Fecal Incontinence

Unlike urinary incontinence, fecal incontinence is less frequent but it represents a significant health and aesthetic problem. Fecal incontinence can be described as involuntary and unintentional leakage of stool.


The majority of causative factors are various disorders of the rectum that disrupt function of the anal sphincter. Other possible causes are neurological diseases related to disorders of sphincter innervation.

Sphincter damage

Damage to the sphincter is possible especially during anal sex, when inserting foreign objects into the rectum (less standard sexual practices) and during childbirth. Combination of larger diameter of newborn’s head and narrow birth canal can result in serious tearing of anal sphincter. Best prevention is timely execution of episiotomy by the obstetrician.

Inflammatory bowel diseases

Both ulcerative colitis and Crohn's disease may seriously damage the rectum including anal sphincter. In particularly anal forms of Crohn's disease can cause complicated anal fistulas that can be infected by bacteria forming abscesses.

Weakened pelvic floor muscles

Weakening of the pelvic floor musculature is more typical for the elderly and for women; the risk factors include obesity, lack of physical activity and multiple births. Weakened pelvic floor is also related to urinary incontinence.

Neurological causes

Every neurological disorder that damages innervation of anal sphincter is related to fecal incontinence. This most often happens because of a stroke, Alzheimer's disease, Parkinson's disease and multiple sclerosis. Direct damage of the spinal cord responsible for sphincter disruption may occur due to trauma or congenital spina bifida.


Anal surgery interventions (solving local cancers, operating complications of Crohn’s disease, etc.) can damage the tissue or innervations of anal sphincter. If the entire rectum is removed, sphincter function is completely destroyed. Such situation often leads to creation of colostomy.


Pelvic irradiation in the treatment of tumor diseases can impair both the sphincter and nerves that control it.

Congenital defects

Congenital malformations of rectum or its anatomical innervation can lead to fecal incontinence in childhood.

Diarrheal states

Liquid consistence of stool obviously increases the risk of fecal incontinence as it is difficult to hold even with healthy sphincter it is harder to maintain even in healthy sphincter. This is why people suffering from chronic diarrhea have more risk of fecal incontinence.


Fecal incontinence is a great social and health problem, especially in immobile patients. Feces contain large amount of bacteria. Liquid or semi-liquid stool irritates and macerates surrounding tissue and causes formation of infected pressure sores.


It is necessary to determine the cause of the incontinence and treat it, if possible. Medication against diarrhea may be administered; obese people should reduce their weight and strengthening the muscles of the pelvic floor. There are even some surgical possibilities to reconstruct the sphincter, create an anatomical adaptation of the rectum or to create a permanent colostomy. When fecal incontinence can not be solved, it is at least important in immobile patients to ensure appropriate local hygiene to prevent occurrence of pressure sores.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources