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Fecal Incontinence

National Digestive Information Clearinghouse

What is ? more common among women. Having any of the following can increase the risk: Fecal incontinence, also called a bowel control problem, is the accidental passing • , which is passing loose, watery of solid or liquid stool or from the stools three or more times a day U.S. Department . Fecal incontinence includes the of Health and • urgency, or the sensation of having very Human Services inability to hold a bowel movement until little time to get to the for a bowel reaching a toilet as well as passing stool into movement NATIONAL one’s underwear without being aware of it INSTITUTES OF HEALTH happening. Stool, also called feces, is solid • a or that damages the waste that is passed as a bowel movement nervous system and includes undigested food, bacteria, • poor overall health from multiple mucus, and dead cells. Mucus is a clear chronic, or long lasting, illnesses liquid that coats and protects tissues in the digestive system. • a difficult childbirth with to the —the muscles, ligaments, Fecal incontinence can be upsetting and and tissues that support the uterus, embarrassing. Many people with fecal , bladder, and rectum incontinence feel ashamed and try to hide the problem. However, people with fecal incontinence should not be afraid or What is the gastrointestinal embarrassed to talk with their health care (GI) tract? provider. Fecal incontinence is often caused The GI tract is a series of hollow organs by a medical problem and treatment is joined in a long, twisting tube from the available. mouth to the anus. The movement of muscles in the GI tract, along with the Who gets fecal release of hormones and enzymes, allows incontinence? for the digestion of food. Organs that make up the GI tract are the mouth, , Nearly 18 million U.S. adults—about one stomach, , — 1 in 12—have fecal incontinence. People of which includes the , cecum, colon, any age can have a bowel control problem, and rectum—and anus. The intestines are though fecal incontinence is more common sometimes called the bowel. The last part in older adults. Fecal incontinence is slightly of the GI tract—called the lower GI tract— consists of the large intestine and anus.

1Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in U.S. adults: epidemiology and risk factors. . 2009;137(2):512–517. How does bowel control work? Esophagus Bowel control relies on muscles and nerves of the rectum and anus working together to Stomach • hold stool in the rectum • let a person know when the rectum Large is full intestine • release stool when the person is ready Small intestine Circular muscles called sphincters close tightly like rubber bands around the anus Colon until stool is ready to be released. Pelvic floor muscles also help with bowel control. Cecum

Appendix Anus Rectum Rectum The lower GI tract

The large intestine absorbs water and any External sphincter remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to stool. Stool passes from the External Internal sphincter sphincter colon to the rectum. The rectum is located between the last part of the colon—called the sigmoid colon—and the anus. The Internal rectum stores stool prior to a bowel sphincter movement. During a bowel movement, stool moves from the rectum to the anus, the Anus opening through which stool leaves the body.

The external and muscles

2 Fecal Incontinence What causes fecal The type of that is most likely to lead to fecal incontinence occurs when incontinence? people are unable to relax their external Fecal incontinence has many causes, sphincter and pelvic floor muscles when including straining to have a bowel movement, often • diarrhea mistakenly squeezing these muscles instead of relaxing them. This squeezing makes it • constipation difficult to pass stool and may lead to a large • muscle damage or weakness amount of stool in the rectum. This type of constipation, called dyssynergic • nerve damage or disordered defecation, is a result of • loss of stretch in the rectum faulty learning. For example, children or adults who have pain when having a bowel • childbirth by vaginal delivery movement may unconsciously learn to • and rectal squeeze their muscles to delay the bowel movement and avoid pain. • • inactivity Muscle Damage or Weakness Injury to one or both of the sphincter Diarrhea muscles can cause fecal incontinence. If Diarrhea can cause fecal incontinence. these muscles, called the external and Loose stools fill the rectum quickly and internal anal sphincter muscles, are damaged are more difficult to hold than solid stools. or weakened, they may not be strong enough Diarrhea increases the chance of not to keep the anus closed and prevent stool reaching a bathroom in time. from leaking. Constipation Trauma, childbirth injuries, cancer surgery, Constipation can lead to large, hard stools and surgery are possible causes that stretch the rectum and cause the internal of injury to the sphincters. Hemorrhoids are sphincter muscles to relax by reflex. Watery swollen blood vessels in and around the anus stool builds up behind the hard stool and and lower rectum. may leak out around the hard stool, leading to fecal incontinence.

