Bowel incontinence means you cannot control when stool leaves your body
Bowel incontinence is the loss of control over bowel movements. It ranges from occasionally leaking a small amount of stool when you pass gas, to not being able to hold stool at all. Some people have it once in a while. Others deal with it every day. The severity and frequency depend on what is causing it.
This is different from constipation or diarrhea, which are about how often you go or what the stool is like. Bowel incontinence is about not being able to hold it when you need to. It can happen at any age, though it becomes more common as people get older. It is also more common after childbirth, after surgery, or with certain medical conditions.
Bowel incontinence is treatable. The first step is understanding what type you have and what is causing it, because the cause determines what might help.
Key Takeaways
- Bowel incontinence is the inability to control when stool leaves your body, ranging from occasional leaking to complete loss of control.
- The two main types are urge incontinence (sudden need to go) and passive incontinence (leaking without feeling it), and they have different causes.
- Common causes include weak pelvic floor muscles, nerve damage, chronic diarrhea, and conditions like irritable bowel syndrome or inflammatory bowel disease.
- A doctor can identify the cause through your medical history and sometimes imaging or other tests, which guides what treatment might work.
- Many treatments exist—from dietary changes and pelvic floor exercises to medications and, in some cases, surgery.
The two types: urge and passive incontinence
Urge incontinence means you feel the need to have a bowel movement, but cannot hold it long enough to reach a toilet. You may have only seconds of warning, or no warning at all. This type is often caused by irritable bowel syndrome, inflammatory bowel disease, diarrhea, or damage to the nerves that signal the need to go.
Passive incontinence means stool leaks out without you feeling it coming. You may not realize it has happened until you notice it. This type usually points to weakness in the muscles that hold stool in, or to nerve damage that means you cannot feel when your rectum is full.
Some people have both types at different times. Knowing which one you experience helps a doctor figure out what is causing it and what might help.
What causes bowel incontinence
The pelvic floor muscles and the anal sphincter (the ring of muscle that holds stool in) have to work together. If either is weak or damaged, incontinence can result. Childbirth, especially with a tear or episiotomy, can damage these muscles. Chronic straining from constipation can weaken them over time. Aging naturally weakens muscles, which is why incontinence becomes more common in older adults.
Nerve damage is another major cause. Diabetes, spinal cord injury, stroke, or multiple sclerosis can all damage the nerves that tell you when your rectum is full or that control the muscles. Surgery on the rectum, colon, or prostate can also injure these nerves.
Chronic diarrhea from any cause—inflammatory bowel disease, celiac disease, irritable bowel syndrome, or infections—makes incontinence more likely because loose stool is harder to hold. Some medications, including certain laxatives and antibiotics, can cause diarrhea that leads to incontinence.
How a doctor figures out what is causing it
Start by seeing your primary care doctor or a gastroenterologist. They will ask about when it started, how often it happens, whether you feel it coming, what your diet is like, what medications you take, and whether you have had surgery or childbirth. They will also ask about other symptoms like pain, urgency, or changes in bowel habits.
A physical exam usually includes a digital rectal exam, where the doctor inserts a gloved finger into the rectum to check the strength of the anal sphincter and feel for any masses or other problems. If the cause is not clear from your history and exam, the doctor may order tests. These might include an ultrasound of the anal sphincter, a test called anorectal manometry (which measures the pressure the sphincter can create), or a colonoscopy to look inside the colon.
Once the doctor knows what is causing it, they can talk with you about what might help. The treatment depends on the cause.
Treatments that may help
For incontinence caused by diarrhea, the first step is often treating the diarrhea itself. This might mean dietary changes, treating an underlying condition like inflammatory bowel disease, or stopping a medication that is causing it. Anti-diarrheal medications like loperamide can help if the diarrhea cannot be stopped another way.
Pelvic floor physical therapy (also called pelvic floor rehabilitation) teaches you to strengthen and control the muscles that hold stool in. A physical therapist trained in this area will show you exercises to do at home. This works best for passive incontinence caused by weak muscles, and it can take weeks to months to see improvement.
Dietary changes can help too. Eating more fiber (if you have diarrhea, less fiber), drinking enough water, and eating at regular times can make bowel movements more predictable. Some people find that avoiding certain foods—caffeine, spicy foods, high-fat foods, or artificial sweeteners—reduces symptoms.
Medications exist for urge incontinence. Anticholinergic drugs like dicyclomine can reduce the urge to go by calming the bowel. Loperamide slows movement through the intestines. These work for some people and not others, and they can have side effects.
For incontinence that does not improve with these approaches, other options exist. Biofeedback therapy teaches you to recognize and control the muscles. Sacral nerve stimulation uses a small device implanted under the skin to send electrical signals to the nerves that control bowel function. Surgery to repair a damaged sphincter is an option in some cases, though it is not always successful.
Managing bowel incontinence day to day
While you are working with a doctor on treatment, there are ways to manage the symptoms. Wearing absorbent pads or protective underwear can give you confidence and protect your clothing. Some people find that using the bathroom on a schedule—at the same times each day—helps prevent accidents by emptying the bowel before an urge strikes.
Keeping a diary of when accidents happen, what you ate, and what you were doing can help you spot patterns. You may notice that certain foods, stress, or activities trigger symptoms. Avoiding those triggers can reduce how often incontinence happens.
Skin care matters too. Stool can irritate skin, so washing with mild soap and water after an accident and using a barrier cream can prevent rashes and breakdown. Some people use wet wipes or a bidet instead of toilet paper.
When to see a doctor
See your doctor if you have lost control of bowel movements, even if it happens only once in a while. Do not assume it is normal or something you have to live with. Bowel incontinence has many causes, and many of them are treatable.
Tell your doctor right away if incontinence comes on suddenly, if it is getting worse, or if it is accompanied by other symptoms like pain, fever, blood in the stool, or weight loss. These can point to a condition that needs prompt attention.
Frequently Asked Questions
Is bowel incontinence a normal part of aging?
It becomes more common with age because muscles weaken and nerve function can decline, but it is not inevitable. Many older adults do not have it. When it does happen, it usually has a specific cause that can be identified and treated, so it is worth seeing a doctor rather than accepting it as just part of getting older.
Can pelvic floor exercises fix bowel incontinence?
They can help, especially if weak pelvic floor muscles are the cause. But they work best when done correctly and consistently, usually over several weeks or months. A physical therapist trained in pelvic floor therapy can teach you the right technique. They do not work for all types of incontinence—for example, they are less helpful if the problem is chronic diarrhea or nerve damage.
What should I eat if I have bowel incontinence?
That depends on what is causing it. If you have diarrhea, you may need less fiber and more foods that thicken stool. If constipation is the problem, more fiber and water help. Keeping a food diary can show you which foods trigger symptoms for you. A doctor or dietitian can give you specific guidance based on your situation.
Can bowel incontinence go away on its own?
Sometimes, especially if it is caused by something temporary like an infection or medication side effect. But if it lasts more than a few weeks or keeps happening, it usually needs treatment. The longer you wait, the more it can affect your quality of life, so talking to a doctor sooner rather than later is worth doing.
Is bowel incontinence the same as irritable bowel syndrome?
No. Irritable bowel syndrome is a condition that causes cramping, bloating, diarrhea, or constipation, but not necessarily incontinence. However, IBS can cause diarrhea that leads to incontinence. If you have IBS and are experiencing incontinence, treating the IBS may help reduce the incontinence.