Faecal incontinence

Diet is the first thing to check. Anything that makes the consistency of the faeces more runny, such as a heavy intake of beer, will make it more difficult for you to hold them in.

 

In the USA, the ‘non-fat fat’, called olestra (Olean), used in some ‘slimming’ foods has gained unwelcome publicity for this reason. It is an artificial mixture of fats, none of which can be digested or absorbed. Instead, it goes straight along the gut and is passed out at the other end. This means that the faeces are runny and slippery with fat, and soiled underwear can result. Some snack foods (for example some crisps) contain olestra, but the amount in the snacks is too small to cause a problem.

 

Anything which makes you pass more wind makes leakage more likely. This is because the anus has to relax to let the wind out, and some faecal material may be propelled out at the same time.

 

Irritable bowel syndrome is the other common cause. In irritable bowel syndrome (also known as IBS), the bowel muscle squeezes strongly, so that it may be difficult to hold the faeces in. If you have abdominal pain as well as leakage of faeces, then IBS is a strong possibility. The pain of IBS can occur anywhere in the abdomen, but is usually felt low down on the right or left side. Passing wind or opening the bowels often relieves it. People with IBS often have to rush to the lavatory, and some leakage is common. There is also often a ‘morning rush’ – the bowels have to be opened urgently several times on rising and after breakfast.

 

Childbirth. After having a baby, more than 1 in 10 women finds that she has difficulty in controlling wind or faecal leakage. It is most likely if you were an older mother (over 35 years of age) or had a large baby. The reason may be that the anal muscle is damaged by a tear, or by the episiotomy cut made during childbirth. Damage to the pudendal nerve can also occur during childbirth, and result in incontinence. The problem is likely to improve somewhat, but if you first noticed faecal incontinence after having a baby, do see your doctor – a surgical operation to repair the damage often gives good results even if you have had the problem for years.

 

It is quite common to have both faecal leakage and leakage of urine. A study of women with incontinence of urine found that almost 1 in 4 also had some leakage of faeces (Obstetrics and Gynecology 2002;100:719–23). The connection is that both are related to childbirth, especially if the baby was large.

 

Ageing. Faecal leakage is also quite common in older people, because the anal muscle becomes weaker with age. This is something that you should definitely discuss with your doctor, because a lot can be done to help. The real reason may be constipation – if you have hard faeces in the lower bowel, some watery faeces can leak round them and be difficult to control. Doctors are very familiar with this problem (called ‘overflow incontinence’) and should know how to deal with it.

 

Medications. Some medications make the faeces looser and therefore more difficult to hold in. Check that you are not taking a laxative from habit. If you are taking an indigestion remedy, check that it does not contain magnesium trisilicate, because this can cause diarrhoea. Misoprostol (a medication for stomach and duodenal ulcers that is sometimes prescribed for elderly people) is another possible culprit.

 

Orlistat (Xenical) is a diet pill that works by blocking the enzymes that digest fat. This means that the fat cannot be absorbed from the gut. With the correct dose, a third of the fat that you eat is blocked, and is excreted in the faeces instead of ending up as part of your spare tyre. By the time it reaches the lower part of the gut, this extra fat has the consistency of light machine oil. As a result, it can cause oily anal leakage, and the problem gets worse with the more fat that you eat. To stop it happening, you have to eat less than 70 g of fat a day.

 

Your doctor will try to work out what the cause is. Before seeing the doctor, you may wish to keep a bowel diary for a week (look at the Bowel Control website listed in the useful contacts). In difficult cases, an ultrasound scan can tell if the anal muscles have been damaged (for example, by childbirth). Medications such as loperamide can be used to prevent the bowel muscle squeezing too strongly and to make the faeces more solid.

 

Recently, a form of treatment called ‘behavioural treatment’ has proved to be helpful. This teaches you how to resist the urgent need to rush to the lavatory. Look at bowel retraining in the self-help section of the Bowel Control website in the useful contacts.

 

If the anal muscles are weak, injections of ‘bulking agents’ into the wall of the anus may help, but these have to be done by a specialist doctor and it is uncertain how effective the treatment is (British Journal of Surgery 2005; 92: 521–7). For major incontinence, a surgical operation is a last resort and may not be successful.
 

