From the Guidelines
Fecal incontinence is primarily caused by bowel disturbances, particularly diarrhea, as well as anorectal dysfunctions, with independent risk factors including current smoking, history of rectocele, stress urinary incontinence, and higher BMI. The causes of fecal incontinence can be multifactorial, involving a combination of factors such as anorectal dysfunctions, bowel disturbances, and other conditions. According to 1, independent risk factors for fecal incontinence include diarrhea, with an odds ratio of 53, as well as cholecystectomy, current smoking, history of rectocele, stress urinary incontinence, and higher BMI. Other conditions associated with fecal incontinence include advanced age, disease burden, anal sphincter trauma, and decreased physical activity.
Some of the key causes of fecal incontinence include:
- Bowel disturbances, particularly diarrhea
- Anorectal dysfunctions
- Current smoking
- History of rectocele
- Stress urinary incontinence
- Higher BMI
- Advanced age
- Disease burden
- Anal sphincter trauma
- Decreased physical activity
- Neurological disorders, such as dementia, stroke, or spinal cord injury
- Inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis
- Iatrogenic anal sphincter injury
- Cognitive impairments, such as dementia
It is essential to identify the specific cause of fecal incontinence to develop an effective treatment plan, which may include conservative therapies, pelvic floor retraining with biofeedback therapy, perianal bulking agents, or sacral nerve stimulation, as recommended by 1.
From the FDA Drug Label
Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency. The causes of fecal incontinence are not directly stated in the drug label. However, it can be inferred that a decrease in the tone of the anal sphincter may be a contributing factor to fecal incontinence, as loperamide increases the tone of the anal sphincter to reduce incontinence.
- Key factors that may contribute to fecal incontinence include:
- Decreased tone of the anal sphincter 2
From the Research
Causes of Fecal Incontinence
The causes of fecal incontinence can be attributed to various factors, including:
- Bowel disturbances, such as diarrhea 3
- Anal sphincter trauma, including obstetrical injury or previous surgery 3, 4
- Neurological disorders, such as pudendal neuropathy 5, 4
- Inflammatory bowel disease 3
- Pelvic floor anatomical disturbances 3
- Diminished rectal compliance, which can be caused by proctitis, low anterior resection, or small pouches 4
- Faecal impaction, which can cause paradoxal diarrhea 4
- Diarrhea 3, 4
- Chronic illness, such as diabetes and obesity 6
- Prior anal sphincter injury 6
- Urinary incontinence 6
Risk Factors
Certain risk factors can increase the likelihood of developing fecal incontinence, including:
- Age, with older women being more likely to experience fecal incontinence 6
- Chronic bowel disturbance 6
- Neurological disease involving the pelvic floor and/or the central nervous system 4
- Damage to the anal sphincter muscle and/or pelvic floor muscles 7
- Neurological changes in the central or peripheral nervous system 7