3 Fecal Incontinence Nerve Damage Hemorrhoids and Rectal The anal sphincter muscles won’t open and Prolapse close properly if the nerves that control External hemorrhoids, which develop under them are damaged. Likewise, if the nerves the skin around the anus, can prevent that sense stool in the rectum are damaged, the anal sphincter muscles from closing a person may not feel the urge to go to the completely. , a condition bathroom. Both types of nerve damage can that causes the rectum to drop down through lead to fecal incontinence. Possible sources the anus, can also prevent the anal sphincter of nerve damage are childbirth; a long-term muscles from closing well enough to prevent habit of straining to pass stool; leakage. Small amounts of mucus or liquid injury; and diseases, such as and stool can then leak through the anus. , that affect the nerves that go to the sphincter muscles and rectum. Rectocele Brain injuries from , head trauma, Rectocele is a condition that causes the or certain diseases can also cause fecal rectum to protrude through the vagina. incontinence. Rectocele can happen when the thin layer Loss of Stretch in the Rectum of muscles separating the rectum from the vagina becomes weak. For women Normally, the rectum stretches to hold with rectocele, straining to have a bowel stool until a person has a bowel movement. movement may be less effective because Rectal surgery, radiation treatment, and rectocele reduces the amount of downward inflammatory bowel diseases—chronic force through the anus. The result may disorders that cause irritation and sores on be retention of stool in the rectum. More the lining of the digestive system—can cause research is needed to be sure rectocele the rectal walls to become stiff. The rectum increases the risk of fecal incontinence. then can’t stretch as much to hold stool, increasing the risk of fecal incontinence. Inactivity Childbirth by Vaginal Delivery People who are inactive, especially those who spend many hours a day sitting or lying down, Childbirth sometimes causes injuries to have an increased risk of retaining a large muscles and nerves in the pelvic floor. The amount of stool in the rectum. Liquid stool risk is greater if forceps are used to help can then leak around the more solid stool. deliver the baby or if an —a cut in Frail, older adults are most likely to develop the vaginal area to prevent the baby’s head constipation-related fecal incontinence for from tearing the vagina during birth—is this reason. performed. Fecal incontinence related to childbirth can appear soon after delivery or many years later.

4 Fecal Incontinence How is fecal incontinence People may want to keep a stool diary for several weeks before their appointment diagnosed? so they can answer these questions. A Health care providers diagnose fecal stool diary is a chart for recording daily incontinence based on a person’s medical bowel movement details. A sample history, physical exam, and medical test stool diary is available on the Bowel results. In addition to a general medical Control Awareness Campaign website at history, the health care provider may ask the www.bowelcontrol.nih.gov. following questions: The person may be referred to a doctor • When did fecal incontinence start? who specializes in problems of the digestive • How often does fecal incontinence system, such as a gastroenterologist, occur? proctologist, or colorectal surgeon, or a doctor who specializes in problems of the • How much stool leaks? Does the stool urinary and reproductive systems, such as a just streak the underwear? Does just a urologist or urogynecologist. The specialist little bit of solid or liquid stool leak out will perform a physical exam and may suggest or does complete loss of bowel control one or more of the following tests: occur? • anal manometry • Does fecal incontinence involve a strong urge to have a bowel movement or does • anal ultrasound it happen without warning? • magnetic resonance imaging (MRI) • For people with hemorrhoids, do • hemorrhoids bulge through the anus? Do the hemorrhoids pull back in by • flexible or colonoscopy themselves, or do they have to be • anal electromyography (EMG) pushed in with a finger? Anal manometry. Anal manometry uses • How does fecal incontinence affect daily pressure sensors and a balloon that can life? be inflated in the rectum to check the • Is fecal incontinence worse after eating? sensitivity and function of the rectum. Anal Do certain foods seem to make fecal manometry also checks the tightness of the incontinence worse? anal sphincter muscles around the anus. To prepare for this test, the person should • Can passing gas be controlled? use an and not eat anything 2 hours before the test. An enema involves flushing water or a into the anus using a

