Managing Fecal Incontinence

In the 1993 movie Philadelphia, a near-loss of fecal control was followed by tears, an emergency hospital visit, and the recognition that the character played by Tom Hanks was now terminally ill with AIDS. For most people, fecal incontinence does not mean that life is over, but if you're unable to find help in managing the condition, it can be painfully limiting.

Even if medical treatment doesn't fully alleviate your symptoms, you can reclaim a sense of control by learning to manage your incontinence and being prepared should an accident occur. Seek help from health professionals, such as continence nurses, and support organizations, such as the International Foundation for Functional Gastrointestinal Disorders (see "Resources").

Figure 7: Prevalence of fecal incontinence according to age and sex   Prevalence of fecal incontinence according to age and gender   Reprinted with permission from the Medical Journal of Australia, 2002, 176: 54–57.

Containment and collection options

Absorbent products, such as pads and disposable undergarments, are designed primarily for urinary incontinence, and people with fecal incontinence often find them unsatisfactory. Of the range of choices available (see "Managing urinary incontinence"), those that provide "heavy" protection are most likely to be helpful for fecal incontinence. According to the limited studies available, disposable products with super-absorbent materials may provide the best protection and be easiest on your skin.

Fecal collection devices (such as Bard FCD and Hollister) are pouches that adhere to the skin around the anus to collect uncontrolled stool leakage. These devices control stool odor and can drain off liquid into a separate bag. To order such products, contact a medical supply house or catalog.

Anal plugs contain fecal incontinence by blocking the passage of stool. Limited research on these devices suggests that they are difficult to tolerate but can be an effective primary or occasional management technique for some people. Devices made of polyurethane (such as Peristeen, available in Canada) seemed to perform better than those made of polyvinyl-alcohol, according to one study. Anal plugs are primarily used by people with diminished anal sensation and those with significant neurological impairment from injury or illness.

Enemas and suppositories

Some people with fecal incontinence are able to eliminate or minimize incontinence or soiling by using enemas or suppositories each morning to cleanse feces from their rectum and lower colon. Seek medical advice about enema and suppository choice and the advisability of using this approach.

Skin care

Proper care of the skin in the anal area is critical to maintaining comfort and preventing skin irritation and breakdown. Skin irritation is more than a misery. It can invite infection and even compromise your treatment if the skin becomes too sore for your muscles to work well. If you have both urinary and fecal incontinence, bacteria in the feces can react with urine to produce ammonia, which lowers the skin pH and leaves it more vulnerable to infection. Yeast infections can also result, when yeast in the feces is nurtured by contact with urine.

Skin should be cleansed after each episode of incontinence. Choose an extremely mild, nonalkaline soap — such as Dove or Basis — or buy one of the special cleansers designed to gently dissolve and remove stool and urine. These are nonirritating, soap-free cleansing lotions; some are available in portable disposable wipes. They eliminate the need to scrub areas of tender skin, and some do not require that you rinse the skin after use. Look for nonalkaline, fragrance-free products.

In studies conducted in nursing homes, cleansers worked better than soap to prevent breakdown of sensitive perineal skin in patients with incontinence. After cleansing, allow the area to air-dry if possible (or blow dry with a hairdryer set on cool) or pat it dry (don't rub). Afterward, apply a protective moisturizer or moisture barrier to protect your skin from damage by urine or stool contact. Barrier products such as petroleum jelly, Aquaphor, or Desitin are readily available and inexpensive.

Film-forming skin protectants — applied by spray, applicator, or individual wipe — go on as a liquid but rapidly evaporate to leave behind a film of clear acrylate. This barrier allows airflow, but protects the skin from moisture. Film-forming skin protectants may help reduce the rubbing of pads or absorbent products or make it less irritating to use products applied with adhesive. Some films last as long as three days before reapplication is needed.

To treat or protect against fungal infection, you may be instructed to use an ointment or cream containing an antifungal agent, such as clotrimazole or miconazole. Ask whether you should apply another barrier product while using the antifungal.

A nurse who deals with incontinence or stoma care can offer advice on skin care issues.

Reducing odor

Minimizing the odor of stool can make leakage less noticeable to others. Dietary changes can help by eliminating foods that commonly increase stool odor. Such foods include fish, eggs, asparagus, garlic, cruciferous vegetables (such as cabbage, broccoli, and cauliflower), onions, beans, and turnips.

Odor may also be reduced by taking an internal deodorant containing chlorophyllin copper (such as Nullo) or bismuth subgallate (such as Devrom), both available without prescription. However, chlorophyllin may color your urine and stool green, creating the possibility of "grass-stained" clothing if an accident occurs. If cramping or diarrhea occurs when taking chlorophyllin, reduce the dose. If symptoms continue, stop taking it.

Emotional concerns

Gaining control over fecal incontinence is a psychological as well as physical challenge. The emotional repercussions can be very difficult to handle. You may find it helpful to remind yourself that it is a medical condition that many other people like you cope with as the result of surgery, childbirth, or medical illness.

Particularly if you have lived with the problem for a long time before seeking help, it may take time and professional support for you to address your painful feelings and regain confidence in your ability to fully participate in normal activities and relationships.

Help is available from health professionals, therapists, and support groups. You can benefit greatly from the advice and experiences of others with the same problem, whether contacted informally or through a support group. Most important, remember that yours is a medical condition, not a personal weakness. It does not reflect negatively on you as a human being.