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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)

Okay, so you’re having fecal leakage, what can we do about it? There are many different treatment options, and it’s best to work with your healthcare providers to decide what’s best for your individual situation.

Here are some things that may be recommended:

Your diet can have a huge impact on bowel health. If you are having loose stools, stool bulking supplements and a high fiber diet may help. (Irion, 2010) Remember, your stool will ideally be a 3 or 4 on the Bristol Stool Scale. It may be helpful to keep a food diary to help you identify any food sensitivities or triggers. (ACOG, 2019)

Pelvic floor muscle training can often improve symptoms of fecal leakage. When the muscles are strong and functioning properly, they can support the rectum and provide control over holding in, or letting go of, poop. (Irion, 2010; ACOG, 2019; Shin 2015) A pelvic floor physical therapist can help you learn to perform pelvic floor muscle exercises properly. They may use electrical stimulation (to help the muscle contract) or biofeedback which helps to form a better connection between your brain and the muscles so that they can function optimally. (ACOG, 2019)

Your daily bowel habits can also affect your symptoms. (Irion, 2010) It may be helpful to attempt a bowl movement immediately after getting up in the morning and after eating a meal. (ACOG, 2019) Setting a schedule of when you should go to the bathroom can help. (ACOG, 2019)

Anal plugs or vaginal bowel control devices can be used to help physically stop stool from leaking. (ACOG, 2019) Anal plugs are inserted into the anus and stop stool from exiting. Vaginal bowel control devices are similar, but they are inserted into the vagina and are often pumped up once inserted. By filling the device with air, it pushes the vaginal walls into the rectum, making it difficult for stool to pass to exit. Your physician may recommend injections of bulking agents. There are several different types, but they are injected around the anal sphincter to assist with keeping stool in until you are ready to pass it. (ACOG, 2019; Shin, 2015; Saldana Ruiz, 2017)

Your physician may also recommend neuromodulation. (ACOG, 2019) This involves stimulating your sacral nerve which can be done either superficially or with an implanted device. Neuromodulation has been shown to be effective at treating symptoms for up to 6 months. (ACOG, 2019)

In moderate to severe cases, your doctor may recommend surgery. (Irion, 2010) The American College of Obstetricians and Gynecologist, does not recommend surgery unless non-conservative treatments have failed, except in the cases of rectal prolapse or fistulas. For women who have suffered damage due to childbirth, surgery is often not recommended until at least 3-6 months postpartum. (Irion, 2010)

If you are experiencing bowel issues, it is important to discuss this with your medical provider who can assess and screen for more serious conditions such as colon cancer, fistulas, and rectal prolapse. (ACOG, 2019)

It is important to see your provider if you are experiencing any combination of the following symptoms: unexplained weight loss, abdominal pain, rectal bleeding, melena (blood in the stool that often makes it look black and tarry), anemia, or changes in the caliber of stools (“pencil stools” that are thinner than normal).

Ready to take back control of your bowels? Here are some steps you can take now:

What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  

By Emily Reul, PT, DPT

1. JM Irion, GL Irion. Women’s health in physical therapy.

2. ACOG practice bulletin no. 210: fecal incontinence. Obstet Gynecol. 2019 Apr;133(4):e260-e273. doi: 10.1097/AOG.0000000000003187.

3. Shin GH, Toto EL, Schey R. Pregnancy and postpartum bowel changes: constipation and fecal incontinence. AM J Gastroenterol. 2015 Apr;110(4):521-9; quiz 530. doi: 10.1038/ajg.2015.76. Epub 2015 Mar 24.

4. Saladana Ruiz N, Kaiser AM. Fecal incontinence – challenges and solutions.. World J Gastroenterol. 2017 Jan 7;23(1):11-24. doi: 10.3748/wjg.v23.i1.11.

5. Guillaume A, Salem AE, Garcia P, Chander Roland B. Pathophysiology and therapeutic options for fecal incontinence. J Clin Gastroenterol. 2017 Apr;51(4):324-330. doi: 10.1097/MCG.0000000000000797.

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