Photography by Sora Shimazaki
Not just period leaks: What you can do about bowel leaks
This article has been sponsored by Medtronic
Top things to know about fecal incontinence:
Fecal incontinence is the loss of bowel control
People often feel shame and fear about discussing their symptoms with a healthcare provider, but even light leaks are worth addressing
There are treatments available, ranging from lifestyle changes and medications to surgical or non-surgical interventions—you don’t have to manage it alone
Tracking your bowel habits with a symptom diary can help you notice patterns and feel more prepared when speaking to a healthcare provider
Understanding bowel leaks
Losing control of your bladder or bowels is more common than you might think, but it can still feel isolating. There are many reasons it can happen, and none of them are your fault. This article focuses on fecal incontinence or unintentional bowel leaks. For a deeper dive into urinary incontinence, you can read our urinary incontinence 101 article.
What is fecal incontinence?
Fecal incontinence, also called stool incontinence or bowel incontinence, is the unintentional leaking of solid or liquid stool. It affects as many as 1 in 5 women (1). The risk for fecal incontinence can increase with age, vaginal or cesarean delivery, higher body weight, and depression (1). Sexual practices such as anal sex can also increase the risk of experiencing bowel leaks (2).
Only a small number of those who experience fecal incontinence receive treatment, even though it can cause distress and impact quality of life (3–6).
Let’s look at the different types of fecal incontinence:
Urge fecal incontinence: Stool leaks after a strong, sudden urge to have a bowel movement (7)
Passive fecal incontinence: Stool leaks without warning or triggers, often without the person noticing (7)
Why does fecal incontinence happen?
Bowel leaks are complex because passing stool involves the nervous system, muscles, and digestive tract. Sometimes, the exact cause of fecal incontinence can’t be identified and is likely due to a combination of factors.
Causes of fecal incontinence may include:
Acute diarrhea: Diarrhea caused by an illness, dietary change, or medication can trigger sudden bowel leaks. People with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) are more prone to diarrhea and may experience more bowel leaks (8–10).
Neurological injuries or conditions: Conditions such as spinal cord injuries, tumors, or seizures can make it harder for the anal sphincter muscle to work the way it’s supposed to and can lead to bowel leaks (8).
Trauma: Pregnancy, birth, or anorectal surgery can cause anal sphincter injury and/or pelvic floor trauma leading to bowel leaks (8).
Medical conditions: Certain medical conditions increase the risk of bowel leaks. Diabetes can cause changes in the nervous system that lead to fecal incontinence. Inflammatory bowel diseases can change bowel habits and function. Nervous system conditions such as multiple sclerosis and Parkinson’s disease can decrease sensation in the rectum, leading to fecal incontinence (8).
Medication-related: Medications can impact bowel function, including antacids, opioids, heart medications, and mental health medications (11). Supplements (like iron and magnesium) may also play a role (11,12).
Fecal impaction: Constipation can cause the buildup of hard stool in the bowel. Looser stool may leak around the impacted, firm stool (overflow incontinence) (8).
Even though bowel leaks can be common, people are often hesitant to talk about them. One study showed that fewer than 3 in 10 women who experience fecal incontinence discuss it with a healthcare provider (5). Feelings of shame, frustration, and anxiety are common (4,5).
Many people are afraid to have bowel leaks in public, which can limit quality of life (5). Bowel leakage can also impact relationships and sex lives. Research has shown that sexual desire and satisfaction may be negatively impacted by fecal incontinence (13).
Who’s affected (and often overlooked)
Incontinence can affect anyone, but some factors put people at higher risk of developing bowel leaks.
New parents
During birth, injury to the pelvic floor or anal sphincter can occur, which may increase the risk of experiencing incontinence. Certain factors in the delivery can even further increase the risk of leaks, like having a larger baby, having a vacuum or forceps-assisted delivery, or having an episiotomy (a small cut made during birth) (8,14).
People who leak urine or stool during pregnancy are at higher risk of ongoing incontinence after birth (14).
Disabled and neurodiverse people
People with intellectual disabilities may be at higher risk of incontinence. Factors such as physical limitations or lack of support for toileting may contribute, and misdiagnosis of other chronic health conditions may also play a role (15). But more research is needed on incontinence in this community.
Neurodiverse children and adolescents are at higher risk of incontinence. This could be related to nervous system differences or to the side effects of medication (16). However, more research is also needed.
People with IBS or IBD
People with irritable bowel syndrome or inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis are more likely to experience stool leaks (9,10).
People in menopause or older age
Risk for incontinence increases with age. Lower estrogen levels thin the urogenital tissue and weaken the pelvic floor, and other factors that change with age, such as weight gain or medical conditions, may also contribute to this increased risk (17).
People affected by obstetric fistulas
In some parts of the world, a lack of care during birth can lead to obstetric fistulas. An obstetric fistula is an abnormal opening between the vagina and the bladder or rectum, resulting in the leakage of urine or stool from the vagina (18). Obstetric fistulas can be surgically repaired, but people may still experience incontinence even after treatment (19).
How do you treat fecal incontinence?
Treatment for fecal incontinence often involves a combination of approaches, depending on the symptoms and underlying causes. Some strategies are usually tried first—like dietary changes or medications—while others, such as neuromodulation devices or surgical interventions, are typically considered after other options haven’t worked. Working with a healthcare provider is key, but there are also some practical steps you can take yourself to help manage symptoms.
Symptom diary
One of the first steps in treating incontinence is to identify the patterns of your symptoms. Keeping track of bowel habits with a diary may be helpful (20).
