Anyone who suffers from fecal incontinence (FI) is bound to find the condition frustrating and embarrassing. For those who are caring for a loved one with FI, it can be difficult to know how to handle and help with the symptoms. While most people are reluctant to discuss this condition with their family and their doctor, addressing it head on can yield a great deal of valuable information and hope for a healthier and happier life.

Below, Kim English, BScN, MN, professor in the Trent/Fleming School of Nursing in Peterborough, Ontario, shares some answers to common questions about fecal incontinence, such as root causes, treatments options and tips for managing daily life with the condition.

“Talking about incontinence is not easy, and this is even truer when it comes to talking about bowel incontinence,” Kim acknowledges. “No one is comfortable bringing up this subject, but many suffer from this condition. It’s important to spread this information and encourage candid discussions between families and their health care providers.”

What Is Fecal Incontinence?

In Kim’s words, “Fecal incontinence is an inability to control bowel movements, which may result in stool leaking. A person dealing with bowel incontinence may pass some stool when attempting to pass gas, or they may experience a complete lack of control.

"Sometimes this loss of control happens because of short-term illnesses, such as diarrhea or gastroenteritis, but other times it may be associated with a longer-term illness or even general aging. Age-related decline is linked to FI due to changes in and/or damage to muscles and nerves in the bowel. Ironically, the condition can also be the result of chronic constipation. If a person becomes impacted, sometimes ‘overflow’ stool can leak from the rectum.”

How Is It Diagnosed?

“Your primary care provider will ask questions about your symptoms, including how long they have been occurring and what types of events bring on symptoms,” Kim says. “If a loved one is experiencing recurring accidents, it is important understand the nature of them as fully as possible. For example, some older individuals experience urge incontinence, which often occurs when they cannot make it to the bathroom in time, while others may experience passive incontinence, which happens when they are unaware that they need to have a bowel movement.

"Although it can be embarrassing to discuss in detail, it is crucial to gather as much information as you can to help your loved one’s physician understand the situation fully. Keeping a diary of eating and drinking habits, symptoms and digestive issues can help to narrow down possible causes. The doctor may also perform some diagnostic tests, including a colonoscopy, to determine the cause of the symptoms.”

What Are Some Treatment Options?

“The treatment for bowel control problems is largely dependent on the cause,” Kim says. “For example, if diarrhea is the culprit, then you may be prescribed medications such as bulk laxatives and/or bulking agents to develop more solid stools that are easier to control and will reduce leakage.

“Another way to treat fecal incontinence is by making some dietary changes. If chronic constipation is the underlying issue, your diet can play a significant role in either contributing to or minimizing symptoms. Increased fluid intake and eating more fiber-rich foods can help alleviate constipation and prevent accidents.

“Exercise can also help—especially those that are targeted at improving anal sphincter function and strengthening the pelvic floor muscles (Kegels). A trained therapist can provide the instructions needed to address these muscles and improve bowel and bladder control. Adding biofeedback therapy to this regimen can help ensure that the movements are being performed correctly and increase one’s awareness of the more subtle sensations involved in bodily functions.

“Bowel training is another option that can promote regular bowel movements (BMs) and prevent accidents, but it takes time to become effective. Essentially, you devise and stick to a pattern of having bowel movements at specific times throughout the day. By adhering to a schedule, your body gets used to going at those prescribed times (like after meals) and it decreases the chances of incontinence.

“In very serious cases, surgical options, such as sphincteroplasty, injections of non-absorbable bulking agents, sacral nerve stimulation, or even bowel diversion might be recommended to better manage symptoms. It all depends on the patient’s overall health and the main cause of their limited bowel control.”

Living with Limited Bowel Control

“For some individuals, more significant muscle and nerve damage from diseases like diabetes, multiple sclerosis, stroke and dementia can make treating and managing incontinence much more complicated. For seniors and their caregivers, adequate planning can help decrease the likelihood of accidents and ensure you are prepared in the event one does occur.

“Taking a ‘Plan B Bag’ that contains extra clothing, wipes, disposable underwear or pads, and a sealable bag for soiled items is always a good idea while you’re out and about with a loved one who is incontinent. Mapping out public restrooms and being diligent about using them as they are available and before they are needed can also prevent mishaps.

"If possible, try to avoid any known triggers. Each person is different, but eating tends to be a natural trigger for increased bowel activity, too, so organizing outings around meals or taking an antidiarrheal medication before eating can help your loved one avoid issues. You may need to help your loved one pay closer attention to their body and learn to pick up on subtle signs yourself. This is difficult, but can be done.”

Maintaining Skin Integrity and Comfort

“This condition can have profound psychological effects, such as embarrassment and isolation, but bowel control problems can also cause physical discomfort. Irritation to tissues in the rectal area can be unpleasant, but this can quickly turn into a more serious problem. Prevention is the best medicine, so do not wait until a loved one develops a complication from FI to seek out better ways for managing their symptoms and caring for their skin.

“The four biggest incontinence-related threats to skin integrity are moisture, altered skin pH, microorganisms and friction. It is of upmost importance to ensure that a patient's perineal area is always clean, dry and conditioned. Make a point of changing damp or soiled garments immediately, cleanse and/or rinse the area thoroughly, and allow it to air dry as often as possible. These steps will reduce odor, maintain skin integrity and keep your loved one comfortable.

“Exercise caution when cleansing or drying with a washcloth or applying topical products, though. Even if a loved one is diligent about their cleanliness and skin care, friction from some of these steps can still cause injury to delicate, thin skin. Opt for gently patting to dry or apply creams in lieu of wiping or rubbing.

"While soap and water is a go-to for most people, special incontinence products are formulated to cleanse effectively while minimizing skin irritation. Examples include no-rinse cleansers and barrier ointments, creams, or sprays. These barrier products protect the skin from over-exposure to moisture, friction, irritation and bacteria that can lead to incontinence dermatitis (diaper rash), infections and even pressure ulcers. For some, a bidet is helpful for adequate rinsing both after normal BMs and episodes of incontinence.

“If your loved one uses disposable incontinence products, such as liners, briefs or bed pads, be sure to choose items that have a soft outer layer that wicks moisture away from the skin and into an absorbent core. Although some products may do a better job of containing accidents, try to avoid those that keep dampness trapped against the skin. This will only cause more problems in the long run."

Seeking Help

“FI is not an easy condition for patients or their caregivers to manage, but there are ways to help decrease symptoms and treat this disorder,” Kim reassures. “The important first step is to speak to your loved one’s primary care provider!”

Thank you, Kim, for your guidance on this sensitive subject. This information will help many readers who are dealing with this issue and looking for tips and techniques to improve their loved one’s condition and quality of life.