II. Definition

  1. Involuntary loss of bowel function with an inability to prevent stool passage

III. Epidemiology

  1. Incidence: 2% (21% in elderly)

IV. Types

  1. Overflow
    1. Results from Fecal Impaction
  2. Reservoir
    1. Decreased rectal capacity
  3. Rectosphincteric
    1. Structural injury to anal sphincter
    2. Neurologic innervation disrupted to the anal sphincter

V. History

  1. Rectal fullness or stool urgency
  2. Urinary Incontinence
  3. Fecal Impaction
  4. Dementia history
  5. Medications
    1. Laxative abuse
    2. See Diarrhea Secondary to Medications
  6. Anal sphincter injury history
    1. Colorectal surgery history
    2. Fourth degree Perineal Laceration with child birth
  7. Neurologic injury history
    1. Cerebrovascular Accident history
    2. Spinal cord injury
    3. Cauda equina symptoms

VI. Exam

  1. Neurologic Exam
  2. Digital Rectal Exam
    1. Assess for Fecal Impaction
    2. Assess for rectal tone

VII. Evaluation: Measures used by colorectal specialists

  1. Rectal tone quantification
    1. Anal manometry
  2. Evaluate for colon masses
    1. Lower endoscopy
  3. Evaluate for anal sphincter defect
    1. Ultrasound
    2. MRI

VIII. Management: General

  1. Schedule stooling times after meals (especially in Dementia)
  2. Allow for easy restroom access
  3. Treat and prevent Fecal Impaction
  4. Consider biofeedback
  5. Loperamide (Imodium)
    1. Limit to occasional use only (e.g. travel)
    2. Risk of Constipation, Fecal Impaction and subsequent worse Fecal Incontinence

IX. Management: Surgery

  1. Indications
    1. Refractory Fecal Incontinence not responding to general measures
    2. Anal spincter dysfunction
      1. Anal sphincter muscle injury
      2. Rectal Prolapse
  2. Surgical repair options
    1. Overlapping sphincter repair
    2. Pelvic floor reconstruction
    3. Artificial bowel sphincter

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Ontology: Fecal Incontinence (C0015732)

Definition (CCC) Involuntary defecation
Definition (MEDLINEPLUS)

Bowel incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you get to a toilet. Millions of Americans have this problem. It affects people of all ages - children and adults. It is more common in women and older adults. It is not a normal part of aging.

