Fecal incontinence causes

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

Overview

Life threatening causes of fecal incontinence include brain injury and stroke. Other common causes of fecal incontinence include aging, acute gastroenteritis, constipation, and fecal impaction.

Causes

Life Threatening Causes

• Brain injury
• Central nervous system injury
• Stroke

Common Causes

• Aging
• Acute gastroenteritis
• Constipation
• Fecal impaction
• Irritable bowel syndrome
• Ulcerative colitis

Causes by Organ System

Cardiovascular	Stroke
Chemical/Poisoning	Aldicarb
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	Bile salt malabsorption, brainerd diarrhea, chronic constipation, chronic diarrhea, colostomy, constipation, cystic fibrosis, diabetic diarrhea, diarrhea, dysentery, dyssynergic defecation, encopresis, fecal impaction, gastroenteritis, hemorrhoidectomy, herniated disc, ileostomy, inflammatory bowel disease, irritable bowel syndrome, pseudomembranous colitis, straining bowel motions, third degree haemorrhoids, ulcerative colitis, viral gastroenteritis, willful soiling
Genetic	Alpha-mannosidosis, adult-onset form, congenital myotonic dystrophy, mental retardation, x-linked zorick type , Potocki-Lupski syndrome
Hematologic	No underlying causes
Iatrogenic	Back surgery, radiation, sphincterotomy
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	Muscle damage
Neurologic	Head injury, Alzheimer's disease, Andrade's syndrome, anterior spinal artery stroke, autonomic neuropathy, brain failure, brain injury, brain tumor, cauda equina syndrome, cauda equina tumor, cauda equine lesion, central nervous system injury, cerebral trauma, congenital myotonic dystrophy, decreased mobility, degenerative diseases, dementia, diabetic peripheral neuropathy, encephalitis, epilepsy, head trauma, Kuru syndrome, lumbar meningomyelocoele, multiple sclerosis, myelitis, nerve damage, nerve-damaging diseases, paraplegia, Parkinson's disease, peripheral neuropathy, pudendal nerve surgical injury, seizure, spina bifida, spinal cord compression, spinal cord conditions, spinal cord injury, spinal cord neoplasm, spinal cord trauma, spinal cord tumor, stroke, tabes dorsalis
Nutritional/Metabolic	Alpha-mannosidosis, adult-onset form, Andrade's syndrome, B12 deficiency, bile salt malabsorption, cystic fibrosis, fructose, lactose, olestra
Obstetric/Gynecologic	Childbirth, episiotomy, excessive perineal descent, forcep delivery, obstetric denervation, obstetric trauma, pelvic floor dysfunction, pelvic fracture, pelvic surgery,rectovaginal fistula, traumatic childbirth, uterine prolapse
Oncologic	Brain tumor, endodermal sinus tumor, extragonadal germ cell tumor, metastases, monocrotophos, rectal cancer, spinal cord tumor
Ophthalmologic	No underlying causes
Overdose/Toxicity	Drug intoxication
Psychiatric	Dementia, encopresis, willful soiling
Pulmonary	Cystic fibrosis
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Diffuse systemic sclerosi
Sexual	No underlying causes
Trauma	Cerebral trauma, head trauma, obstetric trauma, puborectalis muscle trauma, spinal cord trauma, trauma
Urologic	Anal abnormality, anal dilatation surgery, anal dilation, anal skin tags, anal sphincter dysplasia, anal sphincter muscle damage, anal sphincter nerve damage, anorectal fistula, anorectal infection, anorectal surgery, congenital anorectal anomalies, haemorrhoid, prostate surgery, rectal abnormality, rectal cancer, rectal disoders, rectal hypersensitivity, rectal hyposensitivity, rectal inflammation, rectal nerve damage, rectal prolapse, rectal scarring, rectal surgery, rectocele, rectovaginal fistula, reduced anal sensation, reduced anal squeeze pressure, reduced rectal capacity, reduced rectal sensation, sphincter damage
Miscellaneous	Aging, congenital abnormalities, disability, excessive straining during defecation, Foix–Alajouanine syndrome, idiopathic, impalement, Jirasek-zuelzer-wilson syndrome

