From the Guidelines
Fecal incontinence is primarily caused by a combination of factors including bowel disturbances such as diarrhea, anorectal dysfunctions, and chronic illnesses, rather than solely obstetric history or anal sphincter trauma. The most significant risk factors for fecal incontinence (FI) include diarrhea, with an odds ratio of 53 [95% CI=6.1–471] [1], as well as other conditions like cholecystectomy, current smoking, history of rectocele, stress urinary incontinence, and higher BMI. Other associated conditions that may lead to FI include advanced age, disease burden, anal sphincter trauma from obstetrical injury or prior surgery, decreased physical activity, anorectal inflammation from diseases like inflammatory bowel disease, peripheral neuropathy from conditions such as diabetes, and neurological disorders including dementia, stroke, or spinal cord injury 1.
Key factors contributing to fecal incontinence can be summarized as follows:
- Bowel disturbances, particularly diarrhea
- Anorectal dysfunctions
- Chronic illnesses and their burden
- Advanced age
- Disease burden, including diabetes and inflammatory bowel disease
- Anal sphincter trauma
- Neurological disorders
- Decreased physical activity
It's essential to address these underlying conditions and risk factors to manage symptoms of fecal incontinence effectively. Treatment approaches may involve dietary changes, pelvic floor exercises, medications to manage bowel movements, biofeedback therapy, or in severe cases, surgical interventions 2. Identifying and managing the specific cause of fecal incontinence is crucial for improving patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Causes of Fecal Incontinence
- Fecal incontinence is more common in older women and those with chronic bowel disturbance, diabetes, obesity, prior anal sphincter injury, or urinary incontinence 3
- Inflammatory bowel disease (IBD) is also a significant factor, with fecal incontinence being more common among IBD patients than non-IBD controls (OR = 7.73; 95% CI 6.26 to 9.84) 4
- Other potential causes include: + Chronic bowel disturbance + Diabetes + Obesity + Prior anal sphincter injury + Urinary incontinence
Prevalence of Fecal Incontinence
- Nine percent of adult women experience episodes of fecal incontinence at least monthly 3
- The pooled prevalence of fecal incontinence among IBD patients without IPAA is 24% (95% CI 18%-30%) 4