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Friday, February 26th 2010

Useful contacts for faecal incontinence

Click to see all the contacts that you may find useful in relation to faecal incontinence

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Comments on this article

Posted by oily orange coloured stool on 26/02/2010 at 11:52:07 am

I have been experiencing runny stool of the above mentioned colour. I was tking fish oil and have now stopped taking them. A few times there have been blood in my stool.

Posted by Anonymous on 25/02/2010 at 11:24:39 pm

Thanks to this article! I just had a leak and I was for sure it was all oil cus it didn't smell like poo! And it was water resistant! After reading this I found my problem! I had a really oily mean and had passed a wind when this happened!

Posted by Optional on 18/02/2010 at 06:11:07 am

my problem seems to be diferent from thoes mentioned.. going to toilet no problem, i am a very nervouse person wich results in me going to toilet regulary..but after iv'e been and cleaned up i still lose faecal in my underware, it's as thoe my rectrum is still open after iv'e been to toilet.been to doctors and they cant find anything wrong.av you got any sugestions that will help. thank you

Posted by KK on 17/02/2010 at 05:51:28 pm

I have noticed lately that there are white soft small 'balls' about the 1 cm passed out in my faeces. Can someone tell me what are those?

Posted by greg on 16/02/2010 at 06:36:05 pm

Ok i have an ongoing issue since I was about 24. I have a bowel movment and about 2-3 hrs later I have to go wipe my ass a second time. If I don't my rectum becomes extremly itchy. I am not sure if it is really anal leakage and/or hemroids or a combination of the 2. I don't have any accidents on my underwear.

Posted by Chris on 12/02/2010 at 07:02:00 am

I have to share this...I had symptoms of anal leakage for at least 9 months. It would happen unexpectedly an hour or two after eating. The smell was putrid and I was never regular and sometimes extremely constipated. Then I went for my first colonoscopy ever and everything checked out fine. The symptoms resumed about a week later. I never told the doctor my symtoms until 6 months later when I planned a trip to South America. I was really quite worried how I would cope with all the changes in my diet and routine. I was given a referral to return to the gastroenterologist when I got back. On the trip I managed pretty well until the last day when I got an intestinal bug that sent me straight to bed for the rest of the day. Totally nauseous I just needed to sleep. Before I left, my doctor insisted I bring Cipro antibiotic in case of a problem as this can happen in many Latin countries. I slept for a whole day and took my pills; couldn't eat a thing and like a zombie. I was lucky to make my plane late that night. I didn't really recover for a few days after getting home. Then I couldn't believe it. I stopped having all the symptoms I had before the trip. Wow! I couldn't wait to tell the doctor that he cured me twice. It's been 6 months without any symptoms at all. I never went back to the gastroenterologist. I just wanted to give some of you some hope as this is not always a permanent condition and I hope people will get a proper diagnosis and help as this was probably an infection of some kind that was undetected even with a colonoscopy. I read many blogs and thought I would be living with this problem forever. Good luck, I hope this helps someone out there.

Posted by Anonymous on 30/01/2010 at 06:15:00 pm

every time after i leak alittle but for about three wipes then ok ,i have had this for a long time since the service. dont know what to do.

Posted by Soo on 27/01/2010 at 08:26:00 pm

I wipe myself everytime I go to the bathroom just to urinate. When I wipe my anus, there is feces even though I haven't gone since morning. It's there all the time & my under wear gets dirty from it & the smell is awful. What can I do? I think maybe I eat too much olive oil & vegetables & very little meat.

Posted by Ryan Jones on 22/01/2010 at 07:36:00 pm

I have been having what I believe to be a very weird problem. After my partner and I have sex, for days I have this feeling of needing to have a bowel movement. This started to happen the past few times we have done it. It almost feels like he is still inside me. I continue to have liquid leakage for the next 3 or so days. I am beginning to think that we should stop having sex.

Posted by jane on 20/01/2010 at 10:33:00 pm

For the last couple of months, almost every time I go to the toilet, I find excrement sitting in my anus - my doctor said I am not emptying my bowels properly and suggested that I take laxatives. However, she did not listen properly on my first visit but she has now realised that my problem is more serious as there is exterement in my vagina. I have never heard of this before and neither has my doctor!! I am too ashamed to tell anybody, especially my husband!!!

