Fecal Incontinence Treatment

How is fecal incontinence treated?
Treatment for fecal incontinence may include one or more of the following:

Diet and Nutrition
Dietary changes that may improve fecal incontinence include

  • Eating the right amount of fiber. Fiber can help with diarrhea and constipation. Fiber is found in fruits, vegetables, whole grains, and beans. Fiber supplements sold in a pharmacy or in a health food store are another common source of fiber to treat fecal incontinence. The Academy of Nutrition and Dietetics recommends consuming 20 to 35 grams of fiber a day for adults and “age plus five” grams for children. A 7-year-old child, for example, should get “7 plus five,” or 12, grams of fiber a day.
  • Getting plenty to drink. Drinking eight 8-ounce glasses of liquid a day may help prevent constipation. Water is a good choice. Drinks with caffeine, alcohol, milk, or carbonation should be avoided if they trigger diarrhea.

Keeping a Food Diary
A food diary can help identify foods that cause diarrhea and increase the risk of fecal incontinence. A food diary should list foods eaten, portion size, and when fecal incontinence occurs. After a few days, the diary may show a link between certain foods and fecal incontinence. Eating less of foods linked to fecal incontinence may improve symptoms. A food diary can also be helpful to a health care provider treating a person with fecal incontinence.

Common foods and drinks linked to fecal incontinence include

  • Dairy products such as milk, cheese, and ice cream
  • Drinks and foods containing caffeine
  • Cured or smoked meat such as sausage, ham, and turkey
  • Spicy foods
  • Alcoholic beverages
  • Fruits such as apples, peaches, and pears
  • Fatty and greasy foods
  • Sweeteners in diet drinks and sugarless gum and candy, including sorbitol, xylitol, mannitol, and fructose

Medications
If diarrhea is causing fecal incontinence, medication may help. Dr. Jones may sometimes recommend using bulk laxatives, such as Citrucel and Metamucil, to develop more solid stools that are easier to control. Antidiarrheal medications such as loperamide or diphenoxylate may be recommended to slow down the bowels and help control the problem.

Bowel Training
Developing a regular bowel movement pattern can improve fecal incontinence, especially fecal incontinence due to constipation. Bowel training involves trying to have bowel movements at specific times of the day, such as after every meal. Over time, the body becomes used to a regular bowel movement pattern, thus reducing constipation and related fecal incontinence. Persistence is key to successful bowel training. Achieving a regular bowel control pattern can take weeks to months.

Pelvic Floor Exercises and Biofeedback
Exercises that strengthen the pelvic floor muscles may improve bowel control. Pelvic floor exercises involve squeezing and relaxing pelvic floor muscles 50 to 100 times a day. Nacogdoches Gastroenterology can help with proper technique. Biofeedback therapy may also help a person perform the exercises properly. This therapy also improves a person’s awareness of sensations in the rectum, teaching how to coordinate squeezing of the external sphincter muscle with the sensation of rectal filling. Biofeedback training uses special sensors to measure bodily functions. Sensors include pressure or EMG sensors in the anus, pressure sensors in the rectum, and a balloon in the rectum to produce graded sensations of rectal fullness. The measurements are displayed on a video screen as sounds or line graphs. This information is used to help the person modify or change abnormal function. The person practices the exercises at home. Success with pelvic floor exercises depends on the cause of fecal incontinence, its severity, and the person’s motivation and ability to follow the recommendations.

Surgery
Surgery may be an option for fecal incontinence that fails to improve with other treatments or for fecal incontinence caused by pelvic floor or anal sphincter muscle injuries.

  • Sphincteroplasty, the most common fecal incontinence surgery, reconnects the separated ends of a sphincter muscle torn by childbirth or another injury.
  • Artificial anal sphincter involves placing an inflatable cuff around the anus and implanting a small pump beneath the skin that the person activates to inflate or deflate the cuff.
  • Nonabsorbable bulking agents can be injected into the wall of the anus to bulk up the tissue around the anus. The bulkier tissues make the opening of the anus narrower so the sphincters are able to close better.
  • Bowel diversion is an operation that reroutes the normal movement of stool out of the body when part of the bowel is removed. The operation diverts the lower part of the small intestine or colon to an opening in the wall of the abdomen. An external pouch is attached to the opening to collect stool.

Electrical Stimulation
Electrical stimulation, also called sacral nerve stimulation or neuromodulation, involves placing electrodes in the sacral nerves to the anus and rectum and continuously stimulating the nerves with electrical pulses. The sacral nerves connect to the part of the spine in the hip area. A battery-operated stimulator is placed beneath the skin. Based on the person’s response, the health care provider can adjust the amount of stimulation so it works best for that person. The person can turn the stimulator on or off at any time. The procedure is performed in an outpatient center using local anesthesia.

What are some practical tips for coping with fecal incontinence?
Fecal incontinence can cause embarrassment, fear, and loneliness. Taking steps to cope is important. The following tips can help:

  • Carrying a bag with cleanup supplies and a change of clothes when leaving the house.
  • Finding public restrooms before one is needed.
  • Using the toilet before leaving home.
  • Wearing disposable underwear or absorbent pads inserted in the underwear.
  • Using fecal deodorants—pills that reduce the smell of stool and gas. Although fecal deodorants are available over the counter, Nacogdoches Gastroenterology can help people find them.

Eating tends to trigger contractions of the large intestine that push stool toward the rectum and also cause the rectum to contract for 30 to 60 minutes. Both these events increase the likelihood that a person will pass gas and have a bowel movement soon after eating. This activity may increase if the person is anxious. People with fecal incontinence may want to avoid eating in restaurants or at social gatherings, or they may want to take antidiarrheal medications before eating in these situations.

Anal Discomfort
The skin around the anus is delicate and sensitive. Constipation and diarrhea or contact between skin and stool can cause pain or itching. The following steps can help relieve anal discomfort:

  • Washing the anal area after a bowel movement. Washing with water, but not soap, can help prevent discomfort. Soap can dry out the skin, making discomfort worse. Ideally, the anal area should be washed in the shower with lukewarm water or in a sitz bath—a special plastic tub that allows a person to sit in a few inches of warm water. No-rinse skin cleansers, such as Cavilon, are a good alternative. Wiping with toilet paper further irritates the skin and should be avoided. Premoistened, alcohol-free towelettes are a better choice.
  • Keeping the anal area dry. The anal area should be allowed to air dry after washing. If time doesn’t permit air drying, the anal area can be gently patted dry with a lint-free cloth.
  • Creating a moisture barrier. A moisture barrier cream that contains ingredients such as dimethicone—a type of silicone—can help form a barrier between skin and stool. The anal area should be cleaned before applying barrier cream. However, people should talk with their health care provider before using anal creams and ointments because some can irritate the anus.
  • Using nonmedicated powders. Nonmedicated talcum powder or cornstarch can also relieve anal discomfort. As with moisture barrier creams, the anal area should be clean and dry before use.
  • Using wicking pads or disposable underwear. Pads and disposable underwear with a wicking layer can pull moisture away from the skin.
  • Wearing breathable clothes and underwear. Clothes and underwear should allow air to flow and keep skin dry. Tight clothes or plastic or rubber underwear that blocks air can worsen skin problems.
  • Changing soiled underwear as soon as possible.