5 Fecal Incontinence special squirt bottle. A laxative is medication with a fear of confined spaces may be given that loosens stool and increases bowel medication to help them relax. An MRI may movements. For this test, a thin tube with a include the injection of special dye, called balloon on its tip and pressure sensors below contrast medium. With most MRI machines, the balloon is inserted into the anus until the person lies on a table that slides into the balloon is in the rectum and pressure a tunnel-shaped device that may be open sensors are located in the . The ended or closed at one end; some newer tube is slowly pulled back through the machines are designed to allow the person sphincter muscle to measure muscle tone to lie in a more open space. MRIs can show and contractions. No anesthesia is needed problems with the anal sphincter muscles. for this test, which takes about 30 minutes. MRI is an alternative to anal ultrasound that may provide more detailed information, Anal ultrasound. Ultrasound uses a especially about the . device, called a transducer, that bounces safe, painless sound waves off organs to Defecography. This x ray of the area around create an image of their structure. An the anus and rectum shows how well the anal ultrasound is specific to the anus and person can hold and evacuate stool. The rectum. The procedure is performed in test also identifies structural changes in the a health care provider’s office, outpatient rectum and anus such as rectocele and rectal center, or hospital by a specially trained prolapse. To prepare for the test, the person technician, and the images are interpreted uses two and does not eat anything by a radiologist—a doctor who specializes in 2 hours prior to the test. During the test, medical imaging. Anesthesia is not needed. the health care provider fills the rectum with The images can show the structure of the a soft paste that shows up on x rays and is anal sphincter muscles. the same consistency as stool. The person sits on a toilet inside an x-ray machine. The MRI. MRI machines use radio waves and person is first asked to pull in and squeeze magnets to produce detailed pictures of the sphincter muscles to prevent leakage and the body’s internal organs and soft tissues then to strain as if having a bowel movement. without using x rays. The procedure is The radiologist studies the x rays to identify performed in an outpatient center or hospital problems with the rectum, anus, and pelvic by a specially trained technician, and the floor muscles. images are interpreted by a radiologist. Anesthesia is not needed, though people

6 Fecal Incontinence Flexible sigmoidoscopy or colonoscopy. The person will not feel the . A These tests are used to help diagnose pathologist—a doctor who specializes in problems causing fecal incontinence. The diagnosing diseases—examines the tissue in a tests are similar, but colonoscopy is used lab to confirm the diagnosis. to view the rectum and entire colon, while Cramping or may occur during flexible sigmoidoscopy is used to view just the first hour after these tests. Driving is the rectum and lower colon. These tests not permitted for 24 hours after flexible are performed at a hospital or outpatient sigmoidoscopy or colonoscopy to allow the center by a gastroenterologist. For both anesthesia time to wear off. Before the tests, a health care provider will provide appointment, a person should make plans for written bowel prep instructions to follow at a ride home. Full recovery is expected by the home. The person may be asked to follow a next day and the person is able to go back to clear liquid diet for 1 to 3 days before either a normal diet. test. A laxative may be required the night before the test. One or more enemas may be Anal EMG. Anal EMG checks the health required the night before and about 2 hours of the pelvic floor muscles and the nerves before the test. that control the muscles. The health care provider inserts a very thin needle In most cases, people will be given light electrode through the skin into the muscle. anesthesia, and possibly pain medication, The electrode on the needle picks up the to help them relax during flexible electrical activity given off by the muscles sigmoidoscopy. Anesthesia is used for and shows it as images on a monitor or colonoscopy. For either test, the person will sounds through a speaker. An alternative lie on a table while the gastroenterologist type of anal EMG uses stainless steel inserts a flexible tube into the anus. A small plates attached to the sides of a plastic plug camera on the tube sends a video image of instead of a needle. The plug is inserted the intestinal lining to a computer screen. into the anal canal to measure the electrical The test can show problems in the lower GI activity of the external anal sphincter and tract that may be causing the bowel control other pelvic floor muscles. The average problem. The gastroenterologist may also amount of electrical activity when the person perform a biopsy, a procedure that involves relaxes quietly, squeezes to prevent a bowel taking a piece of tissue from the bowel movement, and strains to have a bowel lining for examination with a microscope. movement shows whether there is damage to the nerves that control the external sphincter and pelvic floor muscles.

