The treatment options for bowel incontinence depend on the cause of the incontinence and the severity of the symptoms. Some common treatment options include:
Medications
Depending on the cause of fecal incontinence, options include:
- Anti-diarrheal drugs such as loperamide (Imodium A-D) and those containing diphenoxylate and atropine (Lomotil).
- Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil), if chronic constipation is causing your incontinence.
Exercise and other therapies
If muscle damage is causing fecal incontinence, your doctor may recommend a program of exercise and other therapies to restore muscle strength. These treatments can improve anal sphincter control and the awareness of the urge to defecate.
Options include:
- Kegel exercises. Kegel exercises strengthen the pelvic floor muscles. These muscles support the bladder and bowel and in women, the uterus. Strengthening these muscles may help reduce incontinence. To perform Kegel exercises, contract the muscles that you use to stop the flow of urine. Hold the contraction for three seconds, then relax for three seconds. Repeat this pattern 10 times. As your muscles strengthen, hold the contraction longer. Gradually work your way up to three sets of 10 contractions every day.
- Biofeedback. Specially trained physical therapists teach simple exercises that can increase anal muscle strength. These exercises can help:
- Strengthen pelvic floor muscles.
- Sense when stool is ready to be released.
- Contract the muscles if having a bowel movement at a certain time is inconvenient.
- Bowel training. Your doctor may recommend making a conscious effort to have a bowel movement at a specific time of day: for example, after eating. Establishing when you need to use the toilet can help you gain greater control.
- Bulking agents. Injections of nonabsorbable bulking agents can thicken the walls of the anus. This helps prevent leakage.
- Sacral nerve stimulation. The sacral nerves run from your spinal cord to muscles in the pelvis. They regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses to the nerves can strengthen muscles in the bowel.
- Posterior tibial nerve stimulation. This minimally invasive treatment stimulates the posterior tibial nerve at the ankle. In a large study, however, this therapy didn’t prove to be significantly better than a placebo.
- Vaginal balloon (Eclipse System). This is a pump-type device inserted in the vagina. The inflated balloon results in pressure on the rectal area, leading to a decrease in the number of episodes of fecal incontinence.
- Radiofrequency therapy. This involves delivering radiofrequency energy to the wall of the anal canal to help improve muscle tone. This is sometimes called the Secca procedure. Radiofrequency therapy is minimally invasive and is generally performed under local anesthesia and sedation. However, this procedure isn’t always covered by insurance.
Surgery
Treating fecal incontinence may require surgery to correct an underlying problem, such as rectal prolapse or sphincter damage caused by childbirth. The options include:
- Sphincteroplasty. This procedure repairs a damaged or weakened anal sphincter that occurred during childbirth. Doctors identify an injured area of muscle and free its edges from the surrounding tissue. They then bring the muscle edges back together and sew them in an overlapping fashion. This helps strengthen the muscle and tighten the sphincter. Sphincteroplasty may be an option for people trying to avoid colostomy.
- Artificial bowel sphincter involves implanting an artificial device (prosthesis) around the anus. This device is designed to mimic the normal anal muscle.
- Treating rectal prolapse, a rectocele or hemorrhoids. Surgical correction of these problems will likely reduce or eliminate fecal incontinence. The longer the prolapse goes untreated, the higher will be the risk of fecal incontinence not resolving after surgery.
- Colostomy, also called bowel diversion. This surgery diverts stool through an opening in the abdomen. Doctors attach a special bag to this opening to collect the stool. Colostomy is generally considered only after other treatments haven’t been successful.
When medical treatments can’t completely eliminate incontinence, products such as absorbent pads and disposable underwear can help you manage the problem. If you use pads or adult diapers, be sure they have an absorbent wicking layer on top. This helps keep moisture away from your skin.
It is important to speak with a healthcare provider to determine the best treatment options for your specific case of bowel incontinence.