Posted by Kirk on 20/01/2010 at 09:31:00 pm

Ok embarassing but here goes alot of times after I go to the washroom I have to go back and rewipe again.It's like I didn't wipe good enough the first time but I know I did. Anyways if I don't get a chance to rewipe right away my ass gets very irritated and it hurts alot like a rubbing rash. Please let me know if anyone has a solution. Thanks Kirk

Posted by kit on 04/01/2010 at 01:06:00 am

i have a strange sensation of a worm moving around the tip of my anus. its not painful its just unomfortable because i feel the movement and sometime it pricks the walls. i've had this a few times before- probably a few yrs back and it goes away. i have never been able to find out what it is. right now i'm having my period and i wonder if it is related at all.

Posted by i got nappies on 12/12/2009 at 11:03:00 pm

i have problems with my stomache and anal and nearly 3 times a week i can be normal in the day but few hours later my stomach can go of on one and i leake badly from my anal. i went to day after wearing pullups for 2 months i went i got my self a pack of adult nappies. they helped me loads and im not worred to have a problem now as i know im fully proctected from these nappies.it might seem silly that i wear them but i know it was my only option as the doctors dont know whats up with me so i had to buy them

Posted by I'm Cured on 08/12/2009 at 02:57:00 am

I'm writing this in hopes it might help others. I spent hours on the Internet searching for causes and cures for anal leakage. I read about others having the same symptoms I did and no one could help them, including their doctors. Just like my doctors could not help me. The start of my anal leakage began with a stomach upset causing messy bowel movements. The bowel movements were accompanied with slight leakage that caused irritation and burning in the anal area. It cleared up in a couple of days. A month later I had anal leakage again causing severe irritation. These episodes continued on a monthly cycle. I went to the doctor and she immediately referred me to a gastrologist. He saw the severe irritation and prescribed Nystatin and Triamcinolone Acetonide ointment which was the best medication for the irritation. So far the treatment was addressing one of the effects but not the cause. This doctor said to take Metamucil and Immodium, other than that, he had no answers. He wanted to perform a colonoscopy, but with my severe hypoglycemia, that was out of the question. The time between the episodes started to decrease. It went from monthly cycles to weekly cycles. I thought it must be triggered by something in my diet. My diet was limited, so I started by eliminating certain foods that I thought could cause my problems. Nothing helped. So, I starting eliminating groups of food such as gluten, dairy (lactose), caffeine, alcohol, chocolate, sodas. Still no help. I took Immodium, probotics, different yogurts, increased my dietary fiber to 80 grams (don't do this, it only causes large bulky stools that tears the anal area), and eventually no extra fiber. Nothing helped. It had been 1.5 years since the start of my problem and it was only getting worse. I was having to use cotton balls to prevent large leakage. The leakage would cause second degree burns and hemorrhoids. Desperate and willing to try anything, I was in the pharmacy section of Wal-

Posted by Anonymous on 02/12/2009 at 07:29:00 am

everyday in the morning when i go for a dump,after passing stools normally i strech my anal area so that more stool if there comes out...so that i dont hv to go to toilet again. after cleaning with water jet i still found something yellow like potty on my tissues. was it anal leakage?

Posted by Anonymous on 22/11/2009 at 02:15:00 pm

i got ibs. And now have an itchy anus. Leakage of yellow smelly liquid and blood. Is this the same?

Posted by Anonymous on 07/11/2009 at 02:21:00 pm

I am so relieved to read about other people struggling with the same thing, have felt so alone and can't talk to anyone about it. I also take forever to get clean after a bowel movement and have leakage. I'm FASTITDIOUS about hygine and feel so dirty and unfeminine. I'm also afraid of anal cancer. Is this the first sign?

Posted by Walt on 03/11/2009 at 10:52:00 pm

I went to a specialist who diagnoed mine as Psudo incontenence and that I needed more fiber in my meals and suggested Benofiber. I will see how this works. My problem was minor, but during a prostate exam, the Dr got a dirty finger full so he sent me to the specialist.

Posted by Richard on 10/08/2009 at 11:37:00 pm

Jim... I have EXACTLY the same issue. Blood when I wipe... severe itching... and very slow leakage. HELP ME PLEASE!!

