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Causes
By Mayo Clinic staff
A broad range of conditions and disorders can cause fecal incontinence, including:
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Constipation. It's ironic, but a common cause of fecal incontinence is constipation. That's because chronic constipation may lead to impacted stool — a large mass of dry, hard stool within your rectum. This mass can be too large for you to pass, and as a result, the muscles of your rectum and intestines stretch, and then eventually weaken. Watery stool from farther up in the digestive system may move around the hard mass and leak out, causing fecal incontinence.
Besides causing the muscles of your anus to stretch and weaken, chronic constipation may also make the nerves of the anus and rectum less responsive to the presence of stool in the rectum. Additionally, weakened muscles don't move stool as efficiently through the digestive system.
- Diarrhea. Solid stool is easier to retain in the rectum than is loose stool, so the loose stools of diarrhea can cause or worsen fecal incontinence.
- Muscle damage. Often, the cause of fecal incontinence is injury to the anal sphincter — the rings of muscle at the end of the rectum that help hold in stool. If these muscles are damaged, they're simply not strong enough to hold stool back properly, and some may leak out. This kind of damage can occur during childbirth, especially if you have an episiotomy or forceps are used during delivery.
- Nerve damage. Fecal incontinence can be caused by damage to the nerves that sense stool in the rectum or to those that control the anal sphincter. Nerve damage can be caused by childbirth, constant straining during bowel movements, spinal cord injury or stroke. Diseases such as diabetes and multiple sclerosis also can affect these nerves and cause damage that leads to fecal incontinence.
- Loss of storage capacity (accommodation) in the rectum. Normally, your rectum stretches to accommodate stool. If your rectum is scarred or your rectal walls have stiffened from surgery, radiation treatment or inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, the rectum can't stretch as much as it needs to, so excess stool can leak out.
- Surgery. Surgery to treat hemorrhoids — enlarged veins in the rectum or anus — can damage the anus and cause fecal incontinence, as can more-complex operations involving your rectum and anus.
- Rectal cancer. Cancer of the anus and rectum can lead to fecal incontinence if the cancer invades the muscle walls or disrupts the nerve impulses needed for defecation.
- Other conditions. If your rectum drops down into your anus (rectal prolapse) or, in women, if the rectum protrudes through the vagina (rectocele), fecal incontinence can result. Hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence.
- Robson K, et al. Fecal incontinence in adults. http://www.uptodate.com/home/index.html. Accessed June 18, 2010.
- Bartolo DC, et al. Anal incontinence. Best Practice & Research Clinical Gastroenterology. 2009;23:505.
- Fecal incontinence. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/fecalincontinence.pdf. Accessed June 18, 2010.
- McQuaid KR. Gastrointestinal disorders. In: McPhee SJ, et al. Current Medical Diagnosis and Treatment. New York, N.Y.: McGraw-Hill; 2010. http://www.accessmedicine.com/content.aspx?aID=6395. Accessed June 18, 2010.
- Hannaway CD, et al. Fecal incontinence. Obstetric and Gynecologic Clinics of North America. 2008;35:249.
- Mellgren A. Fecal incontinence. Surgical Clinics of North America. 2010;90:185.
- Wald A. Fecal incontinence in adults. New England Journal of Medicine. 2007;356:1648.
- Anderson CF (expert opinion). Mayo Clinic, Rochester, Minn. June 23, 2010.
- Picco MF (expert opinion) Mayo Clinic, Jacksonville, Fla. June 23, 2010.
- Tjandra JJ, et al. Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective. Diseases of the Colon and Rectum. 2004;47:2138.
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