Bowel control problems can be miserable. The loss of normal control of the bowels that leads to leakage of solid or liquid stool (feces) or gas causing embarrassment & hygiene problems. These problems also are called fecal incontinence. Bowel control problems occur up to eight times more often in women than in men. The problem also is more common in older women or in women who have just given birth.

The most common cause of bowel control problems in women is childbirth. As the baby passes through the vagina, the muscles or the nerves near the rectum may be stretched or torn.  Some women have short-term loss of bowl control right after childbirth. It likely will improve within a few months. In other cases, it does not occur until many years later. As a person ages, the sphincter muscles of the anus may weaken. A minor problem in a younger woman can become worse in later life.

Some Causes of Bowel Control Problems

Causes of bowel control problems include the following:

  • Stools that are too loose (diarrhea)
  • Stools that are too hard (constipation)
  • Certain illnesses such as diabetes, multiple sclerosis, or stroke (they can damage the nerves to the rectum and cause loss of feeling)
  • Problems with the gastrointestinal system, such as inflammatory bowel disease, irritable bowel syndrome, colitis, or cancer of the rectum
  • Surgery or radiation therapy to the pelvic area

Treatment

The most effective treatment to improve bowel control is to avoid loose or soft stools. This can be accomplished by increasing fiber in your diet, & sometimes using an over the counter medication which reduces bowel motility, such as loperamide.

Strengthening the anal & pelvic muscles by doing Kegel exercises or physical therapy with biofeedback is always recommended.

If the muscle around the bowel opening (anal sphincter) has been damaged during childbirth, it can be repaired surgically. This can be assessed using ultrasound. Surgery is less effective if there is nerve damage with muscle weakness, which both increase with age.

A new treatment called sacral neuromodulation (“Interstim”) was approved by the FDA in 2012 for the treatment of bowel incontinence. Studies have shown that it is more effective than surgery & will improve control in over 80% of patients. This treatment seems to work by reestablishing the normal control between the bowel & brain.