Posted by George on 31/07/2009 at 09:26:00 pm

I was eating processed ham for lunch almost daily,and drinking lots of instant coffee.(Still have perk coffee) -Have been off both for almost a month & leakage problem seems to have all but disappeared! Also inst. coffee makes the urine smell.Hope this helps someone. G

Posted by ann on 22/06/2009 at 11:43:00 pm

I have just found this site and no longer feel quite so alone. My problem started after the forceps deliveries of my first two children who were also very large babies. I also had episiotomy's with both. I went to one doctor when it first started, he said "you are young and can run fast"I hardly left the house for many years and wear a large sanitary pad as a security measure. I carry spare briefs wipes and trousers at all times.I was told that there may be an operation that could help but it would probably start again. Surely someone out there must have an answer.

Posted by Anonymous on 19/03/2009 at 11:53:00 pm

I am starting to get worried. Ive started to get sexually active with my boyfriend, and after sex I discharged from my anus...which was weird as it has never happened before! This happened a few days ago. Last night, I had a large amount of alcohol and this morning I had a dose of diarrhea. Tonight i then had more discharge from my anus, plus I went to the toilet and my faeces didnt look right at all! They were stringy and discoloured! Argh any advice?? =[

Posted by Sylvia on 13/03/2009 at 08:24:00 pm

I have suffered from faecal incontinence since the birth of my first child (mid cavity forceps delivery with episiotomy) 5 years ago and was further exacerbated by the normal delivery of my second child. After five years of physiotherapy and bio feedback treatment I have now completed my family (my baby is now 6 months) and surgeons have finally decided to perform an sphincter repair. This is the right choice for me as I cannot go out as my urgency requires me to be less than 20 seconds from a bathroom and finding one that will accommodate a double buggy is not easy! To enjoy life with my children I choose not to eat after 5pm if I am going out the next day and then will only eat once I return home. This si no way to live and whilemy friends and family are understanding it is difficult to explain to strangers your problems when you need assistance.

Posted by Anonymous on 25/02/2009 at 09:37:00 pm

I have pessure of needing to go for a poo. But when i go to the loo nothing happens. Then my bowel will just open. I have to wear protection. Do i have a medical condition. I find the problem worst when i am stressed and away from toilets.

Posted by Jim on 11/02/2009 at 08:26:00 pm

I have been to my personal care physician 2-3 times over the past couple years and complained of an ongoing problem with a slow anal leakage of faeces. Usually accompanied with severe anal itching I will also discover traces of bright red blood smears as I wipe myself with toilet tissue. On occasion, I will even need to clean myself with soap and water. I have tried several different fiber tabs, as per the M.D., (2 times daily). They seem to offer little help. Diagnosed with heart problems and diabetes in the past, I am also taking medication such as: Actos, Levothyroxine, Plavix, Glipizide, Metformin, Metropolol, Potassium, Welchol, Vytorin, Doxazosin and Lisinopril. Do you have any suggestions?

Posted by john chapman on 06/02/2009 at 10:23:00 pm

hiya im experiencing alot of pain in my lower stomach i get blated alot and constipated my doctor has given me laxatives to help relieve it it helps but this is every couple of days i have no control over my bladder as it is i wear nappies 24/7 i poop my self too sometimes is there any name for this illness i have ?

Posted by daughter on 05/02/2009 at 03:16:00 pm

my 4yr old wont go on toilet for a poo.she regularly "leaks" fluid from her bottom.she "holds on" to it for up to a fortnite.when she does go,it quite a tramatic experiance,for both of us. G.P. gave me DAKTACORT,but hasnt made any differance.any advice?

Posted by tony on 21/01/2009 at 03:55:00 pm

I am experiencing anal leakage. Every time I have a bowel movement which is 2 -3 times a day it is normal but wiping never ends. I can keep wiping and wiping and it never seems dry. Even when it's over later I feel wet and have to go back in and wipe again. Any suggestions pls would be helpful. thank you.

Posted by Anonymous on 20/12/2008 at 01:49:00 pm

I have irritation of the anal region & some leakage after passing a motion. Dr. has prescribed Proctosedyl & because this wasn't successful Scheriproct. They do not help much I think they exacerbate the itchingI have a lot of wind & bowel movement not consistent.