Have You Experienced Fecal Incontinence? A Chief Cleveland Clinic Doctor Lists Symptoms, Triggers, and Treatments

If you find yourself passing stool without warning—even carrying wipes or changes of clothes, finding that what you sense as a hint of gas is often something more—then rest assured, you’re in plenty of company. Just as urinary incontinence involves urinary leakage from the bladder, fecal incontinence involves leaking from the bowel. According to a 2024 Frontiers in Surgery review, up to 15% of the general population experiences this sudden and chronic experience with bowel movements. Because of the stigma surrounding it, this condition often goes underreported.

The good news? While a nuisance (and, yes, an embarrassment), fecal incontinence is treatable.

What is fecal incontinence?

Fecal incontinence (FI) is the inability to control bowel movements, resulting in stool leakage. “The amount of leakage can be variable—from minor seepage to total loss of control of stool,” says colorectal surgeon Anna Spivak, DO, Section Chief of Pelvic Floor Surgery at the Cleveland Clinic.

For instance, explains the Mayo Clinic, it can vary from “urge incontinence”—severe urgency, where you can feel the need but can’t make it to the bathroom—to “passive incontinence,” or having a full accident with no sensation. The leakage can range from liquid to solid, from small to large amounts. All this can be variable and increase with age, too. Research has suggested that women tend to be more frequent sufferers.

Don’t confuse temporary stool leakage with fecal incontinence. Occasional stool leakage, or diarrhea, might be triggered by a significant dietary change, illness, or short-term digestive episode; but chronic incontinence is a recurring, long-term loss of bowel control that may suggest an underlying medical condition.

It can significantly impact quality of life, but treatment can improve it.

Common causes of fecal incontinence

Here are four key causes of fecal continence. Note, however, that there can be more than one underlying cause.

Weak pelvic floor and weak sphincter muscles

Weak pelvic floor and weak sphincter muscles are probably the most common cause, more so in women, says Dr. Spivak. She explains that as women get older, maybe they had children, their muscles may not contract and squeeze well for holding a bowel movement. This could also be coupled with diarrhea or other gastrointestinal problems.

Nerve damage

Dr. Spivak suggests that nerve damage is common in women, but she also sees it in male patients. (One shared the story with us of how he was diagnosed with fecal incontinence after multiple bouts of cancer that affected the pelvic region of his body).

In these cases, the nerves that control sphincter muscles and sense stool in the rectum can get injured or stretched during childbirth, spinal cord injury, stroke, diabetes, and multiple sclerosis, according to Mayo Clinic. Chronic constipation (frequently straining during bowel movements) can also be problematic, based on research in The American Journal of Gastroenterology.

Prior surgery

Cases are rising among patients who’ve undergone rectal cancer surgery, says Dr. Spivak. They can get incontinence due to nerve damage in the pelvic area from radiation treatment, called low anterior resection syndrome. Nerve damage may also result from prostate or uterine surgeries, too.

Muscle damage due to childbirth issues/trauma

Injury to the anal sphincter (ring of muscle at the end of rectum) may make it difficult to hold onto stool. “Women who just had babies, and maybe they had a bad tear during vaginal delivery, may experience incontinence,” says Dr. Spivak. Research published in Ultrasound in Obstetrics & Gynecology supports this.

The Mayo Clinic points out that damage may also occur after episiotomy or when forceps are used during childbirth.

Recognizing the symptoms of fecal incontinence

Be on the lookout for:

• Bloating or excessive gas that’s difficult to control
• Bowel movement urgency
• Unpredictable or inconsistent bowel movements
• Accidental stool leakage during physical activity or after meals
• Not getting to the toilet in time (inability to control bowel movements is the main symptom)

Fecal incontinence symptoms fall along a spectrum, Dr. Spivak says. “They can be very bothersome, life-limiting, or a nuisance.” Incontinence “can be a small amount of gas, a small amount of mucus, a small amount of stool, or it can be a full bowel movement accident.” It may occur once a day, multiple times a day, or even once a year. In any of these cases, it’s worth raising with your healthcare provider.

When and how to seek help

Have open discussions with your doctor or primary care provider (PCP) about your bowel movements or any noticeable issues.

If experiencing stool leakage unexplained by recent diet changes, illness, or upset GI, make an appointment with your PCP or gastroenterologist. Seek immediate attention or visit the emergency department if you notice significant blood in your stool or frequent fecal incontinence with dehydration.

What to expect from your doctor’s visit

“The most important part of the diagnosis is the patient’s medical or surgical history and ascertaining the symptoms,” says Dr. Spivak. For instance, did the patient have any prior surgery and, if so, what kind?

To determine suspected nerve and muscle damage, Dr. Spivak notes they follow standardized procedure per American Society of Colon & Rectal Surgeons guidance, which can include:

• Asking questions, such as about stool consistency and leakage, constipation, digestive diseases or urinary incontinence, and prior treatments
• Conducting a physical exam like a digital rectal exam or an anoscopy (A digital rectal exam checks for muscle tone, muscle coordination, and sensation, says the Cleveland Clinic, while, the Clinic notes, an anoscopy examines the inside of the anal canal.)
• Potentially conducting a manometry exam, which measures sphincter tone and rest/squeeze pressures, plus muscle coordination
• Potentially conducting defecography, an X-ray or MRI imaging procedure, if anatomic abnormality is a suspected cause of incontinence

“The most important diagnostic test is a digital rectal exam,” says Dr. Spivak. “It’s sometimes the only test that’s needed.”

Current treatment options

After reviewing your medical and surgical history and diagnostic test results, your doctor will create an individualized treatment plan that may include:

• Implanted device, such as sacral nerve stimulation (SNS), per the Cleveland Clinic—patients are finding significant improvement from this modern modality
• Diet modifications, like adding fiber and avoiding “trigger” and pro-inflammatory foods, suggests a study published in Frontiers in Nutrition
• Pelvic floor therapy—physical therapy to strengthen pelvic floor muscles
• Medication to help firm the stool or lessen bowel activity
• Colostomy surgery (a stoma and colostomy bag) in treatment-resistant or very severe cases

“Treatment for fecal incontinence starts with conservative management,” says Dr. Spivak. That may include diet modifications and physical therapy. “A large percentage of patients don’t need additional treatment beyond conservative measures.”

How to overcome the stigma associated with fecal incontinence

Fecal incontinence doesn’t need to be stigmatized.

• Remember you’re not alone. About 1 in 12 people experience fecal incontinence, with higher rates in older people.
• Don’t suffer silently; treatments may be simple and significantly improve quality of life.
• Find a PCP with whom you’re comfortable talking about your bowel function.

For daily wellness updates, subscribe to The Healthy by Reader’s Digest newsletter and follow The Healthy on Facebook and Instagram. Keep reading:

• Why Does It Burn When I Poop? An Expert Doctor Explains
• What Is ‘Stress Poop’? Gastro Doctors Reveals the Science Behind This Extremely Normal Experience
• New Study Says Pooping This Often May Lower Your Risk of Brain Disorder
• “Why Is My Poop Red?” 9 Possible Reasons, from a Cleveland Clinic G.I. Doctor