7 Fecal Incontinence How is fecal incontinence treated? Keeping a Food Diary Treatment for fecal incontinence may include A food diary can help identify foods that one or more of the following: cause diarrhea and increase the risk of fecal incontinence. A food diary should • eating, diet, and nutrition list foods eaten, portion size, and when • medications fecal incontinence occurs. After a few days, the diary may show a link between • bowel training certain foods and fecal incontinence. • pelvic floor exercises and Eating less of foods linked to fecal incontinence may improve symptoms. • surgery A food diary can also be helpful to a • electrical stimulation health care provider treating a person with fecal incontinence. Eating, Diet, and Nutrition Dietary changes that may improve fecal Common foods and drinks linked to incontinence include fecal incontinence include • Eating the right amount of fiber. • dairy products such as milk, cheese, Fiber can help with diarrhea and and ice cream constipation. Fiber is found in fruits, • drinks and foods containing vegetables, whole grains, and . Fiber supplements sold in a pharmacy • cured or smoked meat such as or in a health food store are another sausage, ham, and turkey common source of fiber to treat fecal incontinence. The Academy of • spicy foods Nutrition and Dietetics recommends • alcoholic beverages consuming 20 to 35 grams of fiber a day for adults and “age plus five” grams • fruits such as apples, peaches, and for children. A 7-year-old child, for pears example, should get “7 plus five,” or • fatty and greasy foods 12, grams of fiber a day. American adults consume only 15 grams a day on • sweeteners in diet drinks and average.2 Fiber should be added to the sugarless gum and candy, including diet slowly to avoid bloating. sorbitol, xylitol, mannitol, and fructose • Getting plenty to drink. Drinking eight 8-ounce glasses of liquid a day may help prevent constipation. Water is a good choice. Drinks with caffeine, , milk, or carbonation should be avoided if they trigger diarrhea.

2Slavin JL. Position of the American Dietetic Association: health implications of . Journal of the American Dietetic Association. 2008;108(31):1716–1731. 8 Fecal Incontinence Examples of Foods That Have Fiber Beans, cereals, and Fiber 1/2 cup of beans (navy, pinto, 6.2–9.6 grams kidney, etc.), cooked 1/2 cup of shredded wheat, 2.7–3.8 grams ready-to-eat cereal 1/3 cup of 100% bran, 9.1 grams ready-to-eat cereal 1 small oat bran muffin 3.0 grams 1 whole-wheat English muffin 4.4 grams

Fruits 1 small apple, with skin 3.6 grams 1 medium pear, with skin 5.5 grams 1/2 cup of raspberries 4.0 grams 1/2 cup of stewed 3.8 grams

Vegetables 1/2 cup of winter squash, cooked 2.9 grams 1 medium sweet potato, baked in skin 3.8 grams 1/2 cup of green peas, cooked 3.5–4.4 grams 1 small potato, baked, with skin 3.0 grams 1/2 cup of mixed vegetables, cooked 4.0 grams 1/2 cup of broccoli, cooked 2.6–2.8 grams 1/2 cup of greens (spinach, collards, 2.5–3.5 grams turnip greens), cooked

Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010.

