What are the causes of fecal incontinence (FI)?

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Last updated: April 18, 2025 • View editorial policy

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

Associated Factors

  • Fecal incontinence is associated with increased risk of nursing home placement and negatively affects quality of life and mental health 3
  • Lack of information about effective solutions is an important barrier for both patients and health care professionals 3

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Management of Fecal Incontinence.

Obstetrics and gynecology, 2020

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.