Accidental Bowel Leakage (Fecal Incontinence)

Overview

Accidental bowel leakage, also known as fecal incontinence, is the involuntary loss of stool or gas. It ranges from occasional leakage to complete loss of bowel control.

Common causes include:

• Anal sphincter injury (obstetric trauma, surgery).

• Neurologic disorders (stroke, spinal cord injury, multiple sclerosis, diabetic neuropathy).

• Chronic diarrhea or constipation.

• Rectal prolapse or rectocele.

• Age-related weakness of sphincter muscles.

It has major effects on quality of life and often requires multidisciplinary management.

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Treatment Options

1. Lifestyle & Dietary Modifications

• High-fiber diet (20–30 g/day) to bulk stool.

• Fiber supplements:

  • Psyllium husk 1 tsp in water once or twice daily.

• Avoid trigger foods (caffeine, artificial sweeteners, fatty foods, spicy foods).

• Scheduled toileting and bowel retraining.

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2. Pharmacological Therapy

• Antidiarrheals (for loose stool):

  • Loperamide: 2–4 mg PO initially, then 2 mg after each loose stool (max 16 mg/day).

  • Diphenoxylate–atropine: 2.5–5 mg PO TID–QID.

• Stool bulking agents (if leakage from loose stool):

  • Methylcellulose 2 g PO daily.

  • Polycarbophil 625 mg PO once or twice daily.

• Stool softeners or osmotic laxatives (if constipation-related leakage):

  • Docusate sodium 100 mg PO BID.

  • Polyethylene glycol (PEG 3350) 17 g in water daily.

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3. Pelvic Floor & Behavioral Therapies

• Kegel exercises: strengthen anal sphincter muscles.

• Biofeedback therapy: improves awareness and coordination of sphincter control.

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4. Advanced Therapies

• Injectable bulking agents (dextranomer/hyaluronic acid gel): injected into anal canal to improve closure.

• Sacral nerve stimulation: electrical stimulation of sacral nerves to improve continence.

• Sphincteroplasty: surgical repair of damaged anal sphincter (especially obstetric injury).

• Colostomy: last-resort option in severe, refractory cases.

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Supportive Care

• Skin care: barrier creams (zinc oxide, petroleum jelly) to prevent irritation.

• Absorbent pads/garments for social comfort.

• Psychological support to address embarrassment and quality-of-life issues.

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Key Notes

• Treatment depends on underlying cause (loose stools vs. sphincter damage vs. neurologic).

• Loperamide is particularly effective because it not only slows transit but also increases sphincter tone.

• Many patients benefit from combined therapy (diet + medication + pelvic floor exercises).

• Referral to a colorectal specialist is appropriate for persistent or severe cases.