Fecal Incontinence: Symptoms, Causes, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is fecal incontinence?
Fecal incontinence is the accidental passing of solid or liquid stool, also called bowel incontinence. [1] It most often results from diarrhea, constipation, or damage to the muscles or nerves controlling the anus, rectum and pelvic floor, and is more common in women and adults over 65. Talk to a healthcare professional, since earlier evaluation means earlier relief.
What the research says
About 1 in 12 adults worldwide has fecal incontinence. In a meta-analysis of 80 population surveys covering 548,316 people, the pooled prevalence was 8.0%, rising to 9.3% in people aged 60 and older versus 4.9% in younger people, and it was higher in women (9.1%) than in men (7.4%) (Mack et al., Clin Gastroenterol Hepatol, 2024). [5]
Both psyllium fiber and loperamide reduced leakage episodes. In a double-blind crossover trial of 80 adults, neither treatment was better than the other for reducing episodes, symptom severity, or quality of life, but constipation occurred in 29% of participants on loperamide versus 10% on psyllium (Markland et al., Dis Colon Rectum, 2015). [6]
Age, diarrhea, and urinary incontinence are the factors most often linked to fecal incontinence. A systematic review of 38 community-based studies reported a median prevalence of 7.7%, with prevalence rising from 5.7% at ages 15-34 to 15.9% above age 90 (Ng et al., Dis Colon Rectum, 2015). [7]
Biofeedback helped about two-thirds of women who completed it. In a study of 400 women with fecal incontinence, 363 (91%) completed anorectal biofeedback, and 202 of the 301 women analyzed (67%) responded, defined as a drop of 50% or more in weekly leakage episodes (Mazor et al., Clin Gastroenterol Hepatol, 2021). [9]
Sacral nerve stimulation improves symptoms, but the benefit can fade. Among 256 patients followed for at least 5 years, the median incontinence score improved from 19/24 at baseline to 7/24 at 6 months, and validated scores improved in about 60% of patients, with efficacy falling over time (Leo et al., Colorectal Dis, 2020). [10]
Long-term results of sacral nerve stimulation look favorable, but device revisions are common. A systematic review of 36 studies (3,770 people) with at least 36 months of follow-up reported success rates of 59.4% to 87.5% in per-protocol analyses, an aggregate revision rate of 35.2% and an explantation rate of 19.7%; all studies had a serious risk of bias (Eggers et al., Neuromodulation, 2025). [11]
What Fecal Incontinence Actually Means
Fecal incontinence is the accidental passing of solid or liquid stool. [1] It can happen when a sudden urge to pass stool arrives and there is no time to reach a toilet. It can also happen when stool leaks without the person sensing the need to pass stool at all. It is sometimes called bowel incontinence or accidental bowel leakage. [1]
The most common causes are diarrhea, constipation, and muscle or nerve damage. The condition can affect a person's ability to work, socialize, or do typical daily activities, and it often causes embarrassment or emotional stress. [1] The good news: the condition is treatable, and evaluation often comes with real relief.
Bowel control depends on a small, coordinated system. The muscles of the anus, rectum, and pelvic floor hold stool in place and release it at the right time. The nerves in that area sense when the rectum is full and signal the brain that it is time to find a toilet. Fecal incontinence happens when something interferes with that system: either the muscles cannot hold stool securely, or the nerves cannot reliably sense it or send the signal.
This matters because the two failure modes feel very different, and they respond to different kinds of care. Knowing which one describes your situation is the first step toward a useful conversation with a healthcare professional.
The Two Types
There are two recognized types of fecal incontinence. Many people experience one, the other, or a mix of both.
Urge incontinence is the sudden urge to pass stool combined with an inability to control that urge. [1] The need can come on so suddenly that reaching a toilet in time simply is not possible.
Passive incontinence is passing stool without being aware of the need to pass it. [1] A person with passive incontinence may not be able to feel that the rectum is full of stool at all.
Stool can also leak when a person passes gas, in either form.
