Bowel incontinence

Definition

Bowel incontinence is the loss of bowel control, resulting in involuntary passage of stool. This can range from an occasional leakage of stool with the passage of gas, to a complete loss of control of bowel movements.

Urinary incontinence, a separate topic, is the inability to control the passage of urine.

Alternative Names

Considerations

Among people over the age of 65, women more frequently experience bowel incontinence, with 13 out of every 1,000 women reporting loss of bowel control.

The most common cause of bowel incontinence, ironically, is constipation. Constipation causes the muscles of the anus and intestines to stretch and weaken (the anus is the opening through which stool leaves the body). The weakened muscles will prevent the rectum from closing tightly, thus resulting in leakage of stool (the rectum connects to the anus). Weakened intestinal muscles will also slow down the bowels, making it difficult to pass stools and further worsening the constipation.

Chronic stretching of the anal and intestinal muscles can also make the nerves of the anus and rectum less responsive to the presence of stool in the rectum.

The ability to hold stool and maintain continence requires normal function of the rectum, anus, and the nervous system. Additionally, the person must possess the physical and psychological ability to recognize and appropriately respond to the urge to defecate.

Problems with incontinence should be reported to the health care provider. Incontinence is not a hopeless situation. Proper treatment can help the majority of people, and often the problem can be eliminated altogether.

Causes

• Chronic constipation or impacted stool in the rectum, leading to diarrhea and stool leakage around the impacted stool (see encopresis)
• Severe diarrhea that overwhelms the ability to control passage of stool
• In women, injury to the anal muscles due to childbirth
• Stress of unfamiliar environment
• Decreased awareness of sensation of bowel fullness
• Nerve or muscle damage (from stroke, trauma, tumor, or radiation)
• Emotional problems
• Gynecological, prostate, or rectal surgery
• Severe hemorrhoids or rectal prolapse
• Colectomy or bowel surgery
• Chronic laxative abuse