9 Fecal Incontinence Medications of rectal filling. Biofeedback training uses If diarrhea is causing fecal incontinence, special sensors to measure bodily functions. medication may help. Health care Sensors include pressure or EMG sensors providers sometimes recommend using bulk in the anus, pressure sensors in the rectum, , such as Citrucel and Metamucil, and a balloon in the rectum to produce to develop more solid stools that are easier graded sensations of rectal fullness. The to control. Antidiarrheal medications such measurements are displayed on a video as or may be screen as sounds or line graphs. The health recommended to slow down the bowels and care provider uses the information to help help control the problem. the person modify or change abnormal function. The person practices the exercises Bowel Training at home. Success with pelvic floor exercises depends on the cause of fecal incontinence, Developing a regular bowel movement its severity, and the person’s motivation and pattern can improve fecal incontinence, ability to follow the health care provider’s especially fecal incontinence due to recommendations. constipation. Bowel training involves trying to have bowel movements at specific times Surgery of the day, such as after every meal. Over time, the body becomes used to a regular Surgery may be an option for fecal bowel movement pattern, thus reducing incontinence that fails to improve with other constipation and related fecal incontinence. treatments or for fecal incontinence caused Persistence is key to successful bowel by pelvic floor or anal sphincter muscle training. Achieving a regular bowel control injuries. pattern can take weeks to months. • Sphincteroplasty, the most common fecal incontinence surgery, reconnects Pelvic Floor Exercises and the separated ends of a sphincter Biofeedback muscle torn by childbirth or another Exercises that strengthen the pelvic floor injury. Sphincteroplasty is performed at muscles may improve bowel control. Pelvic a hospital by a colorectal, gynecological, floor exercises involve squeezing and relaxing or general surgeon. pelvic floor muscles 50 to 100 times a day. A • Artificial anal sphincter involves health care provider can help with proper placing an inflatable cuff around the technique. Biofeedback therapy may also anus and implanting a small pump help a person perform the exercises properly. beneath the skin that the person This therapy also improves a person’s activates to inflate or deflate the cuff. awareness of sensations in the rectum, This surgery is much less common and teaching how to coordinate squeezing of the is performed at a hospital by a specially external sphincter muscle with the sensation trained colorectal surgeon.

10 Fecal Incontinence • Nonabsorbable bulking agents can be What are some practical injected into the wall of the anus to bulk up the tissue around the anus. The tips for coping with fecal bulkier tissues make the opening of the incontinence? anus narrower so the sphincters are Fecal incontinence can cause able to close better. The procedure is embarrassment, fear, and loneliness. Taking performed in a health care provider’s steps to cope is important. The following office; anesthesia is not needed. The tips can help: person can return to normal physical activities 1 week after the procedure. • carrying a bag with cleanup supplies and a change of clothes when leaving the • Bowel diversion is an operation that house. reroutes the normal movement of stool out of the body when part of the bowel • finding public restrooms before one is is removed. The operation diverts the needed. lower part of the small intestine or • using the toilet before leaving home. colon to an opening in the wall of the • wearing disposable underwear —the area between the chest or absorbent pads inserted in the and hips. An external pouch is attached underwear. to the opening to collect stool. The procedure is performed by a surgeon in • using fecal deodorants—pills that a hospital and anesthesia is used. More reduce the smell of stool and gas. information about these procedures Although fecal deodorants are available can be found in the National Digestive over the counter, a health care provider Diseases Information Clearinghouse can help people find them. fact sheet Bowel Diversion at Eating tends to trigger contractions of the www.digestive.niddk.nih.gov. large intestine that push stool toward the Electrical Stimulation rectum and also cause the rectum to contract for 30 to 60 minutes. Both these events Electrical stimulation, also called sacral increase the likelihood that a person will nerve stimulation or neuromodulation, pass gas and have a bowel movement soon involves placing electrodes in the sacral after eating. This activity may increase if nerves to the anus and rectum and the person is anxious. People with fecal continuously stimulating the nerves with incontinence may want to avoid eating in electrical pulses. The sacral nerves connect restaurants or at social gatherings, or they to the part of the spine in the hip area. may want to take antidiarrheal medications A battery-operated stimulator is placed before eating in these situations. beneath the skin. Based on the person’s response, the health care provider can adjust the amount of stimulation so it works best for that person. The person can turn the stimulator on or off at any time. The procedure is performed in an outpatient center using local anesthesia.

