Fecal Incontinence

Bulking agents are injected in and around the anal canal to help hold in stool for people with fecal incontinence. Dextranomer hyaluronic acid (Solesta®), is FDA approved for this problem. It is thought to narrow the anal canal, which helps to improve control of stool by the anal sphincter muscles.

Bulking agents can be effective for women with moderate symptoms. This option does not work for everyone. Studies have found bulking agents to be effective for about half of the women who choose this option. It may take 3 to 6 months before improvements are seen. In addition, some women need more than one injection to see improvements. This treatment may not be covered by your insurance.

The procedure is typically done in an outpatient setting, similar to a colonoscopy. Mild or moderate discomfort or pain in the rectum or anus is common. In addition, you may experience some mild bleeding or spotting in the rectum. Ask your doctor about risks and side effects.

An emerging treatment is a flexible ring of magnets that is implanted around the anal canal to increase the strength of the anal sphincter. Straining to defecate when you need to normally will separate the beads to allow voluntary passage of stool. This treatment seems to be effective for some patients in the short term, however studies to determine how well this works over time are still underway.

A rectocele is a prolapse of the rectum upward into the vagina, similar to a hernia. If stool is getting “trapped” in the rectocele pouch, it can seep out later. Repairing the rectocele surgically can sometimes lead to improved bowel emptying.

Significant hemorrhoids may prevent the anus from making a tight seal and lead to stool leakage. Repair of the hemorrhoids can sometimes help reduce this seepage.

If a fistula (abnormal connection between the bowel and vagina) is present, closing the fistula is generally curative when there are no other factors contributing to the anal incontinence.

If a rectal prolapse is present with a bulge at the anus, there are several surgeries that can be done to repair this. Some of these are done through the abdomen, either with a large incision or with laparoscopic surgery. Other people undergo surgery at the anal opening. Discuss with your colorectal surgeon what is best for you.

When other treatment options have failed for severe ABL, one option is to re-route the bowels so that they empty in a bag rather than through the anus. These are called a colostomy or ileostomy depending on which part of the bowel is brought up to the bag.