Accidental bowel leakage can be frustrating, unpredictable and hard to talk about. At the OHSU Center for Women’s Health, we know how much it can affect your daily life. We offer the latest care for fecal incontinence. 

You’ll find:  

• Team-based care from top experts in treating women with fecal leaks.
• Thorough evaluation using the latest tests and technology.
• Effective non-surgical treatment options, including physical therapy.
• Complete care in a comfortable, welcoming setting.

What is fecal incontinence?

Fecal incontinence is a loss of bowel control that results in leaks of gas, mucus or stool. It can range from small leaks once in a while to the complete inability to hold stool. It can cause embarrassment, disrupt your activities, and affect your quality of life.

What causes fecal incontinence?

The muscles or nerves in your intestines become weak or damaged from an injury, aging or another disorder.

The most common causes in women we treat are:

• Childbirth injuries: Pregnancy and vaginal delivery can damage the muscles, tissues and nerves around your rectum. The injuries can cause long-term weakness and fecal leaks.
• Anal sphincter injuries: Childbirth can damage or tear the muscles around your anus that hold in stool. Past surgical procedures or other health conditions also can weaken or hurt these muscles.
• Nerve injuries: If the nerves in your rectum and anal sphincter aren’t working well, it can cause muscle weakness, a loss of feeling, and an inability to control your stool. Childbirth, chronic constipation and illness can damage these nerves.  
• Pelvic organ prolapse: If your pelvic organs lose support and fall out of position (prolapse), it can cause bowel problems. For example, when your rectum presses into the wall of your vagina, you can have trouble starting or finishing bowel movements.

Who gets bowel control problems?

Fecal incontinence affects about 8% of adults in the United States. The rates are higher in older women. About 15% of women over age 70 have it.

Risks for women include:

• Aging
• Pregnancy and vaginal delivery, especially with a larger baby, a vaginal tear or surgical cut (episiotomy), or the use of forceps
• Pelvic floor disorders
• Chronic constipation or diarrhea
• Conditions that affect the nerves
• Stroke

Symptoms of fecal incontinence

Talk with your care provider if you have:  

• Accidental leaks of gas, mucus or stool
• An inability to hold stool until you reach the bathroom
• Stool streaks or stains regularly on your underwear
• Fecal leaks when you exercise, cough or sneeze
• Chronic diarrhea or constipation

Diagnosing fecal incontinence

We check your entire pelvic floor to find any disorders or injuries that may contribute to your fecal leaks.

Passing stool involves a complex system of nerves and muscles. Careful evaluation helps us create the right care plan for you.

Your care team will talk with you about what to expect before each test. These may include:

24-hour bowel diary: Before your first visit, we will ask you to record how much you eat, drink and use the bathroom. This will help us find any daily habits you could change.

Manometry: This test measures the pressure in your rectum and anus while you squeeze those muscles. We insert a thin, flexible tube in your rectum to map the pressure zones.

Ultrasound: We are the region’s top experts in using 3D ultrasound to find any injuries or other problems in your pelvic organs. This safe, painless test uses sound waves to create detailed images of your organs on a screen.

Nerve studies: We are one of the few places in the U.S. offering specialized nerve tests to check your pelvic nerves. While rarely needed, these tests can find problems with nerves that control your bowel muscles.

Treatments to stop fecal leaks

We have the expertise to help you gain control over your bowel movements. We offer a full range of care options, from diet changes to robotic surgery.

We will work with your primary care provider and specialists in the Digestive Health Center and other parts of OHSU to treat the causes of your fecal incontinence.

Non-surgical treatments

Diet changes: Small changes can make a difference to your bowel function. We may recommend increasing fiber, avoiding caffeine or adjusting how often you eat.

Medications: We can prescribe medication to treat some types of incontinence. You doctor will talk with you about drugs that might relieve your symptoms.

Physical therapy: Our physical therapists are skilled in helping you build muscle strength through your pelvic floor. Exercises combined with biofeedback devices can help you target the right muscles for the best results.

Pessary: You can insert this flexible device in your vagina to compress your rectum. It comes in different sizes and shapes.

Surgical treatments

If you have severe muscle or nerve damage, you may need surgery to fix the problem.

Our most common procedures for fecal incontinence are:

• Sacral neuromodulation: Your doctor places a small device in your lower back to stimulate the nerves that control your bowel muscles. This is a two-step outpatient procedure that can stop fecal leaks.
• Sphincteroplasty: We repair torn muscles in your anal sphincter to restore full control of your bowel. During the procedure, the surgeon overlaps the two ends of the torn muscle and stiches them into place.  

Resources about fecal incontinence

• Bowel Control, Voices for PFD
• Bowel Health, National Association for Continence
• Bowel Control Problems, National Institute of Diabetes and Digestive and Kidney Diseases
• Accidental Bowel Leakage, The American College of Obstetricians and Gynecologists
• Fecal Incontinence, American Association of Gastroenterology
• Bowel Incontinence, U.S. National Library of Medicine