Fecal Incontinence
You don't have to live with this.
Fecal incontinence is common, under-discussed, and highly treatable. Most patients see meaningful improvement with the right plan. The first step is simply getting evaluated.
Fecal incontinence affects approximately 18 million adults in the United States, with slightly higher prevalence in women. It occurs when there's a disruption in the normal bowel control mechanisms, causing involuntary leakage or complete loss of bowel control. Many patients suffer in silence for years because of embarrassment, not realizing how treatable the condition actually is. The impact on daily life is real, and proper diagnosis is the starting point for meaningful relief.
You Are Not Alone
18 million
US adults affected by fecal incontinence. Most never talk about it, but most can find significant relief with proper treatment.
Types of Fecal Incontinence
Fecal incontinence isn't a single condition. Understanding which type you have shapes treatment.
Urge incontinence
You feel the need to go but can't reach the bathroom in time. Often linked to weakened external anal sphincter muscles.
Passive incontinence
Leakage happens without awareness. Often linked to weakened internal sphincter muscles or reduced rectal sensation.
Overflow incontinence
Liquid stool leaks around a blockage of hard stool in the rectum. Usually related to chronic constipation.
Common Symptoms
Patients experiencing fecal incontinence commonly report:
Unintentional stool leakage
Difficulty reaching the restroom in time
Frequent urge to defecate
Chronic diarrhea or constipation
Passing gas or liquid involuntarily
Staining or soiling of underwear
Skin irritation or discomfort from leakage
If any of these apply, an evaluation is worthwhile. Early treatment tends to work better than letting the condition settle in.
Risk Factors and Causes
Several factors can contribute to fecal incontinence, often in combination. Identifying the underlying cause is essential for choosing the right treatment.
Childbirth
Vaginal deliveries, especially those involving tears, episiotomy, or forceps, can damage the anal sphincter or pelvic floor. Symptoms sometimes don't appear until years later.
Aging
Natural weakening of the sphincter muscles and reduced rectal sensation over time contribute to symptoms in older adults.
Chronic diarrhea or constipation
Frequent loose stool overwhelms the sphincter. Severe constipation can lead to overflow incontinence around retained stool.
Muscle damage
Prior anal surgery, injury, or childbirth trauma can weaken the sphincter muscles that keep stool in.
Nerve damage
Conditions like diabetes, multiple sclerosis, spinal cord injury, or stroke can affect the nerves that control bowel function.
Hemorrhoids and rectal prolapse
Both can interfere with the sphincter's ability to close completely.
Pelvic floor dysfunction
Weakened or uncoordinated pelvic floor muscles affect bowel control, often in combination with urinary issues.
IBD or IBS
Inflammatory or functional bowel conditions can produce urgency and loose stools that outpace sphincter function.
How Fecal Incontinence Is Diagnosed
During your consultation, Dr. Chung will carefully discuss your symptoms, medical history, and lifestyle factors. A thorough physical examination follows, typically including a digital rectal exam to assess sphincter tone. Several diagnostic tests help pinpoint the underlying cause:
Anorectal manometry
Measures the strength of the anal sphincter muscles and the sensitivity of the rectum. Helps identify muscle or nerve problems.
Endoanal ultrasound
Provides a detailed image of the sphincter muscles to detect tears or weaknesses, often related to past childbirth or surgery.
MRI defecography
Evaluates how the pelvic floor functions during defecation. Useful when pelvic floor dysfunction is suspected.
Colonoscopy
May be recommended to rule out underlying conditions like IBD, tumors, or inflammation that could be contributing.
Treatment Options
Treatment is highly individualized. Most patients improve with a combination of approaches, starting with conservative measures and escalating only if needed.
First line
Dietary and bowel habit changes
Adjusting fiber intake to improve stool consistency is often the simplest and most effective starting point. Dr. Chung may recommend increasing dietary fiber, maintaining hydration, identifying trigger foods with a food diary, and establishing a regular bowel movement schedule to prevent accidents.
Foundation of care
Pelvic floor rehabilitation
Strengthening the pelvic floor muscles through targeted exercises, often in partnership with a pelvic floor physical therapist, can significantly improve bowel control. Biofeedback therapy uses sensors to help you learn to activate the right muscles correctly. Highly effective for many patients, especially when muscle weakness is the main issue.
Supportive
Medications
Bulk-forming agents like Citrucel or Metamucil regulate bowel movements and improve stool consistency. Antidiarrheal medications like loperamide can slow bowel transit and improve control in patients whose main issue is loose or urgent stools.
When needed
Procedural treatments
When conservative approaches aren't enough, several procedural options can help. Sphincteroplasty surgically repairs damaged sphincter muscles and restores control. Sacral nerve stimulation (neuromodulation) uses a small implanted device to stimulate nerves controlling bowel function, which has meaningfully helped many patients who hadn't responded to other treatments.
About pelvic floor physical therapy: Many patients benefit significantly from working with a specialized pelvic floor physical therapist, who can provide personalized exercises, biofeedback training, and manual therapy. Dr. Chung can refer you if this is part of your treatment plan.
Recovery and Ongoing Care
Recovery timelines and aftercare depend on the treatment approach. Dietary and pelvic floor interventions typically show results over weeks to months of consistent practice. Surgical and neuromodulation treatments have their own recovery timelines, with detailed postoperative guidance provided.
Ongoing follow-up helps fine-tune the treatment plan and maintain progress. Most patients experience meaningful improvement and regain confidence in daily activities.
Take the first step
Fecal incontinence is a medical condition, not something to be embarrassed about. Dr. Chung treats this condition with the matter-of-factness it deserves. A consultation is confidential, straightforward, and often the beginning of real improvement.
Book a consultation
Call (714) 988-8690
