Bowel Incontinence: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Bowel Incontinence?
A gastroenterologist, a doctor who treats digestive tract problems, often treats bowel incontinence. A colorectal surgeon may help if surgery is needed. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is bowel incontinence?
Bowel incontinence, also called fecal incontinence, is the inability to control your bowels. You may not be able to hold stool until you reach a toilet. Some people leak stool without knowing it. It is not always a normal part of aging.
Symptoms
The symptoms depend on the type of fecal incontinence:
- Urge fecal incontinence. You know you need to pass stool but cannot control it before you reach a toilet.
- Passive fecal incontinence. Stool or mucus passes without you knowing it.
- Soiling. Some experts include streaks or stains of stool or mucus on underwear as a symptom.
Stool touching the skin can also cause anal irritation, pain, or itching.
Causes and who gets it
Fecal incontinence has many causes:
- Diarrhea. Loose, watery stools fill the rectum quickly and are hard to hold in. It is the most common risk factor.
- Constipation. Hard stools can stretch and weaken the rectum muscles over time, letting watery stool leak around them.
- Muscle injury or weakness. Weak muscles in the anus, pelvic floor, or rectum may not keep the anus closed. Surgery on the anus or rectum can cause this.
- Nerve damage. Damaged nerves can make the muscles work poorly or make it hard to sense stool. Causes include straining, brain injury, and spinal cord injury.
- Nerve diseases such as dementia, multiple sclerosis, Parkinson's disease, and stroke.
- A stiff rectum. Scarring from surgery, pelvic radiation, or inflammatory bowel disease can make the rectum less able to stretch.
- Hemorrhoids and rectal prolapse, a condition where the rectum drops down through the anus. Both can keep the anal muscles from closing fully.
- Childbirth. A vaginal delivery sometimes injures the anal sphincters, the muscles that keep the anus closed. The chance is higher after a large baby, forceps, or an episiotomy.
How doctors diagnose it
Doctors use your medical history, a physical exam, and medical tests. Your doctor may ask when it started, how often it happens, and whether you feel an urge first. You may be asked to keep a stool diary, a chart of your bowel movements.
The exam usually includes a digital rectal exam. Tests may include:
- Blood, stool, and urine tests to look for infection, inflammation, or diabetes.
- Anorectal manometry, a test that checks how sensitive your rectum is and how well the anal sphincters work.
- Endoscopy, such as a colonoscopy, a test that lets doctors look inside your anus, rectum, and colon.
- Imaging tests such as ultrasound or MRI.
Treatment
Treatment depends on the cause. The first step is to see a doctor. Diet changes, medicines, bowel training, and pelvic floor exercises can improve symptoms by about 60 percent. Other options:
- Absorbent pads worn inside underwear. This is the most frequently used treatment.
- Diet changes. Your doctor may recommend avoiding foods and drinks that make your diarrhea worse. A food diary can help find which foods affect you.
- Medicines. For diarrhea, options include loperamide (Imodium). For constipation, laxatives or stool softeners may help.
- Bowel training. This means having bowel movements at set times, such as after meals. It may take weeks to months to help.
- Kegel exercises. Tightening and relaxing the pelvic floor muscles many times a day can strengthen them.
- Biofeedback therapy. Devices help you learn the exercises and sense stool filling the rectum.
- Sacral nerve stimulation. Thin wires near the sacral nerves send mild electrical pulses that help the nerves work.
- Prescription medicines for causes such as irritable bowel syndrome or Crohn's disease.
- Surgery. Sphincteroplasty, the most common surgery, reconnects the ends of an anal sphincter torn by childbirth or an injury. It may be an option when other treatments fail.
When to see a doctor
See a doctor if your fecal incontinence is frequent or severe, or if it affects your quality of life. It is not something to be ashamed of, and it can often be treated. It will not usually go away on its own. The first step in treating fecal incontinence is to see a doctor. Call 911 if you lose control of your bowels after a head or spine injury, or if it comes with sudden weakness, trouble speaking, fainting, or severe belly pain.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This kind of doctor can start an evaluation and refer you to a gastroenterologist. They can also follow up with you as your treatment is adjusted.
Common questions
Is bowel incontinence a normal part of aging?
Not always. It is a medical problem that can often be treated.
Can it be treated without surgery?
Often yes. Diet changes, medicines, bowel training, and pelvic floor exercises can improve symptoms by about 60 percent. Surgery is usually saved for cases that do not improve with other treatments.
What is bowel training?
It means having bowel movements at set times, such as after meals. Regular bowel movements may take weeks to months to develop.
Should I be embarrassed to talk to a doctor?
No. Doctors ask about this often and will not be shocked. The more details you give, the better your doctor can help.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases - Symptoms & Causes of Fecal Incontinence
- National Institute of Diabetes and Digestive and Kidney Diseases - Treatment of Fecal Incontinence
- National Institute of Diabetes and Digestive and Kidney Diseases - Diagnosis of Fecal Incontinence
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
