anal incontinence / Accidental Bowel Leakage
Anal incontinence is the loss of bowel control, which results in leakage of gas or stool through the anus. It is sometimes called accidental bowel leakage, and symptoms can range from difficulty controlling gas (flatal incontinence) to difficulty controlling stool (fecal incontinence). Anal incontinence affects 1 in 10 women, and some women do not feel it as it is occurring. Some women develop anal incontinence after childbirth, while others may develop it later in life.
Anal incontinence can be very distressing, and women are often reluctant and embarrassed to talk about it. However, there are many lifestyle changes, as well as medical and surgical treatments that can help treat anal incontinence.
Each woman may experience anal incontinence symptoms differently.
Common symptoms of anal incontinence include:
Causes and Diagnoses
Anal incontinence or accidental bowel leakage usually occurs because the anal sphincter and pelvic floor muscles are not functioning properly. The anal sphincter muscle is a circular muscle that surrounds the anal canal, and the pelvic floor muscles (levator ani) form a sling around the anal canal.
Both the anal sphincter and pelvic floor muscles help women control their stools and flatus. Damage to these muscles is usually attributed to childbirth, aging, or other conditions that affect stool consistency. The muscles may be torn or the nerves that help them function may be damaged leading to impaired function of the continence mechanism.
Sometimes, anal sphincter injuries are recognized in the delivery room. However, often they are not as obvious and do not become a problem until later in life. Many women may experience anal incontinence from loss of muscle strength as they get older. Common risk factors for anal incontinence/ accidental bowel leakage include:
What to Expect at My Evaluation Appointment
To better evaluate your symptoms, a pelvic floor specialist might:
A pelvic floor specialist might also conduct the following diagnostic tests:
Diet and Stool Bulking
Some dietary and lifestyle changes can help reduce symptoms of anal incontinence/accidental bowel leakage, including:
Pelvic floor physical therapy is one of the best ways to manage anal incontinence/accidental bowel leakage. Women can work with specialized physical therapists to learn how to improve their anal sphincter and pelvic floor muscle function. Learn more about our Pelvic Floor Physical Therapy Program.
The Eclipse System
This is an FDA-approved device that inserts into the vagina (like a pessary) and is effective for treating fecal incontinence. The urogynecologists at Northwestern Medicine Women’s Integrated Pelvic Health Program are some of the few providers in the country offering this treatment.
The device is placed in the vagina (similar to where a tampon is positioned) and exerts pressure on the rectum through the vaginal wall, effectively occluding the rectum. When a trip to the bathroom is needed, the device is deflated during the bowel movement and then re-inflated after evacuation using an external pump. A pelvic floor specialist will determine the right size Eclipse device for each woman and teach her to control it herself.
Sacral neuromodulation is indicated for treatment of urinary retention, overactive bladder, urgency urinary incontinence, and urgency / frequency, as well as anal incontinence/accidental bowel leakage. This therapy utilizes an innovative and implantable neurostimulator about the size of a stop watch. Learn more about Sacral Neuromodulation.
External Anal Sphincteroplasty
If there is a tear in the anal sphincter muscle, the patient may be a candidate for a surgery called anal sphincteroplasty. Most often injuries to the anal sphincter muscle occur with perineal lacerations as a sequelae of vaginal childbirth and might require surgical repair or revision outside of the postpartum period.
An anal sphincteroplasty repairs the tear in the sphincter muscle and rebuilds the perineal body (area between the rectum and vagina). It does not require any incisions on the abdomen, and women go home from the hospital on the same day as surgery. After surgery, women are advised to pursue specialized pelvic floor physical therapy to improve the function of the newly reattached anal sphincter and pelvic floor muscles. They also are instructed on the optimal bowel regimen for better control.
How do I determine the best treatment option?
A pelvic floor specialist will perform a thorough evaluation to determine the cause of your symptoms and identify your individual treatment goals. The specialist will then work with you to help select the best treatment regimen.
Most women’s anal incontinence/accidental bowel leakage will improve with conservative treatments such as behavior modification, diet changes, and pelvic floor muscle exercises. However, some women need additional therapy with an Eclipse device, sacral neuromodulation, or anal sphincteroplasty.
To Request an Appointment
If you're suffering from a pelvic floor disorder, you don't have to live with the symptoms. To learn about treatment options, call 312.694.7337 to schedule an appointment with one of our urogynecologists.
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