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Fecal Leakage

You’re out an about, and suddenly it happens—you’ve had a little leakage, or even worse, you’ve completely pooped in your pants! This can be so traumatizing, shameful, and embarrassing, but there is hope!

Let’s back track and talk about what fecal leakage, or fecal incontinence, is. In a properly functioning body, when you need to have a bowel movement, your body sends a signal to the brain and your pelvic floor muscles hold feces in until you are on the toilet and tell the body to let it out. However, when any part of this is not working right, you can have fecal leakage which is the involuntary loss of feces or flatulence, also known as gas. (Irion, 2010)

This leakage has been reported in up to 17% of individuals affected with urinary incontinence or pelvic organ prolapse. (Irion, 2010) But many studies have shown that individuals are often too embarrassed or ashamed to discuss these symptoms with their healthcare providers, so the numbers may be even higher. Because many women feel ashamed, they do not seek treatment and just try to live with it. (ACOG, 2019)

Having fecal incontinence has been linked with depression, social isolation, shame, embarrassment, worsened sexual function, and increased economic burden. (ACOG, 2019) But there is hope to improve or cure these symptoms!

In order to address these symptoms, it’s important to figure out what is causing them. Here are a few different things that can contribute:

  • Your anal sphincter is the muscle that contracts to keep your anus closed (so poop can’t come out), and it is controlled by the pudendal nerve. Damage to either of these structures, which can happen during traumatic events like childbirth, can cause fecal leakage. (Irion, 2010) While this tearing is not very common with childbirth, it can be attributed to extensive perineal tearing and episiotomies during delivery, as well as, having instrument assisted delivery like use of forceps or vacuum extraction. (Irion, 2010; Guillaume, 2017)

  • Your rectum and anus have receptors in them to tell you when you have to go (and also what needs to come out—like gas or stool). When these receptors or their signals are not working, you can have leakage and not know it. (Shin, 2015; Guillaume, 2017)

  • Dyssnergia is a term used when the pelvic floor muscles and/or anal sphincter do not relax and contract at the appropriate times. For example, if your muscles are contracting while you are attempting to have a bowel movement, this can cause incomplete emptying which can lead to leakage afterwards. (ACOG, 2019)

  • Some medications, like metformin which is commonly used to treat diabetes, can cause loose stools which are harder to hold in and therefore lead to leakage. (ACOG, 2019; Saldana Ruiz, 2017) Other medications that can cause loose stools are antacids, antibiotics, antidepressants, laxatives, and proton pump inhibitors (like Prilosec). (ACOG, 2019; Guillaume, 2017)

Now why does it happen? That’s a complicated question to answer, but some of the following can put you at a greater risk from having fecal leakage: (ACOG, 2019; Guillaume, 2017)

  • Increasing age

  • Urinary incontinence

  • Obesity

  • Smoking

  • Decreased physical activity

  • Anal intercourse

  • History of pelvic irradiation

  • Conditions such as diabetes and irritable bowel syndrome (IBS)