Fecal urge incontinence: lack of ability to retain stool despite efforts to do so
  • Passive fecal incontinence: the involuntary loss of stool without awareness of the need to defecate preceding the event

References: [2][3]

Epidemiological data refers to the US, unless otherwise specified.

References: [4]

  • Chronic or recurring fecal leakage
  • May be associated with flatus, abdominal discomfort, and/or bloating

References: [4]

  • Supportive measures
    • Dietary changes
    • Keeping a food diary
    • Bowel control exercises
  • Medical therapy
  • Biofeedback therapy: cases of external anal sphincter weakness or nerve injury
  • Surgical therapy: reserved for patients with refractory fecal incontinence or significant structural abnormalities (e.g., rectal prolapse, rectocele)

References: [4]

We list the most important complications. The selection is not exhaustive.

  1. Ng K-S, Sivakumaran Y, Nassar N, Gladman MA. Fecal Incontinence. Diseases of the Colon & Rectum. 2015; 58 (12): p.1194-1209. doi: 10.1097/dcr.0000000000000514 . | Open in Read by QxMD
  2. Whitehead WE, Borrud L, Goode PS, et al. Fecal Incontinence in US Adults: Epidemiology and Risk Factors. Gastroenterology. 2009; 137 (2): p.512-517.e2. doi: 10.1053/j.gastro.2009.04.054 . | Open in Read by QxMD
  3. Ditah I, Devaki P, Luma HN, et al. Prevalence, Trends, and Risk Factors for Fecal Incontinence in United States Adults, 2005–2010. Clinical Gastroenterology and Hepatology. 2014; 12 (4): p.636-643.e2. doi: 10.1016/j.cgh.2013.07.020 . | Open in Read by QxMD
  4. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders.. Am J Gastroenterol. 2014; 109 (8): p.1141-57; (Quiz) 1058. doi: 10.1038/ajg.2014.190 . | Open in Read by QxMD