Treatment

Treatment for fecal incontinence depends on the cause and severity; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary for successful control since continence is a complicated chain of events.

Dietary Changes

Food affects the consistency of stool and how quickly it passes through the digestive system. If your stools are hard to control because they are watery, you may find that eating high fiber foods adds bulk and makes stool easier to control. But people with well-formed stools may find that high fiber foods act as a laxative and contribute to the problem. Other foods that may make the problem worse are drinks containing caffeine, like coffee, tea, and chocolate, which relax the internal anal sphincter muscle.

You can adjust what and how you eat to help manage fecal incontinence.

• Keep a food diary. List what you eat, how much you eat, and when you have an incontinent episode. After a few days, you may begin to see a pattern involving certain foods and incontinence. After you identify foods that seem to cause problems, cut back on them and see whether incontinence improves. Foods that typically cause diarrhea, and so should probably be avoided, include
  
  
  • caffeine
  • cured or smoked meat like sausage, ham, or turkey
  • spicy foods
  • alcohol
  • dairy products like milk, cheese, and ice cream
  • fruits like apples, peaches, or pears
  • fatty and greasy foods
  • sweeteners, like sorbitol, xylitol, mannitol, and fructose, which are found in diet drinks, sugarless gum and candy, chocolate, and fruit juices
  
  
  
• Eat smaller meals more frequently. In some people, large meals cause bowel contractions that lead to diarrhea. You can still eat the same amount of food in a day, but space it out by eating several small meals.
  
  
• Eat and drink at different times. Liquid helps move food through the digestive system. So if you want to slow things down, drink something half an hour before or after meals, but not with the meals.
  
  
• Eat the right amounts of fiber. For many people, fiber makes stool soft, formed, and easier to control. Fiber is found in fruits, vegetables, and grains. You'll need to eat 20 to 30 grams of fiber a day, but add it to your diet slowly so your body can adjust. Too much fiber all at once can cause bloating, gas, or even diarrhea. Also, too much insoluble, or undigestible, fiber can contribute to diarrhea. So if you find that eating more fiber makes your diarrhea worse, try cutting back to two servings each of fruits and vegetables and removing skins and seeds from your food.
  
  
• Eat foods that make stool bulkier. Foods that contain soluble, or digestible, fiber slow the emptying of the bowels. Examples are bananas, rice, tapioca, bread, potatoes, applesauce, cheese, smooth peanut butter, yogurt, pasta, and oatmeal.
  
  
• Get plenty to drink. You need to drink eight 8-ounce glasses of liquid a day to help prevent dehydration and to keep stool soft and formed. Water is a good choice, but avoid drinks with caffeine, alcohol, milk, or carbonation if you find that they trigger diarrhea.
  
  

Over time, diarrhea can rob you of vitamins and minerals. Ask your doctor if you need a vitamin supplement.

Medication

If diarrhea is causing the incontinence, medication may help. Sometimes doctors recommend using bulk laxatives to help people develop a more regular bowel pattern. Or the doctor may prescribe antidiarrheal medicines such as loperamide or diphenoxylate to slow down the bowel and help control the problem.

Bowel Training

Bowel training helps some people relearn how to control their bowels. In some cases, it involves strengthening muscles; in others, it means training the bowels to empty at a specific time of day.

• Use biofeedback. Biofeedback is a way to strengthen and coordinate the muscles and has helped some people. Special computer equipment measures muscle contractions as you do exercises—called Kegel exercises—to strengthen the rectum. These exercises work muscles in the pelvic floor, including those involved in controlling stool. Computer feedback about how the muscles are working shows whether you're doing the exercises correctly and whether the muscles are getting stronger. Whether biofeedback will work for you depends on the cause of your fecal incontinence, how severe the muscle damage is, and your ability to do the exercises.
  
  
• Develop a regular pattern of bowel movements. Some people—particularly those whose fecal incontinence is caused by constipation—achieve bowel control by training themselves to have bowel movements at specific times during the day, such as after every meal. The key to this approach is persistence—it may take a while to develop a regular pattern. Try not to get frustrated or give up if it doesn't work right away.
  
  

Surgery

Surgery may be an option for people whose fecal incontinence is caused by injury to the pelvic floor, anal canal, or anal sphincter. Various procedures can be done, from simple ones like repairing damaged areas, to complex ones like attaching an artificial anal sphincter or replacing anal muscle with muscle from the leg or forearm. People who have severe fecal incontinence that doesn't respond to other treatments may decide to have a colostomy, which involves removing a portion of the bowel. The remaining part is then either attached to the anus if it still works properly, or to a hole in the abdomen called a stoma, through which stool leaves the body and is collected in a pouch.

Reference:

National Digestive Diseases Information Clearinghouse, USA.