Embarrassing fecal incontinence? You’re not alone

DEAR DR. ROACH » I hope you can help elderly folks (like myself, age 83) who have a very embarrassing situation wherein their stool seeps out of them. The problem is only noted when I sit down and find that my underwear sticks to me. The problem appears to happen anytime, and sometimes AFTER a bowel movement. DEAR READER » Fecal incontinence is a far more common problem than often realized, partially because many people are too embarrassed to even mention it to their doctors. As people get older, it becomes more prevalent, as there are additional risk factors, especially people with diarrhea (more likely with liquid stool than with solid), diabetes and women who have taken hormone replacement.

There are many possible causes for fecal incontinence, and successful treatment depends on finding the underlying cause. However, I can recommend some general advice that will help many cases.

The first is that if stools are very hard, taking fiber or a stool softener may solve the problem. Constipation is a frequent, unrecognized and counterintuitive reason for this problem. Conversely, liquid stools are much more likely to pass involuntarily, so fiber or an antidiarrheal medicine are helpful in people with frequent loose or liquid bowel movements. Often, the problem is a decrease in nerve function in the area, both the sensory part (alerting you to the need to defecate) and the motor part (properly holding the sphincter closed when it needs to be). The fact that you are often unaware of this happening suggests a problem with sensation.

Caffeine and sugars, which are hard for some people to digest, should be avoided to see if that helps.

A gastroenterologist is the right person to see for this if initial treatment fails. This may include an endoscopic evaluation of the rectum and measurements of the pressures in the anus and rectum. Many people don’t get help because they are embarrassed to ask for it — don’t let that be the case for you.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.