Advice | This embarrassing bathroom accident is more common than you think (2024)

It’s more common than you think: One study based on data from the National Health and Nutrition Examination Survey found fecal incontinence affects about 8 percent of U.S. adults.

Since people often don’t bring it up on their own, I’ve made it a point to ask my patients directly about it because effective treatments are available.

Increasing fiber in the diet is one of the first things I recommend. Three of my colleagues at Massachusetts General Hospital were part of a group that researched this: In a study involving about 60,000 older women, they found that a high-fiber diet was associated with a reduced risk of fecal incontinence.

It sounds counterintuitive, but fiber is useful to bulk up looser stool and promote water absorption by the colon. It’s also helpful for constipation, which is a common cause of fecal incontinence due to overflow diarrhea.

An analysis of the same cohort also found that eating more pro-inflammatory foods, such as processed meats or sugary sodas, was associated with a higher risk of fecal incontinence. The authors hypothesized that pro-inflammatory foods could have negative interactions with the gut microbiome and diminish the function of the muscles and nerves of the pelvic floor.

Of everything you’ve heard about these foods, this is quite a motivating reason to minimize eating them.

Beyond constipation, fecal incontinence can be caused by common underlying issues such as diarrhea, irritable bowel syndrome, inflammatory bowel disease and lactose intolerance. It can also be a sign of certain health conditions, like diabetes and even neurological problems.

But it’s possible there’s no underlying “diagnosis” driving the fecal incontinence. Sometimes the triggers are things we’re doing inadvertently — like side effects of medications (including antibiotics) or dietary aggravators like artificial sweeteners that lead to looser, more urgent stool that is hard to control.

All this said, I wouldn’t consider frequent fecal incontinence “normal,” no matter your age.

There has been a lot of back and forth in medical literature about whether childbirth-related injuries raise your risk, but several studies have shown fecal incontinence actually affects men and women similarly.

Menopausal hormone therapy has been shown to modestly increase the risk of fecal incontinence with higher chances the longer you’re on therapy, potentially due to the effect of estrogens on the pelvic floor. (My colleagues at Massachusetts General Hospital also formed part of this research group.)

When a patient comes to me about this, I ask them questions about their pattern of incontinence, which can shed light on two common reasons this happens: problems with the muscles and nerves of the pelvic floor and problems with stool quality.

Does your bowel leakage happen passively, sometimes without you even realizing it? That could suggest a pelvic floor issue that could be treated by a specialist.

Does it occur with a sense of urgency, feeling like you need the bathroom right now, but then not making to it in time? That could be related to a bowel disturbance like diarrhea that may respond to medication.

Depending on your history, your physician may want to pursue additional testing for disorders that can change your stool quality and raise the risk of incontinence. They may also do a physical exam or specialized tests like anorectal manometry or an MRI exam to better assess your pelvic floor.

Your doctor may identify other issues with the pelvic floor leading to your leakage such as a prolapse, which may need surgery to fix. Sometimes, dysfunction of the pelvic floor muscles may benefit from biofeedback, a specialized physical therapy that involves inserting a probe inside the anal canal and analyzing how the pelvic muscles move during defecation.

I know, I know. But pelvic floor physical therapy is more weird than it is uncomfortable — and it works well!

The social consequences of fecal incontinence can be devastating. It’s why initiating a conversation about it is the hardest — but most important — step toward not just figuring out what’s going on, but also improving your quality of life.