Symptoms and Warning Signs
The main symptom is an inability to control passing stool. [1] For some people this occurs during a short-term illness that causes diarrhea. For others, fecal incontinence is an ongoing condition. Other signs include finding stool in your underwear after a bowel movement and leaking during physical activity. [8]
Clue | What it points to |
Sudden urge you cannot hold back | Urge incontinence: the rectum fills faster than control can respond |
Leakage you never sensed coming | Passive incontinence: reduced awareness of stool in the rectum |
Leaking stool when passing gas | Reduced seal of the anal muscles |
Occurs during a short-term diarrhea illness | Often temporary; typically resolves as the illness clears |
Ongoing, frequent leakage | Often points to muscle or nerve damage that deserves evaluation |
When to See a Doctor
See a healthcare professional if you or your child develops fecal incontinence. This is especially important when any of the following apply:
Many people are embarrassed to talk about fecal incontinence, and that embarrassment is itself part of the problem, because it delays care. The sooner you are evaluated, the sooner you may find relief from your symptoms.
Causes
For many people, there is more than one cause. Understanding the four groups of causes helps explain why the same symptom can have such different roots.
Diarrhea and Constipation
Very soft and very hard stools can both lead to fecal incontinence. Loose or watery stool fills the rectum quickly and is difficult to hold. [1] On the other end of the spectrum, a large, hard stool can block the rectum, and softer stool leaks around the blockage. [1]
Damaged or Weakened Muscles
The muscles of the anus, rectum, and pelvic floor control the holding and passing of stool. [1] [2] When they are damaged or weak, control fails. Common weakening factors include:
Nervous System Disorders
Illness or injury can affect how the nerves and muscles of the anus, rectum, or pelvis work together. These conditions can also blunt a person's awareness that stool needs to pass. They include:
Diseases of the brain, such as Parkinson's disease, Alzheimer's disease or other dementias, stroke, or cerebral palsy.
Long-term diseases affecting nerve function, such as diabetes or multiple sclerosis. [1]
Spinal cord injury or tumor.
Damage to nerves during surgery.
Overusing laxatives can also damage the nerves involved in bowel control. [8]
Physical Problems of the Anus or Rectum
Irregular physical changes in the anus or rectum can also contribute:
Scarring or inflammation of the rectum, from injury or long-term disease, that affects the rectum's ability to hold stool. [1]
Dropping of the rectum through the anus, called rectal prolapse. [1]
Hemorrhoids that may prevent the anal muscles from closing fully. [1]
Bulging of the rectum into the vagina, also called rectocele. [1]
Cause group | How it leads to leakage |
Diarrhea | Loose, watery stool fills the rectum quickly and is hard to hold [1] |
Constipation | A large hard stool blocks the rectum; softer stool leaks around it [1] |
Muscle damage | Anus, rectum, and pelvic floor muscles cannot hold securely, often after vaginal delivery, surgery, accidents, radiation, or age |
Nerve damage | Signals and awareness fail: Parkinson's, dementia, stroke, cerebral palsy, diabetes, multiple sclerosis, spinal cord injury, or surgical nerve injury |
Structural problems | Rectal prolapse, rectocele, hemorrhoids, or scarring and inflammation prevent a proper seal |
Who Is at Higher Risk
Several factors raise the likelihood of developing fecal incontinence.
Risk factor | Why it raises the risk |
Age over 65 | Fecal incontinence is more likely in adults over 65 [1] |
Sex | More common in women [5], likely because of possible injuries during delivery; menopause hormone treatments may also increase risk |
Digestive diseases | Crohn's disease, irritable bowel syndrome, and celiac disease all increase risk |
Mental disability or dementia | Affects the ability to plan toilet use or sense the need |
Physical disability or limited mobility | Makes reaching a toilet in time harder; the underlying injury may also have damaged nerves or muscles |
Lifestyle factors | Being overweight, inactivity, smoking, and caffeinated or alcoholic drinks |
Possible Complications
Left unaddressed, fecal incontinence can take a toll beyond the bathroom. Emotional distress is common: many people feel embarrassed, experience anxiety or depression, hide the problem, and avoid social situations.
Repeated contact with stool can also irritate the delicate, sensitive skin around the anus, causing pain and itching. Sores, called ulcers, may appear in the tissues of the rectum.
