Once your doctor identifies the cause of your bowel control problem, you can discuss the best treatment for you. The type of treatment depends on the cause and severity of the problem. This section offers you additional information on treatment options. If these simple measures don't work, then you should talk to your primary care physician. If you can't solve these problems together, then a specialist should be consulted.
Diet Changes – Anal incontinence in women who experience diarrhea or loose bowel movements will often improve with avoiding spicy foods or stimulants such as caffeine, which speed up transit time in the bowel. Fiber supplementation (with whole grains, fruits, vegetables, or high fiber cereals) or over the counter fiber supplements can help make stools more formed, resulting in more complete passage during bowel movements and improved evacuation of stools. Since fiber is also used to treat constipation this can be confusing – fiber is very helpful for many bowel problems for different reasons. It will help draw water into the stool, making the stool a soft, formed mass that can be more easily held in the rectum than watery stool.
Pelvic floor Muscle Exercises (Kegel Exercises) – Learning how to control and strengthen the pelvic floor muscles helps women reduce fecal incontinence. Like any other form of exercise, improvement requires good exercise technique and dedication to doing the exercises regularly. Even after you stop going to PT visits, you have to keep doing the exercises. Specially trained physical therapists can help those having difficulty learning these exercises. This can be a very valuable treatment, but you need to see a specialized therapist who can help pelvic floor problems. They may also utilize a special form of therapy called Biofeedback. See your doctor for a referral.
Medications – Sometimes medications can be used to treat or prevent diarrhea, decreasing the frequency or looseness of bowel movements. Taking these medications before you are about to go out can help you control the stool.
- loperamide (Imodium) – over the counter medication
- diphenoxylate and atropine (Lomotil) – prescription medication
Other medications that can be used to help with incontinence include enemas, which are performed prior to leaving the house. Emptying the rectum like this helps minimize the risk of stool being there to leak out while you are away from the toilet.
Sacral Nerve Stimulation – Electrical stimulation of the nerves that control the anal sphincter through a device surgically implanted in your buttocks can improve symptoms of fecal incontinence in some people. This treatment may be offered to patients who do not benefit from dietary changes and medications. It uses a device similar to a pacemaker to help the anal sphincter contract. The device can provide benefit for years before the battery needs to be replaced. You may need to return to your doctor for adjustments to find the right setting that controls your bladder symptoms. This can be done at home or in the doctor’s office with a device similar to a TV remote control.
Rectal Mucosal Bulking Injection – This is a procedure that involves the injection of a biologic gel into the rectal mucosa to bulk or thicken the mucosa and narrow the anal canal. By narrowing the anal canal the pressure is increased slightly so there a greater resistance to involuntary stool leakage. This procedure is for patients who have not had satisfactory improvement with dietary changes, pelvic floor physical therapy, or medications.
Surgery – There are several types of surgery that might be helpful:
- Overlapping anal sphincteroplasty – Damaged anal sphincter muscles can sometimes be repaired with surgery, more successfully when the nerves are working properly. This surgery can have a low success rate and therefore is only offered to a select number of patients who are most likely to do well.
- Rectocele repair - If stool is getting “trapped” in the rectocele and seeping out later, repair of a rectocele can sometimes lead to improved bowel emptying.
- Hemorrhoid surgery –significant hemorrhoids may prevent the anus from making a tight seal. Repair of the hemorrhoids can sometimes help with anal seepage.
- Fistula repair – closing the fistula is generally curative when there are no other factors contributing to the anal incontinence.
Original publication date: May 2008; Content Update: July 2013