Fecal incontinence
Fecal incontinence is the recurrent, involuntary passage of fecal material for at least three months, most often from a combination of obstetric or surgical sphincter injury, altered stool consistency, and impaired rectal sensation. Diagnosis rests on history and digital rectal exam followed by anorectal manometry and anal endosonography, and treatment moves stepwise from correcting stool consistency and reversible causes to pelvic floor therapy, biofeedback, and, for refractory or structural disease, bulking agents, sacral nerve stimulation, or sphincteroplasty.
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What this article covers
- Overview
Definition: fecal incontinence is the recurrent, uncontrolled passage of fecal material for at least three months; it excludes isolated flatus incontinence or passage of clear mucus alone.
- Epidemiology
Grossly underreported: true prevalence is higher than clinic-reported rates because of embarrassment and lack of routine screening by clinicians.
- Risk factors
Obstetric anal sphincter injury: vaginal delivery, particularly with forceps use, a large infant, or a third- or fourth-degree perineal laceration, is the leading structural risk factor in women.
- Pathophysiology
Impaired rectal storage and sensation: the rectum normally accommodates and senses an incoming stool bolus; reduced compliance or blunted sensory perception means the patient does not receive adequate warning before leakage.
- Clinical features
Recurrent involuntary stool loss for 3 or more months: the defining feature; episodes range from minor soiling to complete evacuation and may occur with or without perceived warning.
- Differential diagnosis
Fecal impaction with overflow incontinence: liquid stool leaks around a palpable, obstructing fecal mass on digital rectal exam; treatment is disimpaction rather than sphincter-directed therapy.
- Diagnosis
Fecal incontinence is established clinically, by history of recurrent involuntary passage of fecal material for at least three months, confirmed on digital rectal examination: the diagnosis does not…
- Management
Treat reversible and contributing factors first: identify and correct diarrhea, constipation, offending medications, smoking, obesity, and physical inactivity, since initial therapy is directed at…
- Complications
Perianal skin breakdown: chronic fecal exposure causes maceration, altered skin pH, and dermatitis, increasing the risk of pressure injury and secondary skin infection.
- Prognosis
Improves substantially with correction of reversible factors: many patients gain meaningful control once diarrhea, constipation, or impaction is treated, without needing advanced intervention.
- Prevention
Minimize obstetric sphincter trauma: careful management of instrumented vaginal delivery (forceps or vacuum) and prompt recognition and primary repair of third- and fourth-degree perineal lacerations…
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