Fecal Incontinence In Women: Causes And Treatment Options

Fecal incontinence may not be easy to talk about, but it’s more common than many women realize. About one in five adults will experience it during their lives. Though it can feel embarrassing or isolating, help is available — and for many women, that help starts with a conversation.

Tobi J. Reidy, DO, a colon and rectal surgeon at Franciscan Health, is passionate about guiding patients through this often-overlooked condition with compassion, expertise and a full range of treatment options.

“It’s not a common dinner table topic, but it’s exceedingly common,” Dr. Reidy said. “Just knowing that can help patients open up and seek help.”

What Is Fecal Incontinence?

Fecal incontinence, also known as bowel incontinence, is the inability to control bowel movements, which can lead to unintentional leakage.

“Some people just think it’s a part of aging,” Dr. Reidy explained. “But that doesn’t mean you have to live with it.”

Common Symptoms: From Leaking Stool To Urgency

Symptoms of bowel incontinence can vary, from small accidents to complete loss of control. You might experience:

• Stool leakage during physical activity or after you eat

• Unexpected leakage during movement or posture changes

• A sudden urge to go and not make it to the bathroom in time
• Difficulty sensing when you need to go
• Frequent or uncontrollable gas
• Soiling underwear without realizing it

“It’s not just about the physical symptoms,” said Dr. Reidy. “The emotional toll — anxiety, fear of social outings or avoiding travel — is just as important to address.” You don’t have to manage these symptoms alone. Support is available.

What Causes Fecal Incontinence In Women?

Fecal incontinence can happen for many reasons, especially in women. Five of the most common causes include:

1. Aging, which weakens pelvic muscles. “Just like other parts of the body, the pelvic floor can weaken over time,” said Dr. Reidy.
2. Childbirth, especially vaginal delivery, can stretch or damage pelvic muscles and nerves.
3. Hormonal changes, such as those during menopause.
4. Medical conditions, including diabetes or neurological diseases.
5. Medications or dietary changes, which may affect stool consistency.

“Three main components help maintain continence: muscle strength, nerve function and stool consistency,” Dr. Reidy said. “When any of those systems doesn’t work properly, leakage can occur.”

Fecal Incontinence After Childbirth: What To Know

Many women first experience fecal incontinence after childbirth, especially after a vaginal delivery, forceps or episiotomy-assisted delivery.

“Even women who recover well after childbirth may notice changes later in life, especially around menopause,” Dr. Reidy explained. That’s often due to pelvic muscle or nerve injury.

The good news? Childbirth-related bowel incontinence is highly treatable, especially when addressed early. Pelvic floor therapy, dietary adjustments and other interventions can provide long-term relief.

How Is Fecal Incontinence Diagnosed?

Diagnosing fecal incontinence starts with a medical history and physical exam.

“We can learn a lot when we talk to and examine the patient,” said Dr. Reidy. “We use tests that evaluate the pelvic floor, nerves and muscles, but we also use more advanced tests that measure muscle pressure and nerve activity.”

Common diagnostic tools include:

• Annual manometry – measures muscle pressure
• Endoanal ultrasound or MRI – visualizes muscle structures
• Electromyography (EMG) – assesses nerve function

What Are The Best Treatments For Fecal Incontinence?

Many women experiencing fecal incontinence see improvement with simple, conservative strategies.

“All my patients start with dietary changes,” Dr. Reidy said. You can adjust fiber and hydration to improve stool consistency.

“Pelvic floor physical therapy is also an extremely effective way to retrain muscles and improve control.”

“More than 50 to 80 percent of women improve with these treatments. For those who need additional support, other options include:

• Bulking agent injections: This minimally invasive procedure helps the anal canal close more effectively.
• Sacral neuromodulation: We place a small wire near a nerve that controls bowel and bladder function. “It’s the gold standard in treatment and can be life-changing for many people,” Dr. Reidy said.
• In rare cases, surgery or a colostomy: We use these procedures as a last resort for severe cases.

Is Fecal Incontinence Reversible?

“Most patients see significant improvement with nonsurgical treatments,” Dr. Reidy said. “The goal is to help patients regain the freedom to enjoy activities without fear or embarrassment.”

Every person’s path is unique, and so is their care plan.

When To See A Doctor

If you’ve noticed occasional issues, it may not seem serious. But if it happens regularly, once or twice a week or month, it’s time to talk to your provider.

“Untreated, symptoms can become socially disabling and lead to isolation,” Dr. Reidy cautioned.

Help is here before it gets to that point.

Visit our fecal incontinence specialty page and schedule an appointment.