Fecal incontinence
A stigmatized condition causing involuntary loss of bowel contents.
Fecal incontinence (FI), sometimes called encopresis in certain forms, is the inability to control bowel movements, resulting in the accidental leakage of gas, liquid stool, mucus, or solid feces. It is a symptom rather than a disease itself, and it can stem from various underlying issues, usually involving a breakdown in more than one of the body’s continence mechanisms. The most frequent causes are thought to be damage from childbirth (either immediate or delayed), complications from prior anal or rectal surgery (especially procedures on the anal sphincters or hemorrhoidal cushions), and changes in bowel habits—such as those linked to irritable bowel syndrome, Crohn’s disease, ulcerative colitis, food intolerances, or constipation that leads to overflow incontinence. Reported rates vary: about 2.2% of adults living in the community are affected, while one study of non-institutionalized U.S. adults from 2005 to 2010 found a rate of 8.39%, and among older adults in nursing homes, the figure approaches 50%.
FI has three major consequences. First, it can cause local skin problems around the anus, such as maceration (softening and whitening from constant moisture), urinary tract infections, or pressure sores. Second, it creates financial burdens for individuals (costs of medications and incontinence products, lost productivity), employers (missed workdays), and insurers and society (higher healthcare costs and unemployment). Third, it significantly reduces quality of life, often leading to low self-esteem, shame, humiliation, depression, a need to plan life around easy toilet access, and avoidance of enjoyable activities. Because FI is a stigmatized condition, people may feel too embarrassed to seek medical help, instead trying to manage it secretly on their own, which can worsen the problem.
Despite being one of the most psychologically and socially devastating conditions for an otherwise healthy person, FI is generally treatable. More than half of seriously ill hospitalized patients rated bladder or bowel incontinence as “worse than death.” Management can involve a personalized combination of dietary changes, medications, and surgery. However, healthcare professionals are often poorly informed about treatment options and may not fully grasp the impact of FI.
Quick Facts
- Synonym
- Faecal incontinence, bowel incontinence, anal incontinence, accidental bowel leakage
- Causes
- Puerperal disorder, ulcerative colitis
- Medication
- Cholestyramine
- Frequency
- 2.2%
Facts from the source article.
Lore & Background
Fecal incontinence affects virtually all aspects of sufferers' lives, greatly diminishing physical and mental health, and affecting personal, social, and professional life. Emotional effects may include stress, fearfulness, anxiety, exhaustion, fear of public humiliation, feeling dirty, poor body image, reduced desire for sex, anger, humiliation, depression, isolation, secrecy, frustration, and embarrassment. Physical symptoms such as skin soreness, pain and odor may also affect quality of life. More than 50% of hospitalized seriously ill patients rated bladder or fecal incontinence as 'worse than death'.
Reader's Guide
Fecal incontinence is a sign or symptom representing an extensive list of causes, usually resulting from a complex interplay of several coexisting factors. Up to 80% of people may have more than one abnormality contributing. The most common factors are thought to be obstetric injury and after-effects of anorectal surgery, especially those involving the anal sphincters and hemorrhoidal vascular cushions. Vaginal delivery causes stretching of pelvic muscles and the pudendal nerve, with risk increased by difficult or prolonged labor, forceps use, higher birth weights, or midline episiotomy. FI is a much under-reported complication of surgery, with procedures like partial internal sphincterotomy, fistulotomy, anal stretch, hemorrhoidectomy, or transanal advancement flaps potentially leading to FI. Management may be achieved through an individualized mix of dietary, pharmacologic, and surgical measures. Health care professionals are often poorly informed about treatment options and may fail to recognize the effect of FI.
Did You Know?
- FI affects an estimated 2.2% of community-dwelling adults, while among institutionalized elders figures come close to 50%.
- Obstetric injury is a leading cause of fecal incontinence, and 60% of females who sustained obstetric tears also had pudendal nerve damage.
- The 'keyhole deformity' refers to scarring within the anal canal and is a cause of mucus leakage and minor incontinence.
More in Symptoms and signs: Digestive system and abdomen 1-24
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