Fecal Incontinence

Fecal incontinence is the inability to control the passage of liquid or solid stools. More than 6 million people in the United States suffer from fecal incontinence.

Many people are too embarrassed to discuss fecal incontinence – also called accidental bowel leakage – with their doctors. But successful treatments are available.

At Virginia Mason, we treat patients with all types of incontinence every day. We discuss these matters with our patients in a matter-of-fact way that soon puts most people at ease. 

Causes of Fecal Incontinence
Evaluating Fecal Incontinence
Non-surgical Treatments for Fecal Incontinence
Surgery Options for Fecal Incontinence
Why Virginia Mason?

At Virginia Mason, we care about your intimate concerns and want to help you get back to the quality of life that you desire. We have a full array of highly trained and compassionate specialists who can help you.

Causes of Fecal Incontinence

People experience various degrees of incontinence, from loss of small amounts of liquid stool to complete loss of control of stool. Common causes of fecal incontinence include:

  • Pelvic floor problems: Fecal incontinence is very common in women with pelvic floor problems, including pelvic organ prolapse.
  • Chronic constipation: Hard stools may lead to injury in pelvic muscles. Constipation is the most common cause of fecal incontinence in elderly people.
  • Trauma or injury: Vaginal childbirth is one of the most common causes of injury to the anal sphincter (a ring of muscles that keeps the anus closed) and the nerves that supply it.
  • Neurological diseases: Stroke, spinal cord injuries, multiple sclerosis and Parkinson’s disease may affect the nerves that control the bowels and decrease the function of the rectum and anal sphincter.
  • Aging: Elderly people can also suffer from anal sphincter dysfunction and weakening.

Evaluating Fecal Incontinence

At Virginia Mason, your evaluation team may include a urogynecologist, urologist, gynecologist, gastroenterologist, colorectal surgeon, and a pelvic floor physical therapist. Our goal is to help you understand your diagnosis and treatment options in a discrete and comfortable environment.

The evaluation includes a full medical history and a physical exam. You may be asked to keep a diary of your bowel function. You may also need some tests to help determine the best treatment option.

Testing may include:

  • Anal Manometry: Testing anal sphincter function by measuring the pressure and strength the sphincter can generate through a small tube
  • Endosonography: Using an ultrasound rectal probe to look at the actual sphincter muscle and the injured area
  • Sigmoidoscopy or colonoscopy: Inserting a small camera into the anus to look for masses or lesions in the lining inside the rectum and colon
  • Electromyography: Inserting small needles into pelvic and sphincter muscles to measure their function

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Non-surgical Treatments for Fecal Incontinence

If your fecal incontinence is associated with constipation, it is important to treat that first.

Managing constipation includes:

  • Increasing fluid intake
  • Regular exercise
  • Increasing fiber intake or taking a stool softener or bulking agent

Avoiding bowel irritants can also help. These include caffeine, alcohol, spicy foods and leafy green vegetables.

Pelvic floor exercises help to strengthen the muscles that support your pelvic organs.

Pelvic floor physical therapy is done with a physical therapist who uses special instruments to measure your pelvic muscles and to customize your treatments. This may help you identify your pelvic muscles and help you better perform the exercises.

Surgery Options for Fecal Incontinence

People who continue to experience fecal incontinence despite other treatments may need a surgical procedure. The need for surgery depends on multiple factors, including the cause of the incontinence, your health, age, the severity of your symptoms and your personal preferences. 

Sacral Neuromodulation (InterStim®)

In the first stage, an electrode lead is placed adjacent to the nerves that control the rectum and anal sphincter. It is then attached to a temporary pacemaker outside your body. The procedure takes about 30 minutes. Afterward, you take the pacemaker home, with the nerves being comfortably stimulated for 1-2 weeks to see if the therapy works to control your symptoms.

If this first-stage therapy improves your symptoms by more than 50 percent, the second stage involves placing a small pacemaker under the skin in the upper buttock area. This procedure is usually performed on an outpatient basis, either under local anesthesia with mild sedation or general anesthesia. 

It takes less than half an hour to implant the pacemaker, and you go home the same day. Follow-up visits are scheduled to see how you are doing. 

Anal Sphincteroplasty

This is a surgery that reconstructs the anal sphincter muscles. It is sometimes done as an outpatient surgery, though an overnight stay in the hospital may be necessary.


In certain cases, a colostomy may be done to divert the colon and create an opening in the skin of the abdomen. After a colostomy, stools go through the opening – called a stoma – and out into a bag that is connected to the skin.

Many people lead full and normal lives with colostomy bags. Before leaving the hospital, they are trained in how to care for the stoma and change colostomy bags.

Why Virginia Mason?

At Virginia Mason, we care about your intimate concerns and want to help you get back to the quality of life that you desire. We have a full array of highly trained and compassionate specialists who can help you.

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