Fecal incontinence causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Anticholinergics, antidepressants, caffeine, laxatives, medications, muscle relaxants, orlistat, pergolide, pramipexole, sorbitol,
Ear Nose Throat	No underlying causes
Endocrine	Diabetes mellitus
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Adenovirus infection, astrovirus infection, bacterial infection, coronovirus infection, enterovirus infection, infection, lymphogranuloma, proctitis, pseudomembranous colitis, reovirus infection, rotavirus infection, viral gastroenteritis
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	Olestra
Obstetric/Gynecologic	Childbirth, episiotomy, excessive perineal descent, forcep delivery, obstetric denervation, obstetric trauma, obstetrical injury,, pelvic floor dysfunction, pelvic fracture, pelvic surgery, rectovaginal fistula, traumatic childbirth, uterine prolapse
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	Aldicarb
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Impalement, Jirasek-zuelzer-wilson syndrome

Causes in Alphabetical Order

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Causes

Constipation

Constipation is the most common cause of fecal incontinence. Constipation causes prolonged muscle stretching and leads to weakness of the intestinal muscles. After a certain point, the rectum will no longer close tightly enough to prevent stool loss, resulting in incontinence.

Muscle damage

Fecal incontinence can be caused by injury to one or both of the ring-like muscles at the end of the rectum called the internal and external anal sphincters. During normal function, these sphincters help retain stool. In women, damage can occur during childbirth. The risk of injury is greatest when the birth attendant uses forceps to help the delivery or does an episiotomy. Hemorrhoid surgery can damage the sphincters as well. A pelvic tumor that grows in or becomes attached to the rectum or anus also can cause muscle damage, as can surgery to remove the tumor. Although anal sex resulting in repeated injury to the internal anal sphincter can lead to incontinence, the threat is relatively small. One study among 14 anoreceptive homosexual men and ten non-anoreceptive heterosexual men showed that anoreceptive homosexual men have decreased anal canal resting pressure relative to non-anoreceptive heterosexual men and no associated fecal incontinence. Another study among forty anoreceptive homosexual men and ten non-anoreceptive heterosexual men found a very significant increase in fecal incontinence (fourteen, or 35% amongst the anoreceptive men, and one, or 10% in the non-anoreceptive sample) amongst the the anoreceptive sample.

Nerve damage

Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that detect stool in the rectum. Damage to the nerves controlling the sphincter muscles may render the muscles unable to work effectively. If the sensory nerves are damaged, detection of stool in the rectum is disabled, and one will not feel the need to defecate until too late. Nerve damage can be caused by childbirth, long-term constipation, stroke, and diseases that cause nerve degeneration, such as diabetes and multiple sclerosis.

Loss of storage capacity

Normally, the rectum stretches to hold stool until it is voluntarily released. But rectal surgery, radiation treatment, and inflammatory bowel disease can cause scarring, which may result in the walls of the rectum becoming stiff and less elastic. The rectum walls are unable to stretch as much and are unable to accommodate as much stool. Inflammatory bowel disease also can make rectal walls very irritated and thereby unable to contain stool.

Diarrhea

Main article: Diarrhea

Diarrhea, or loose stool, is more difficult to control than solid stool that is formed. Where diarrhea is caused by temporary problems such as mild infections or food reactions, incontinence tends to last for a period of days. Chronic conditions, such as Irritable Bowel Syndrome, or Crohn's disease can cause severe diarrhea lasting for weeks or months until successful treatment can be found.

Pelvic floor dysfunction

Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocele), and generalized weakness and sagging of the pelvic floor.

Other causes

Fecal incontinence can have other causes including one or a combination of the following:

• Excretory problems
• Fecal impaction
• Diseases, drugs, and indigestible dietary fats that interfere with the intestineal absorption. Respective examples include cystic fibrosis, orlistat, and olestra.
• Lateral internal sphincterotomy (Surgical procedure for helping Anal fissures heal)
• Seizure
• Drug Induced - Pergolide, Pramipexole