Medications

Depending on the cause of fecal incontinence, options include:

• Anti-diarrheal drugs such as loperamide hydrochloride (Imodium) and diphenoxylate and atropine sulfate (Lomotil)
• Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil), if chronic constipation is causing your incontinence
• Injectable bulking agents such as Dextranomer Microspheres/Hyaluronate Sodium in 0.9 % Nacl (Solesta) are injected directly into the anal canal

Dietary changes

What you eat and drink affects the consistency of your stools. If constipation is causing fecal incontinence, your doctor may recommend drinking plenty of fluids and eating fiber-rich foods. If diarrhea is contributing to the problem, high-fiber foods can also add bulk to your stools and make them less watery.

Exercise and other therapies

If muscle damage is causing fecal incontinence, your doctor may recommend a program of exercise and other therapies to restore muscle strength. These treatments can improve anal sphincter control and the awareness of the urge to defecate. Options include:

• Biofeedback. Specially trained physical therapists teach simple exercises that can increase anal muscle strength. People learn how to strengthen pelvic floor muscles, sense when stool is ready to be released and contract the muscles if having a bowel movement at a certain time is inconvenient. Sometimes the training is done with the help of anal manometry and a rectal balloon.
• Bowel training. Your doctor may recommend making a conscious effort to have a bowel movement at a specific time of day: for example, after eating. Establishing when you need to use the toilet can help you gain greater control.
• Sacral nerve stimulation (SNS). The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can strengthen muscles in the bowel. This treatment is usually done only after other treatments are tried.
• Posterior tibial nerve stimulation (PTNS/TENS). This minimally invasive treatment may be helpful for some people with fecal incontinence, but more studies are needed.
• Vaginal balloon (Eclipse System). This is a pump-type device inserted in the vagina. The inflated balloon results in pressure on the rectal area, leading to a decrease in the number of episodes of fecal incontinence. Results for women have been promising, but more data are needed.

Surgery

Treating fecal incontinence may require surgery to correct an underlying problem, such as rectal prolapse or sphincter damage caused by childbirth. The options include:

• Sphincteroplasty. This procedure repairs a damaged or weakened anal sphincter. Doctors identify an injured area of muscle and free its edges from the surrounding tissue. They then bring the muscle edges back together and sew them in an overlapping fashion, strengthening the muscle and tightening the sphincter. The procedure is used for people who have fecal incontinence right after childbirth.
• Treating rectal prolapse, a rectocele or hemorrhoids. Surgical correction of these problems will likely reduce or eliminate fecal incontinence.
• Sphincter replacement. A damaged anal sphincter can be replaced with an artificial anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you're ready to defecate. To go to the toilet, you use a small external pump to deflate the device and allow stool to be released. The device then reinflates itself.
• Sphincter repair (dynamic graciloplasty). In this surgery doctors take a muscle from the inner thigh and wrap it around the sphincter, restoring muscle tone to the sphincter.
• Colostomy (bowel diversion). This surgery diverts stool through an opening in the abdomen. Doctors attach a special bag to this opening to collect the stool. Colostomy is generally considered only after other treatments have been tried.