Causes include

Treatments include changes in diet, medicines, bowel training, or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Definition (NCI_CTCAE) A disorder characterized by inability to control the escape of stool from the rectum.
Definition (NCI_NCI-GLOSS) Inability to hold stool in the rectum.
Definition (NCI) Involuntary passage of stool from the rectum.(NICHD)
Definition (NAN) Change in normal bowel habits characterized by involuntary passage of stool
Definition (MSH) Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus.
Definition (CSP) failure of control of the anal sphincters, with involuntary passage of feces and flatus; it may be either psychogenic or organic in origin.
Concepts Disease or Syndrome (T047)
MSH D005242
ICD9 787.6
ICD10 R15 , R15.9
SnomedCT 207139008, 207142002, 70026004, 72042002, 162091006, 139367004, 142629005, 158446000, 158449007, 165229000
LNC MTHU013375
English Fecal Incontinences, Incontinence, Fecal, Incontinences, Fecal, FAECAL INCONTINENCE, FECAL INCONTINENCE, Faecal incontinence, Feces Incontinence, Incontinence of faeces NOS, Incontinence of feces NOS, [D]Incontinence of feces (context-dependent category), [D]Incontinence of feces NOS (context-dependent category), [D]Incontinence of faeces, [D]Incontinence of faeces NOS, [D]Incontinence of feces, [D]Incontinence of feces NOS, Alteration in bowel elimination: incontinence, unable to restrain bowel movement (symptom), rectal discharge incontinent of stool (physical finding), unable to restrain bowel movement, rectal discharge incontinent of stool, incontinent of stool, fecal incontinence, Bowel incontinena, Incontinent of faeces, Incontinence fecal, Feces incontinence of, Fecal Incontinence, Fecal Incontinence [Disease/Finding], rndx bowel incontinence, rndx bowel incontinence (diagnosis), incontinence stool, Incontinence;bowel, bowel incontinent, stool incontinence, Incontinence;faeces, of bowel incontinence, incontinence of stool, incontinent bowel, incontinence faecal, incontinence bowel, Fecal incontinence NOS, Incontinent of feces, Incontinent of feces (& symptom), Incontinent of feces (finding), Incontinent of faeces (& symptom), Incontinence of faeces (finding), [D]Incontinence of feces (situation), Incontinent of faeces (& symptom) (finding), Incontinent of feces - finding, Incontinence-faeces-sym, [D]Incontinence of feces NOS (situation), Incontinence faecal, [D]Incontinence of faeces NOS (situation), Incontinent of faeces - finding, Incontinent of feces symptom, Incontinence-feces-sym, [D]Incontinence of faeces (situation), Incontinent of faeces symptom, Fecal incontinence, Bowel Incontinence, Incontinence of feces, Bowel incontinence, Incontinence of faeces, Involuntary stool, Bowels: incontinent, Incontinence of feces (finding), BOWEL INCONTINENCE, Incontinence of bowel, feces; incontinence, incontinence; fecal, Foecal incontinence, Incontinence (Fecal), faecal incontinence, Incontinence;feces, bowel incontinence
Portuguese INCONTINENCIA FECAL, Incontinência intestinal, Incontinência fecal, Incontinência Fecal
Spanish INCONTINENCIA FECAL, Incontinencia intestinal, Incontinencia de heces, Incontinente de heces, [D]incontinencia fecal, SAI (categoría dependiente del contexto), [D]incontinencia fecal (categoría dependiente del contexto), alteración de la evacuación intestinal: incontinencia (hallazgo), incontinencia de heces, incontinencia fecal (hallazgo), trastorno de la evacuación intestinal: incontinencia, deposiciones fecales involuntarias, incontinencia fecal, alteración de la evacuación intestinal: incontinencia, [D]incontinencia fecal (situación), [D]incontinencia fecal, [D]incontinencia fecal, SAI (situación), [D]incontinencia fecal, SAI, Incontinencia fecal, Incontinencia Fecal
German STUHLINKONTINENZ, Stuhl Inkontinenz, inkontinent Stuhl, Inkontinenz Stuhl, Inkontinenz von Stuhl, Darminkontinenz, Incontinentia alvi, Stuhlinkontinenz
Dutch fecesincontinentie, incontinent voor feces, feces, incontinentie van, darmincontinentie, foecale incontinentie, Incontinentie voor ontlasting, faeces; incontinentie, incontinentie; faeces, Incontinentie voor faeces, fecale incontinentie, Incontinentia alvi, Incontinentie voor feces
French Incontinent des matières fécales, Incontinence colique, Incontinence intestinale, INCONTINENCE DES MATIERES, Incontinence fécale, Incontinence anale, Incontinence des matières fécales
Italian Incontinenza intestinale, Incontinente alle feci, Incontinenza fecale
Japanese 便失禁, 大便失禁, ダイベンシッキン, ベンシッキン
Swedish Avföringsinkontinens
Finnish Ulosteenpidätyskyvyttömyys
Russian KALA NEDERZHANIE, КАЛА НЕДЕРЖАНИЕ
Czech Střevní inkontinence, Inkontinence stolice, inkontinence stolice, fekální inkontinence, feces - inkontinence
Korean 분변의 실금
Croatian FEKALNA INKONTINENCIJA
Polish Nietrzymanie stolca, Nietrzymanie kału
Hungarian Faeces tartási képtelenség, Széklet-incontinentia, Faeces incontinentiája, Faeces incontinentia, Faecalis incontinentia, Széklettartási képtelenség, Faecestartás zavara, Bél incontinentia
Norwegian Avføringsinkontinens, Analinkontinens