Fortunately, effective treatments are available for fecal incontinence. Treatment for fecal incontinence can help improve or restore bowel control. Depending on the cause of your incontinence, treatment may include dietary changes, medications, special exercises that help you better control your bowels, or surgery.
Foods that can cause diarrhea and worsen fecal incontinence include spicy foods, fatty and greasy foods, cured or smoked meat, and dairy products (especially if you are lactose intolerant). Caffeine-containing beverages can act as laxatives, as can products which contain artificial sweeteners (e.g., sugar-free gum and diet soda). Several anti-diarrheal agents (e.g., loperamide, anticholinergic agents, clonidine, bile salt binding agents, alosetron) that can effectively treat diarrhea are now available. Some of these agents (e.g., loperamide) are available over-the-counter while others are prescription only. Some medications work better for patients than others.
If you have constipation, your doctor may suggest that you eat fiber-rich foods, and prescribe fiber supplements. On the other hand, if you have diarrhea, your doctor may recommend anti-diarrheal medications (e.g., loperamide (Imodium)) or fiber supplements to help bind stool.
If fecal incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel retraining program and exercise therapies that will help you improve muscle strength in the vicinity of your anus. In some cases, bowel training means learning to go to the toilet at a specific time of day. For example, your doctor may recommend that you make a conscious effort to have a bowel movement after eating. This helps you gain greater control by establishing with some predictability when you need to use the toilet. Most agree that use of loperamide comprises a first line treatment for fecal incontinence, before moving to biofeedback. In other cases, bowel training involves an exercise therapy called biofeedback. For fecal incontinence, biofeedback involves inserting a pressure-sensitive probe into your anus. This probe registers the strength of your anal sphincter. You can practice sphincter contractions and learn to strengthen your own muscles by viewing the scale's readout as a visual aid. These exercises can strengthen your rectal muscles. It is also possible to improve rectal sensation with biofeedback therapy.
If you leak large amounts of stool frequently, consider applying a moisture-barrier cream to prevent direct contact between irritated skin and feces. Ask your doctor to recommend a product. Be sure the area is clean and dry before you apply any cream. Non-medicated talcum powder or cornstarch also may help relieve anal discomfort. Wear cotton underwear and loose clothing and change your soiled underwear quickly. If you use pads or adult diapers, be sure they have an absorbent wicking layer on top; this layer wicks moisture away from your skin.
If a rigorous trial of the conservative measures specified above is not effective, surgery or a less invasive procedure (e.g., sacral nerve stimulation, injection of biomaterials) may be considered.
The sacral nerves travel from the spinal cord to muscles in the pelvis. These nerves regulate rectal sensation and strength of the anal sphincter muscles. Sacral nerve stimulation is carried out in stages. First, small needles are positioned in the sacral nerves traveling from the spinal cord to muscles of your lower bowel, and these muscles are stimulated by an external pulse generator to identify which muscle stimulates anal contractions the most. The muscle response to the stimulation generally isn't uncomfortable. If this procedure improves symptoms over 2-3 weeks, a permanent pulse generator may be implanted.
Injection of a silicone-based material into the anal sphincter may improve incontinence by narrowing the anal canal.
A sphincteroplasty, which is an operation to repair a damaged anal sphincter, may be beneficial in women who have fecal incontinence due to anal sphincter damage caused by childbirth. Other operations, such as an artificial sphincter or a muscle transplant (graciloplasty) are not done very often because they are often associated with complications. A colostomy is the last resort to treat fecal incontinence. A colostomy is an operation that diverts stool through an opening in the abdomen instead of through the rectum. A special bag is attached to this opening to collect the stool.
There are many options to help patients with fecal incontinence. Make an appointment with a gastroenterologist for an evaluation.