What Can Be Done
Treatments exist, and they can improve both the leakage itself and overall quality of life. Which options fit depends on the cause, which is why evaluation matters: the treatment for a nerve-based leak is very different from the treatment for a muscle-based one. A healthcare professional can identify the underlying cause and guide the plan.
In the meantime, three self-directed habits directly support bowel control:
Reduce constipation. Increase exercise, eat more high-fiber foods, and drink plenty of fluids. [1] [3]
Control diarrhea. Avoid foods and drinks that make diarrhea worse, such as caffeinated drinks, alcohol, dairy products, and fatty foods. [1] [4]
Do not strain. Straining during bowel movements can eventually weaken the anal sphincter muscles or damage nerves.
Diet changes are usually the first step. Besides the items above, beans, spicy foods and artificial sweeteners can make diarrhea worse, and bowel training teaches the body to pass stool at predictable times of day. [8]
Kegel exercises, done daily, strengthen the pelvic muscles that support the rectum. [8] Antidiarrheal medicines such as loperamide or diphenoxylate and bulk-forming laxatives such as psyllium or methylcellulose may also be used. [8]
If these steps are not enough, a procedure may be recommended. [8] Sacral nerve stimulation is now the most common procedure; sphincteroplasty sews damaged anal sphincter muscles back together; an artificial sphincter is a device placed around the anus; and a colostomy is kept for cases where other treatments have not helped. [8]
Day-to-day steps help too: clean the skin with moist, perfume-free towelettes, rinse with warm water and use a barrier cream such as zinc oxide; find the bathroom when you arrive somewhere new and use the toilet before you go out; carry a change of clothes; and consider nonprescription fecal deodorant pills. [8]
Preparing for Your Appointment
Fecal incontinence is difficult to talk about, and going in prepared makes the conversation easier. Before the visit, write down:
How often the leakage happens, and whether it involves solid stool, liquid stool, or both.
Whether you feel the urge before leaking, or whether it happens without warning.
Any delivery history (including forceps use or an episiotomy), surgeries, or injuries.
All medications and supplements, and any conditions such as diabetes or nerve disorders.
Foods or drinks that seem to make symptoms worse.
A good first question to ask: "What do you think is causing my symptoms: muscles, nerves, or stool consistency?" That single question points the entire evaluation in the right direction.
Your provider will likely ask about frequency and severity, urge versus unawareness, bowel habits, childbirth history, nerve-related conditions, and how the symptoms affect your daily life.
Fecal incontinence is usually assessed by a gastroenterologist or a colorectal surgeon, starting with questions, a physical exam and a rectal exam. [8] Tests may include anorectal manometry, a balloon expulsion test, endorectal ultrasound or MRI, an anal sphincter EMG, defecography and endoscopy. [8]
Conclusion
Fecal incontinence is a medical condition with identifiable causes and real treatment options, not something to quietly manage alone. Whether the problem is a sudden urge, an unnoticed leak, or both, the causes trace back to stool consistency, muscles, nerves, or the structure of the rectum and anus. Embarrassment is the most common reason people delay care, and it is also the most common reason symptoms persist. Evaluation is the fastest route to relief.
Next Steps
If symptoms happen often or affect your daily life, talk to a healthcare professional soon. Earlier evaluation means earlier relief. Start with the self-care habits in this article (fiber, fluids, trigger avoidance, and no straining) while you arrange a visit.
Frequently Asked Questions
What is fecal incontinence in simple terms?
Fecal incontinence is the accidental passing of solid or liquid stool, sometimes with a sudden urge you cannot control, sometimes without any awareness that it is happening. It is also called bowel incontinence or accidental bowel leakage. [1]
Why does stool leak without me feeling it?
Passive incontinence happens when a person cannot feel that the rectum is full of stool, often because the nerves that sense fullness have been affected by injury, disease, or aging.
Is fecal incontinence a normal part of aging?
Fecal incontinence becomes more common after age 65, but it is not inevitable [1] and it is not something to simply accept. Age-related muscle weakening is one of several causes, and evaluation can identify what is actually driving the leakage.
