Fecal incontinence (FI) affects up to 17 million people in the United States, according to the International Foundation for Functional Gastrointestinal Disorders. It’s also the second most common reason older adults make the decision to go into assisted living or long-term care facilities. Even though fecal incontinence is common, it can be embarrassing or upsetting for seniors to talk about, and often goes unchecked.
The good news is that, in most situations, elderly fecal incontinence is treatable or manageable. Learn about common bowel incontinence causes and treatment plans, and how to talk to a doctor about your elderly loved one’s FI.
Fecal incontinence is the inability to control bowel movements. The condition can range from an occasional leakage of stool to a complete loss of bowel control.
Healthy bowel function is controlled by rectal sensation, the ability of the digestive system to accommodate waste, and the anal sphincter muscles. A malfunction in one or more of these things may result in fecal incontinence, according to Dr. Satish Rao, a gastroenterology specialist at Augusta University Health in Augusta, Georgia. Nearly half of those with FI have “impaired rectal sensation,” which means they aren’t aware of the need to use the restroom, says Rao.
During the digestive process, feces moves from the large intestine — also called the sigmoid colon — into the rectum. In response, rectal walls stretch, signaling the need for a bowel movement. The two anal sphincter muscles — an involuntary inner muscle and a voluntary outer seal — hold the stool in the rectum until a toilet is reached, at which time you relax to release the stool. If the signal is misinterpreted, the sphincter muscles are damaged, or a toilet isn’t reached in time, fecal incontinence may occur.
Sometimes, FI is related to chronic conditions — other times, surgical and medical procedures are at fault. Common conditions that may lead to bowel incontinence include:
Nerve damage. Since our nerves let us know when it’s time for a bowel movement, damage can lead to incontinence. This damage can come from surgery, spinal injury, or a chronic condition, like diabetes or multiple sclerosis.
Muscle damage. Lack of muscle control may make it difficult to hold in stool. The muscle at the end of the rectum, called the anal sphincter, can be damaged during accidents, prostate surgeries, or childbirth.
Chronic constipation. Continuing constipation can cause impacted stool to form in the rectum over time. This stool may become too large to pass. Rectal muscles and intestines will stretch to accommodate the blockage, and eventually weaken, allowing looser stool from further up the intestines to leak around the impacted stool. Chronic constipation can also lead to muscle and nerve damage.
Diarrhea. Loose stool can worsen existing fecal incontinence, since it’s more difficult to retain in the rectum. Also, needing the bathroom immediately increases the likelihood of not making it in time.
Hemorrhoids. Hemorrhoids are swollen veins in the lower rectum. They can keep the anus from closing completely, allowing leakage.
Rectal inelasticity. Rigid rectal walls can lead to loss of storage capacity. This stiffening of the rectal walls can be due to scarring, surgery, radiation, or inflammatory bowel disease (IBS).
Surgery. Surgeries can cause muscle and nerve damage that leads to fecal incontinence — especially surgical procedures to remove hemorrhoids or other operations around the rectum or anus.
Rectal prolapse. Prolapse occurs when the rectum drops down into the anus. This is often caused by chronic straining to move the bowels.
Rectocele. Similar to rectal prolapse, rectocele occurs when the rectum protrudes from the vagina rather than the anus. This can lead to fecal incontinence, in addition to reproductive and feminine health problems.
Chronic laxative abuse. Overuse of laxatives can lead to FI later in life.
Age. Fecal incontinence can occur at any age, but it’s more common in older adults, and often progresses with age.
Stress or fear. Adjusting to a new environment can be stressful and lead to temporary fecal incontinence.
Menopause and hormone therapy. Low estrogen levels after menopause can lead to fecal incontinence, according to a 2017 study published in the journal Gastroenterology. Also, hormone replacement therapy throughout life may lead to FI in seniors, the research suggests.
Physical disability. Having difficulties reaching a toilet in time can be a cause of FI. Older people may have experienced falls or have medical conditions that limit their mobility or speed. It often takes time to adjust to the need to plan for extra time to get to a bathroom.
Dementia. Fecal incontinence often accompanies late-stage Alzheimer’s disease and other types of dementia.
Childbirth. Vaginal deliveries — especially those assisted by forceps, vacuums, or episiotomies — increase the likelihood of fecal incontinence later in life. Risk rises with the number of deliveries.
If you or an elderly loved one is experiencing FI, talk to a doctor. Usually, a general practitioner will refer you to a specialist, who may ask questions about living arrangements, diet, and current and past bowel function, according to Rao.
A patient may also be asked to bring a record of fecal incontinence to their first visit, or to create one between appointments.
In this journal, they will likely record:
After gathering information, the doctor may do a physical examination of the anus and perineum, the area between the anus and the genitals, to check for hemorrhoids or infection. They may also schedule one or more of these common tests:
Fecal incontinence may have severe emotional effects, which can contribute to anxiety, depression, and even social isolation. This is one reason management of FI is so important for seniors, who are already at increased risk of isolation and mental illness.
Minor incontinence may be managed at home, while more severe incontinence can benefit from biofeedback training, prescription medication, or surgery.
After a diagnosis is made, the doctor may suggest minor changes as a first step of treatment for bowel incontinence in the elderly:
Biofeedback exercises are a nonsurgical, non-invasive therapy option shown to reduce incontinence symptoms in a large percentage of people, according to the International Foundation for Functional Gastrointestinal Disorders. Through biofeedback therapy, patients learn to control bodily processes that are normally involuntary.
If other treatment methods don’t work, surgery may help reduce — or eliminate — FI. Surgical options to discuss with a doctor include:
If your elderly family member suffers from fecal incontinence, thorough care and planning can help avoid complications such as skin rashes, odors, and accidents.
UCSF Center for Colorectal Surgery. “Fecal Incontinence.” https://colorectalsurgery.ucsf.edu/conditions–procedures/fecal-incontinence.aspx
Johns Hopkins Medicine. “Fecal Incontinence in Women.” https://www.hopkinsmedicine.org/health/conditions-and-diseases/fecal-incontinence-in-women-qa-with-an-expert
Journal of Neurogastroenterology and Motility. “The Long-term Clinical Efficacy of Biofeedback Therapy.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879852/
Mayo Clinic. “Fecal Incontinence.” https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397