Gutbliss - Dr. Robynne Chutkan



Bowel (or fecal) incontinence is the loss of bowel movement control, which results in the accidental evacuation of feces from the rectum. Bowel incontinence can range from “wet gas,” or gas that is accompanied by small amounts of liquid feces, to a complete bowel movement.

Incontinence often occurs with little or no warning, and the physiological urge to go that is most often experienced before a bowel movement is nonexistent. Bowel incontinence is an embarrassing condition that dramatically interferes with everyday life, especially when chronic.


Bowel incontinence is most times an acute condition caused by a bout of diarrhea, but it can also be chronic. Symptoms, whether acute or chronic, most often experienced with bowel incontinence include:

  • Bloating
  • Gas
  • Diarrhea
  • Constipation
  • Stool leaking from the rectum or the accidental evacuation of a complete bowel movement
  • Inability to control bowel movements
  • Lack of “an urge to go”


Common causes of bowel incontinence include:

  • Diarrhea
  • Constipation
  • Pregnancy
  • Aging
  • Nerve damage
  • Muscular damage
  • Pelvic floor disorder
  • Anal fissure
  • Rectal prolapse
  • Rectocele
  • Irritable bowel syndrome
  • Rectal scarring
  • Childbirth (especially if an episiotomy or forceps were used)
  • Poor diet
  • Hemorrhoid complications


Bowel incontinence is diagnosed in a clinical setting based on your symptoms. Keep in mind that incontinence is a symptom with a root cause. Uncovering the root cause of your incontinence and arriving at a correct diagnosis is paramount in correcting the condition. Bowel incontinence is a condition with many causes and therefore, a variety of tests and procedures are sometimes used to diagnose it. Based on your health history and symptoms, one or a combination of the following tests may be administered to help uncover the cause of your incontinence:

  • Anal electromyography: electrodes attached to the anal musculature are used to test for nerve damage
  • Anal manometry: a flexible tube with a balloon on its end is inserted into the rectum; the balloon is expanded to test for rectum function, including tightness and sensitivity
  • Anorectal ultrasonography: an ultrasound like a vaginal ultrasound, is taken of the anus and rectum; this test assesses sphincter structure
  • Balloon expulsion test: a balloon is inserted into the rectum and filled with water; the time it takes to expel the balloon is recorded; this is used to test for defecation disorder
  • Colonoscopy: a thin tube with a camera on its end is inserted into the large intestine through the rectum to inspect the colon
  • Digital rectal exam: a finger is inserted into the rectum to assess its musculature; this is used to test for rectal prolapse
  • Endorectal ultrasound: an ultrasound of the lower colon is administered to investigate the anal sphincter
  • MRI: an imaging test that uses magnetic and radio waves takes picture of the abdominal and pelvic regions to look at musculature and/or the GI tract’s performance during a bowel movement.
  • Proctography: a series of x-ray images are taken during a bowel movement; this is used to test the stool-holding volume and stool elimination process of your rectum
  • Proctosigmoidoscopy: a thin tube with a camera on its end is inserted into the rectum to evaluate the sigmoid colon; this test is used to uncover inflammation, bowel obstructions, and scar tissue


Arriving at the root cause of your incontinence is the most important step in treating and overcoming it. Once you know the cause, treatment options for that specific condition can be sought out and implemented. Some common treatments for bowel incontinence include:


Medications are often the first line of defense for bowel incontinence, although they shouldn’t be. Your incontinence is caused by a real and definitive factor and using medications may only throw a veil over the cause, leading to mounting complications down the road. Medications commonly used to treat incontinence include antidiarrheal drugs, laxatives, and medications that decrease spontaneity of the bowels.

Integrative Recommendations for Treating Incontinence

The following treatments for bowel incontinence are associated with diet and lifestyle behaviors and are lasting treatments that may not only heal your incontinence but will also encourage digestive and overall health.

  • Biofeedback: If your bowel incontinence is caused by a pelvic floor disorder or is in part due to psychological factors, biofeedback can be an extremely helpful tool. In just a few sessions, biofeedback can help to re-establish the musculature of the pelvis, as well as the physiological signs that tell you it’s time to expel your bowels.
  • Diet & Exercise: No matter the cause of your bowel incontinence, diet and exercise are extremely useful factors in overcoming your condition. A diet high in fiber, rich in nutrient-dense vegetables, and low in animal products, can help create bowel movements that are less likely to leak and more likely to give you a strong physiological urge to go. Psyllium, or plant fiber, may also be an important addition to your dietary regimen, as it helps create a more substantial stool. If you suspect that constipation is causing your bowel incontinence, drinking plenty of water (2 liters or more per day) and exercising daily can help regulate your bowel movements. Exercise may be a challenge if you are suffering from chronic incontinence. If this is the case, exercise in the comfort of your home, and realize that even 15 minutes a day of moving your body can help improve your bowels.
  • Healthy Bathroom Habits: Healthy bathroom habits can help re-train the bowels and in turn, improve incontinence. These habits include:
    • Go when you have the urge to go.
    • Sit on the toilet at approximately the same time every morning to encourage a Pavlovian-type response.
    • Get in and out quickly to avoid sluggish bowel emptying.
    • Create the right environment in your bathroom; creating the right ambience is essential for having good bowel movements. Temperature, lighting, accessibility, and privacy—all are important.

Surgical Repair

If your incontinence is due to severe structural damage that is un-repairable using lifestyle modifications, biofeedback, or other methods, in some instances surgery, although a last resort, may be your best option.

Uncovering and addressing the root cause of your incontinence is key to successfully correcting the condition and improving symptoms.


Dr Robynne Chutkan
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