11 Fecal Incontinence Anal Discomfort The skin around the anus is delicate and sensitive. Constipation and diarrhea or contact between skin and stool can cause pain or itching. The following steps can help relieve anal discomfort: • Washing the anal area after a bowel movement. Washing with water, but not soap, can help prevent discomfort. Soap can dry out the skin, making discomfort worse. Ideally, the anal area should be washed in the shower with lukewarm water or in a —a special plastic tub that allows a person to sit in a few inches of warm water. No-rinse skin cleansers, such as Cavilon, are a good alternative. Wiping with toilet paper further irritates the skin and should be avoided. Premoistened, alcohol- free towelettes are a better choice. • Keeping the anal area dry. The anal area should be allowed to air dry after washing. If time doesn’t permit air drying, the anal area can be gently patted dry with a lint- free cloth. • Creating a moisture barrier. A moisture barrier cream that contains ingredients such as dimethicone—a type of silicone—can help form a barrier between skin and stool. The anal area should be cleaned before applying barrier cream. However, people should talk with their health care provider before using anal creams and ointments because some can irritate the anus. • Using nonmedicated powders. Nonmedicated talcum powder or cornstarch can also relieve anal discomfort. As with moisture barrier creams, the anal area should be clean and dry before use. • Using wicking pads or disposable underwear. Pads and disposable underwear with a wicking layer can pull moisture away from the skin. • Wearing breathable clothes and underwear. Clothes and underwear should allow air to flow and keep skin dry. Tight clothes or plastic or rubber underwear that blocks air can worsen skin problems. • Changing soiled underwear as soon as possible.

12 Fecal Incontinence What if a child has fecal • Fecal incontinence has many causes, incontinence? including A child with fecal incontinence who is – diarrhea toilet trained should see a health care – constipation provider, who can determine the cause and – muscle damage or weakness recommend treatment. Fecal incontinence – nerve damage can occur in children because of a birth – loss of stretch in the rectum defect or disease, but in most cases it occurs – childbirth by vaginal delivery because of constipation. – hemorrhoids and rectal prolapse Children often develop constipation as – rectocele a result of stool withholding. They may – inactivity withhold stool because they are stressed about toilet training, embarrassed to use a • Health care providers diagnose fecal public bathroom, do not want to interrupt incontinence based on a person’s playtime, or are fearful of having a painful or medical history, physical exam, and unpleasant bowel movement. medical test results. As in adults, constipation in children can • Treatment for fecal incontinence may cause large, hard stools that get stuck in the include one or more of the following: rectum. Watery stool builds up behind the – eating, diet, and nutrition hard stool and may unexpectedly leak out, – medications soiling a child’s underwear. Parents often mistake this soiling as a sign of diarrhea. – bowel training – pelvic floor exercises and biofeedback Points to Remember – surgery • Fecal incontinence, also called a bowel – electrical stimulation control problem, is the accidental passing of solid or liquid stool or mucus • A food diary can help identify foods from the rectum. Fecal incontinence that cause fecal incontinence. includes the inability to hold a bowel • Fecal incontinence can occur in children movement until reaching a toilet as well because of a birth defect or disease, as passing stool into one’s underwear but in most cases it occurs because of without being aware of it happening. constipation. • Nearly 18 million U.S. adults—about one in 12—have fecal incontinence. People with fecal incontinence should not be afraid or embarrassed to talk with their health care provider.

13 Fecal Incontinence Hope through Research trials to look at other aspects of care, such as improving the quality of life for people The National Institute of Diabetes and with chronic illnesses. To learn more about Digestive and Kidney Diseases (NIDDK) clinical trials, why they matter, and how to and other components of the National participate, visit the NIH Clinical Research Institutes of Health (NIH) conduct and Trials and You website at www.nih.gov/health/ support research into many kinds of digestive clinicaltrials. For information about current disorders, including fecal incontinence. The studies, visit www.ClinicalTrials.gov. Behavioral Therapy of Obstetric Sphincter Tears (BOOST), funded under NIH clinical trial number NCT01166399, surveys women For More Information who suffered a tear of the anal sphincters American Academy of Family Physicians during childbirth to determine the incidence P.O. Box 11210 of fecal incontinence in this population. Shawnee Mission, KS 66207–1210 The NIDDK is sponsoring a study of Phone: 1–800–274–2237 or 913–906–6000 biofeedback for fecal incontinence, Fax: 913–906–6075 funded under NIH clinical trial number Email: [email protected] NCT00124904. The aims of the study are Internet: www.aafp.org to compare biofeedback with alternative American College of Gastroenterology therapies, identify which patients are most 6400 Goldsboro Road, Suite 200 likely to benefit, and assess the effect of Bethesda, MD 20817 treatment on quality of life. Phone: 301–263–9000 Adaptive Behaviors among Women with Email: [email protected] Bowel Incontinence: The ABBI Trial, Internet: www.acg.gi.org funded under NIH clinical trial number American Gastroenterological Association NCT00729144, focuses on the validation 4930 Del Ray Avenue of the Adaptation Index instrument as a Bethesda, MD 20814 measurement of adaptive behaviors used Phone: 301–654–2055 to reduce symptoms of fecal incontinence Fax: 301–654–5920 among women. The Adaptation Index was Email: [email protected] developed with input from investigators Internet: www.gastro.org of the Pelvic Floor Disorders Network and refined through focus groups and is American Neurogastroenterology and being validated in women with urinary Motility Society incontinence and . 45685 Harmony Lane Belleville, MI 48111 Clinical trials are research studies involving Phone: 734–699–1130 people. Clinical trials look at safe and Fax: 734–699–1136 effective new ways to prevent, detect, or Email: [email protected] treat disease. Researchers also use clinical Internet: www.motilitysociety.org