Is fecal incontinence more common in women?
Yes. It is more common in women [5], likely because of possible injuries during vaginal delivery, including forceps delivery and episiotomy. Menopause hormone treatments may also increase risk.
Can diet help fecal incontinence?
Yes. High-fiber foods and plenty of fluids reduce constipation, and avoiding diarrhea triggers such as caffeinated drinks, alcohol, dairy products, and fatty foods reduces loose-stool leakage. [1] Avoid straining during bowel movements, which can weaken the anal sphincter over time.
Additional Resources
For further reading, these authoritative external references support the information above:
National Institute of Diabetes and Digestive and Kidney Diseases. Bowel Control Problems (Fecal Incontinence)
National Institute of Diabetes and Digestive and Kidney Diseases. Kegel Exercises
National Institute of Diabetes and Digestive and Kidney Diseases. Constipation
National Institute of Diabetes and Digestive and Kidney Diseases. Diarrhea
Crohn's & Colitis Foundation. crohnscolitisfoundation.org
Content reviewed and produced following the Rinnit editorial framework. Last updated: October 13, 2026.
This article is for general educational purposes only and does not replace professional medical advice. See a licensed healthcare professional for diagnosis and treatment decisions.
Related Reading
Kegel Exercises for Men: Benefits and How to Do Them explains how men can strengthen their pelvic floor muscles.
Anorectal Manometry: Why It's Done, How to Prepare, What Happens and What Results Mean explains the pressure test that finds muscle and nerve causes of constipation and incontinence.
References
National Institute of Diabetes and Digestive and Kidney Diseases. Bowel Control Problems (Fecal Incontinence). NIDDK. Last reviewed July 2017. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence
National Institute of Diabetes and Digestive and Kidney Diseases. Kegel Exercises. NIDDK. Last reviewed November 2021. https://www.niddk.nih.gov/health-information/urologic-diseases/kegel-exercises
National Institute of Diabetes and Digestive and Kidney Diseases. Constipation. NIDDK. Last reviewed May 2018. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation
National Institute of Diabetes and Digestive and Kidney Diseases. Diarrhea. NIDDK. Last reviewed September 2024. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/all-content
Mack I, Hahn H, Gödel C, et al. Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2024;22(4):712-731.e8. PMID 37734583. https://doi.org/10.1016/j.cgh.2023.09.004
Markland AD, Burgio KL, Whitehead WE, et al. Loperamide Versus Psyllium Fiber for Treatment of Fecal Incontinence: The Fecal Incontinence Prescription (Rx) Management (FIRM) Randomized Clinical Trial. Dis Colon Rectum. 2015;58(10):983-93. PMID 26347971. https://doi.org/10.1097/DCR.0000000000000442
Ng KS, Sivakumaran Y, Nassar N, Gladman MA. Fecal Incontinence: Community Prevalence and Associated Factors--A Systematic Review. Dis Colon Rectum. 2015;58(12):1194-209. PMID 26544818. https://doi.org/10.1097/DCR.0000000000000514
Cleveland Clinic. Fecal (Bowel) Incontinence. Cleveland Clinic. Last updated October 10, 2023. https://my.clevelandclinic.org/health/diseases/14574-fecal-bowel-incontinence
Mazor Y, Prott G, Jones M, et al. Factors Associated With Response to Anorectal Biofeedback Therapy in Patients With Fecal Incontinence. Clin Gastroenterol Hepatol. 2021;19(3):492-502.e5. PMID 32251788. https://doi.org/10.1016/j.cgh.2020.03.050
Leo CA, Thomas GP, Bradshaw E, et al. Long-term outcome of sacral nerve stimulation for faecal incontinence. Colorectal Dis. 2020;22(12):2191-2198. PMID 32954658. https://doi.org/10.1111/codi.15369
Eggers E, Crouss T, Beausang J, et al. Long-term Outcomes of Sacral Nerve Stimulation on the Treatment of Fecal Incontinence: A Systematic Review. Neuromodulation. 2025;28(5):715-726. PMID 39152989. https://doi.org/10.1016/j.neurom.2024.06.504
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