Causes in Alphabetical Order

• Head injury
• Adenovirus infection
• Aging
• Aldicarb 
• Alpha-mannosidosis, adult-onset form
• Alzheimer's disease
• Anal abnormality
• Anal dilatation surgery
• Anal skin tags
• Anal sphincter damage
• Anal sphincter dysplasia
• Anal sphincter muscle damage
• Anal sphincter nerve damage
• Andrade's syndrome
• Anorectal fistula
• Anorectal infection
• Anorectal surgery
• Anterior spinal artery stroke
• Anticholinergics
• Antidepressants
• Astrovirus infection
• Autonomic neuropathy
• B12 deficiency
• Back surgery
• Bacterial infection
• Bile salt malabsorption
• Brain failure
• Brain injury
• Brain tumor
• Brainerd diarrhea
• Caffeine
• Cauda equina syndrome
• Cauda equina tumor
• Cauda equine lesion
• Central nervous system injury
• Cerebral trauma
• Childbirth
• Chromosome 17, trisomy 17p11.2
• Chronic constipation 
• Chronic diarrhea
• Chronic laxative abuse
• Colostomy
• Congenital abnormalities
• Congenital anorectal anomalies
• Congenital myotonic dystrophy
• Constipation
• Coronovirus infection
• Cystic fibrosis
• Decreased mobility
• Degenerative diseases
• Dementia
• Diabetes mellitus
• Diabetic diarrhea
• Diabetic peripheral neuropathy
• Diarrhea
• Diffuse systemic sclerosi
• Disability
• Drug intoxication
• Dysentery
• Dyssynergic defecation
• Encephalitis
• Encopresis
• Endodermal sinus tumor 
• Enterovirus infection
• Epilepsy
• Episiotomy
• Excessive perineal descent
• Excessive straining during defecation
• Extragonadal germ cell tumor
• Fecal impaction
• Foix-Alajouanine syndrome 
• Forcep delivery
• Fructose
• Gastroenteritis
• Haemorrhoid
• Head trauma
• Hemorrhoidectomy
• Herniated disc 
• Idiopathic
• Ileostomy
• Impalement
• Infection
• Inflammatory bowel disease
• Irritable bowel syndrome
• Jirasek-zuelzer-wilson syndrome
• Kuru syndrome
• Lactose
• Laxatives
• Lumbar meningomyelocoele
• Lymphogranuloma
• Medications
• Mental retardation, x-linked, zorick type 
• Metastases
• Monocrotophos
• Multiple sclerosis
• Muscle damage
• Muscle relaxants
• Myelitis 
• Nerve damage
• Nerve-damaging diseases 
• Neurologic
• Obstetric denervation
• Obstetric trauma
• Olestra
• Orlistat
• Paraplegia
• Parkinson's disease
• Pelvic floor dysfunction
• Pelvic fracture
• Pelvic surgery
• Pergolide
• Peripheral neuropathy
• Potocki-Lupski syndrome
• Pramipexole
• Proctitis
• Prostate surgery
• Pseudomembranous colitis
• Puborectalis muscle trauma
• Pudendal nerve surgical injury
• Radiation
• Rectal abnormality
• Rectal cancer
• Rectal hypersensitivity
• Rectal hyposensitivity
• Rectal inflammation
• Rectal nerve damage
• Rectal prolapse
• Rectal scarring
• Rectal surgery
• Rectocele
• Rectovaginal fistula
• Reduced anal canal pressures
• Reduced anal sensation
• Reduced anal squeeze pressure
• Reduced rectal capacity
• Reduced rectal sensation
• Reovirus infection
• Rotavirus infection
• Sedation
• Seizure
• Sorbitol
• Sphincterotomy
• Spina bifida
• Spinal cord compression
• Spinal cord conditions
• Spinal cord injury
• Spinal cord lesions
• Spinal cord trauma
• Spinal cord tumor
• Spinal metastases
• Straining bowel motions
• Stroke
• Tabes dorsalis
• Third degree haemorrhoids
• Trauma
• Traumatic childbirth
• Ulcerative colitis
• Uterine prolapse
• Viral gastroenteritis
• Willful soiling

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