Bowel incontinence

Reasons people have bowel incontinence include:

• Ongoing (chronic) constipation. This causes the anal muscles and intestines to stretch and weaken, leading to diarrhea and stool leakage.
• Fecal impaction. It is most often caused by chronic constipation. This leads to a lump of stool that partly blocks the large intestine.
• Long-term laxative use.
• Colectomy or bowel surgery.
• Not sensing that it's time to have a bowel movement.
• Emotional problems.
• Gynecological, prostate, or rectal surgery.
• Injury to the anal muscles due to childbirth.
• Nerve or muscle damage (from injury, tumor, or radiation).
• Severe diarrhea that causes leakage.
• Severe hemorrhoids or rectal prolapse.
• Stress of being in an unfamiliar environment.

In adults age 65 and older, women tend to have problems with bowel control more often than men. However, bowel incontinence can happen in both women and men, as well as in younger people with certain medical conditions.

Children who have problems with leakage due to toilet training problems or constipation may have encopresis.

The rectum, anus, pelvic muscles, and nervous system must work together to control bowel movements. If there is a problem with any of these, it can cause incontinence. You must also be able to recognize and respond to the urge to have a bowel movement.

Many people feel embarrassed about bowel incontinence and may not tell their health care provider. But because incontinence can be treated, you should tell your provider if you are having problems. Proper treatment can help most people gain control of their bowels. Exercises to make the anal and pelvic muscles stronger can help the bowels work properly.

Bowel incontinence is the loss of bowel control, causing you to unexpectedly pass stool. This can range from sometimes leaking a small amount of stool and passing gas, to not being able to control bowel movements.

Urinary incontinence is when you are not able to control passing urine. It is not covered in this article.

Madoff RD, Melton GB. Diseases of the rectum and anus. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 131.

Rao SSC. Fecal incontinence. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Your provider will take your medical history. Be sure to tell your provider about all the prescription and over-the-counter medicines you take. Taking antacids or laxatives can cause bowel incontinence, particularly in older people.

Your provider will also perform a physical exam, focusing on your stomach area and rectum. Your provider will insert a lubricated finger into your rectum to check sphincter tone and anal reflexes, and to look for any problems.

Diagnostic tests may include:

• Barium enema
• Blood tests
• Colonoscopy
• Electromyography (EMG)
• Rectal or pelvic ultrasound
• Stool culture
• Test of anal sphincter tone (anal manometry)
• X-ray procedure using a special dye to evaluate how well the sphincter contracts (balloon sphincterogram)
• X-ray procedure using a special dye to see the bowel while you have a bowel movement (defecography)

Report any problems with bowel incontinence to your provider. Contact your provider if:

• A child who has been toilet trained has any stool incontinence.
• An adult has stool leakage or incontinence during the day or night.
• You have skin irritation or sores as a result of bowel incontinence.
• You have severe diarrhea.