14 Fecal Incontinence International Foundation for Functional Acknowledgments Gastrointestinal Disorders Publications produced by the Clearinghouse P.O. Box 170864 are carefully reviewed by both NIDDK Milwaukee, WI 53217–8076 scientists and outside experts. This Phone: 1–888–964–2001 or 414–964–1799 publication was originally reviewed by Fax: 414–964–7176 Arnold Wald, M.D., University of Pittsburgh Email: [email protected] Medical Center; Paul Hyman, M.D., Internet: www.iffgd.org University of Kansas Medical Center; and Pelvic Floor Disorders Network Diane Darrell, A.P.R.N., B.C., Research Data Coordinating Center College of Nursing, Kansas City, MO. 6110 Executive Boulevard, Suite 420 William E. Whitehead, Ph.D., University of Rockville, MD 20852 North Carolina Center for Functional GI and Phone: 301–230–4645 Motility Disorders, reviewed the updated Fax: 301–230–4647 version of the publication. Internet: http://pfdn.rti.org The Simon Foundation for Continence The Bowel Control P.O. Box 815 Awareness Campaign Wilmette, IL 60091 The National Institute of Diabetes and Phone: 1–800–23–SIMON (1–800–237–4666) Digestive and Kidney Diseases (NIDDK) or 847–864–3913 Bowel Control Awareness Campaign Fax: 847–864–9758 provides current, science-based information Internet: www.simonfoundation.org about the symptoms, diagnosis, and Voices for PFD treatment of bowel control problems, American Urogynecologic Society also known as fecal incontinence. The Foundation Awareness Campaign is an initiative of the 2025 M Street NW, Suite 800 National Digestive Diseases Information Washington, D.C. 20036 Clearinghouse, a service of the NIDDK. Phone: 202–367–1167 Download this publication and learn Fax: 202–367–2167 more about the Awareness Campaign at Email: [email protected] www.bowelcontrol.nih.gov. Internet: www.voicesforpfd.org

15 Fecal Incontinence You may also find additional information about this National Digestive Diseases topic by visiting MedlinePlus at www..gov. Information Clearinghouse This publication may contain information about medications. When prepared, this publication 2 Information Way included the most current information available. Bethesda, MD 20892–3570 For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll- Phone: 1–800–891–5389 free at 1–888–INFO–FDA (1–888–463–6332) or visit TTY: 1–866–569–1162 www.fda.gov. Consult your health care provider for more information. Fax: 703–738–4929 Email: [email protected] Internet: www.digestive.niddk.nih.gov The National Digestive Diseases Information The U.S. Government does not endorse or favor any specific commercial product or company. Trade, Clearinghouse (NDDIC) is a service of the proprietary, or company names appearing in this National Institute of Diabetes and Digestive document are used only because they are considered and Kidney Diseases (NIDDK). The necessary in the context of the information provided. If a product is not mentioned, the omission does not NIDDK is part of the National Institutes of mean or imply that the product is unsatisfactory. Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. This publication is available at www.digestive.niddk.nih.gov.

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NIH Publication No. 13–4866 December 2012

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