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Tests and diagnosis
By Mayo Clinic staff
Medical history
To determine the cause of fecal incontinence, your doctor will ask you questions related to your condition — such as when and how often you experience an inability to control your bowels.
Physical exam
In addition to talking with you, your doctor may also perform a physical examination. The exam usually includes a visual inspection of your anus and the area between your anus and genitals (perineum) for hemorrhoids, infections and other conditions. Your doctor may use a pin or probe to examine this area of skin. Normally this touching causes your anal sphincter to contract and your anus to pucker. This test helps your doctor check for nerve damage.
Medical tests
A number of medical tests also are available to help pinpoint the cause of fecal incontinence. These may include:
- Digital rectal exam. Your doctor inserts a gloved and lubricated finger into your rectum to evaluate the strength of your sphincter muscles and to check for any abnormalities of the rectal area. During the exam, your doctor may ask you to bear down. Bearing down helps check whether rectal prolapse or certain other conditions exist.
- Anal manometry. In this commonly used test, your doctor inserts a narrow, flexible tube into your anus and rectum. Once the tube is in place, a small balloon at the tip of the tube may be expanded. This test lets your doctor know how tight your anal sphincter is. It also measures the sensitivity and function of your rectum.
- Anorectal ultrasonography. In this procedure, which evaluates the structure of your sphincter, your doctor inserts a narrow, wand-like instrument into your anus and rectum. This instrument, which is attached to a computer and video screen, emits sound waves. The waves bounce off the walls of your rectum and anus, producing video images of these internal structures.
- Proctography. In this procedure, also known as defecography, your doctor uses a small amount of liquid called barium to coat the walls of your rectum. Barium makes your rectum more visible on X-rays, which are then taken. This test measures how much stool your rectum can hold. It also evaluates how well stool is evacuated from your rectum.
- Proctosigmoidoscopy. In this test, your doctor uses a long, slender tube with a tiny video camera attached to examine your rectum and sigmoid — the lower portion of your colon. This test detects signs of inflammation, tumors or scar tissue that may cause fecal incontinence. Your doctor may also want to perform colonoscopy to see the entire colon.
- Anal electromyography. This test involves the insertion of tiny needle electrodes into muscles around your anus that can reveal signs of nerve damage.
- 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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