A bowel diary could include measures such as:
Timing of bowel movements
Amount of stool
Stool consistency
Timing and type of food and drink intake
Leaking episodes
Other symptoms, such as urgency
Once you track this, you can bring it to your healthcare provider. They will be able to evaluate your symptoms and make a plan for treatment. If you’d like help understanding your treatment choices or preparing for a conversation with your healthcare provider, this patient decision aid can also help.
Dietary changes
By keeping a symptom diary, you can also track potential triggers for bowel leaks. This can help you avoid foods that worsen symptoms. You can try increasing foods high in fiber (such as beans, fruits, vegetables, and whole grains) (21). A fiber supplement might also be helpful (22). If you tend to experience diarrhea, you may want to avoid alcoholic beverages, caffeine, spicy or greasy foods, dairy products, and foods with artificial sweeteners (23).
Pelvic floor physical therapy and biofeedback
Pelvic floor physical therapy may be a tool for improving bowel leaks. Your pelvic floor physical therapist will evaluate your symptoms, history, and lifestyle factors. They may perform abdominal, rectal, or pelvic exams to fully assess your muscles and connective tissues. Pelvic floor physical therapists can then prepare a treatment plan aimed at reducing the symptoms (24).
Some pelvic floor physical therapists use biofeedback to check anal sphincter and pelvic floor muscle strength and coordination. Biofeedback may help with the mind-body connection needed for continence; however, evidence on its use is limited (3,22,25).
Medications
Medications can sometimes be used to treat fecal incontinence by improving stool patterns. For loose stools, antidiarrheal medications like loperamide may be recommended (1). For some people, a fiber supplement might be helpful (22). For chronic constipation, a laxative or stool softener could help soften and regulate bowel movements (21).
Medical interventions
Transanal irrigation, or the introduction of fluid to the rectum through the anus in order to empty stool, may help decrease the severity of fecal incontinence (26).
Vaginal inserts can apply pressure on the rectum to keep it closed and prevent bowel leaks (22,26).
Anal plugs may reduce passive fecal incontinence, but are intended for occasional use only (26,27).
Sacral neuromodulation (SNM) is a type of neuromodulation therapy that uses mild electrical pulses to stimulate the nerves that control bowel function. For fecal incontinence, SNM is the recommended neuromodulation therapy. An electrode is placed near the sacral nerves, and a small, battery-powered device sends electrical pulses to the nerves to help them work properly. The pulses aren’t painful, and you can turn the device on or off whenever you need (21).
These types of treatments are typically considered when the first-line treatment options haven’t worked (21,22,28).
Injectable bulking agents are sometimes used to treat passive bowel leaks. Many different types of injections have been suggested, including collagen, hyaluronic acid, and silicone. However, research has not consistently shown that injections reduce fecal incontinence (3,22,27).
Surgery
Rarely, for bowel leaks caused by an anal sphincter injury or for fecal incontinence that can’t be treated with other options, surgery may be considered. Sphincteroplasty is a surgery that repairs an injured anal sphincter. It may temporarily improve symptoms, but the effect often fades with time (1,3,22).
When to see a healthcare provider
If you are experiencing bowel incontinence, it’s important to talk to a trusted healthcare provider about it. Your general healthcare provider can refer you to see a gastroenterologist (a doctor who specializes in the digestive system) or a coloproctologist (a specialist in the colon and rectum).
It’s especially important to contact your healthcare provider if:
Incontinence often happens or becomes more severe (8)
It impacts your wellbeing or quality of life (8)
You pass black, red, or bloody stool (29)
You experience fecal incontinence in addition to other symptoms, like weight loss, bloody stools, or abdominal pain (3)
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You’re not alone, and you deserve care
Incontinence is common, but help is available. By breaking your silence on bowel leaks, you can get treatment that may help improve your quality of life. Talking to a trusted healthcare provider is a great first step on your road to symptom improvement.
Tracking with Clue can help you identify any patterns. Using the “Stool” category, you can monitor experiences like stool consistency, and you can also track potential triggers—like diet, exercise, or medications—to get a fuller picture of what might affect your symptoms.
Incontinence is not your fault, and you are not alone.
FAQs
What kind of doctor do you see for fecal incontinence?
Many people start by seeing a general practitioner (or primary care provider) to discuss fecal incontinence. You might also visit a surgeon or specialist, depending on your exact symptoms and their causes. Your general healthcare provider can refer you to see a gastroenterologist or a coloproctologist. A dietician can also help you make changes to your diet to improve symptoms (23,29).
Can stress cause fecal incontinence?
Stress impacts our bodies in many ways. Researchers are still learning more about how and why stress changes gut function. Chronic stress is associated with constipation, diarrhea, and altered gut bacteria (30). There’s still limited research on the direct impact of stress on fecal incontinence. Tracking your mood in the Clue app can help you see whether periods of stress relate to your bowel symptoms.
What foods should I avoid with bowel incontinence?
Foods and drinks that stimulate the bowel and lead to diarrhea may worsen fecal incontinence. This can include alcoholic beverages, caffeinated beverages, dairy products, fatty or greasy foods, or spicy foods. For some people, certain sugars or sweeteners can trigger the bowels (like fructose, sorbitol, mannitol, xylitol). Fiber is sometimes used to treat incontinence, but high fiber fruits and vegetables can worsen symptoms for some people. A symptom diary may help track specific foods, beverages, or habits that impact your leaks (23).
