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UW Health SMPH
American Family Children's Hospital

Fecal Incontinence/Accidental Bowel Leakage (ABL)

Fecal incontinence or accidental bowel leakage (ABL) - the impaired ability to control gas or stool - can range in severity from mild difficulty with gas control to severe loss of control over liquid or formed stools on a daily basis. It is not an uncommon condition and it often coexists with urinary problems, but unfortunately, due to embarrassment, many sufferers of fecal incontinence do not seek treatment.
At UW Health, several methods of assessment and forms of treatment are available. Collaboration among medical and surgical specialists is an integral part of our multi-disciplinary approach to complex pelvic floor disorders. When dealing with such problems as urinary incontinence and other disorders, a combined approach is often necessary prior to undertaking proper treatment.
What causes fecal incontinence/ABL?

There are numerous causes, the most common being injury during childbirth, which may help explain the higher prevalence of fecal incontinence in women. These childbirth injuries are usually due to a separation of the muscles (sphincters) that control continence. Injury of the nerves controlling these muscles may also contribute to the problem.

Previous anal surgery is another potential cause of fecal incontinence - however, injury to these muscles may not become evident immediately. This is because the muscles controlling bowel function tend to weaken with age and incontinence may not become an issue until later in life.

Other risk factors include:
  • Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), Crohn's disease, ulcerative colitis and other digestive disorders, such as chronic constipation and chronic diarrhea (especially after gallbladder removal)
  • Diabetes
  • Obesity
  • Stroke
  • Neurologic conditions
  • Dementia
  • Multiple sclerosis
  • Radiation to the pelvic floor from cancer treatment
  • Surgery in the pelvis (such as prostate, cervical, uterine and colorectal cancer)
  • Trauma due to either an accident or a vaginal birth
  • Scleroderma
  • Damage to the central nervous system and spinal cord
  • Rectal prolapse 
How is the cause determined?

Initially, discussion with your physician will determine the severity of the problem. An appointment can then be made with a colon and rectal surgeon, which will entail a complete physical exam and an account of your history with the problem.
Further testing can include: 
  • Anorectal manometry: Measures resting and squeeze pressures throughout the length of the anal canal
  • Pudendal nerve testing:  A procedure in which an electrode is used to locate the nerve and sense sphincter contraction. Anorectal manometry and pudendal nerve testing assess the degree of muscle weakness and determine whether injury to the nerves is also contributing to your condition.
  • Ultrasound: If muscle injury is a possibility, an ultrasound that allows visualization of internal and external sphincter muscles will also be performed to assess for a defect.
  • Defecography: If no defect is found, a special x-ray called defecography may then be necessary to investigate other potential causes of incontinence. 
How is fecal incontinence/ABL treated?

Mild problems may be addressed with dietary changes or constipating medications. Strengthening the pelvic floor through Kegel squeezes can also improve symptoms.
Some people will benefit from biofeedback training to learn to sense the stool and strengthen the muscles to control the problem. In biofeedback training, an EMG sensor connected to a computer provides a visual display of the patient's efforts to control pelvic floor muscles. Over the course of the biofeedback training sessions, the patient then learns to isolate the appropriate muscles, typically resulting in an improvement in incontinent episodes.
Physicians who specialize in the treatment of ABL may also offer an office-based procedure called Solesta to bulk the anal canal, or an outpatient surgery to place a pacemaker for the pelvic floor called sacral neuromodulation, or Interstim.
If a separation in the muscle is found during assessment of a patient, surgery to repair these muscles can be performed with excellent results. Sphincterplasty is the surgical procedure that repairs the defect in the muscles that control continence. It involves "overlapping" the normal muscle to repair the defect, hopefully resulting in improved bowel control.