Some gynecologists have undergone advanced pelvic surgery training and have the necessary skills and experience to diagnose and treat fecal incontinence. However, it is more likely that the gynecologist will refer the patient to other specialists. These may include:

• Gastroenterologists. Physicians specializing in the diagnosis and treatment of diseases of the digestive system.
• Proctologists. Physicians specializing in diseases of the colon, rectum and anus.
• Colorectal surgeons. Physicians specializing in the diagnosis and surgical treatment of benign and malignant (cancerous) diseases of the colon, rectum and anus.

The type of treatment a patient receives depends upon the cause and severity of the fecal incontinence. Treatment may consist of dietary changes, medication, bowel training (behavioral programs to establish or re-establish regular bowel control) or surgery.

Certain foods and eating behaviors can affect the consistency of stool, which may cause diarrhea or constipation and lead to fecal incontinence. Making simple dietary changes can help patients manage fecal incontinence. Recommended diet modification techniques include:

• Keeping a food diary. Make a list of foods eaten, time of consumption and incidences of fecal incontinence. Patterns between foods consumed and incontinence may emerge.
• Eating smaller meals more frequently during the day. Eating six small meals a day instead of three large ones may reduce fecal incontinence. Large meals cause bowel contractions in some people.
• Eating and drinking at separate times. Liquid helps move food through the digestive system, which may contribute to diarrhea in some people. To slow the process, drink fluids a half hour before meals and avoid fluid consumption while eating.
• Consuming adequate amounts of fiber. Soluble fiber (e.g., oatmeal, rye, navy beans) is digestible and makes stool soft, formed and easier to control. However, eating too much insoluble fiber (e.g., whole grain breads and cereals), which is indigestible, can contribute to diarrhea. It is important to note that most fiber-rich foods contain both soluble and insoluble fiber. Patients making dietary changes should learn which foods are most likely to benefit them.
  
• Drinking plenty of fluids. Drinking eight 8-ounce glasses of water a day prevents dehydration and keeps stool soft and formed. However, drinks with alcohol, milk or carbonation (e.g., sodas) should be avoided because they can trigger diarrhea and fecal incontinence.
  
  
• Avoiding caffeine. Drinks and food containing caffeine (e.g., coffee, tea, soda and chocolate) may worsen fecal incontinence because caffeine acts as a laxative and relaxes internal and external anal sphincter muscles.

If dietary changes alone are not effective, medications may be used to treat fecal incontinence. These may include:

• Bulk laxatives. Products that increase fecal volume to stimulate bowel movement. They help regulate bowel movements, alleviating diarrhea or constipation associated with fecal incontinence. Patients should consult with their physicians before using any type of laxative, since chronic use of some laxatives can actually cause constipation and may lead to fecal incontinence.
• Anticholinergics. Medicines that reduce spontaneous motions of the bowels (bowel motility).
• Antidiarrheals. Medicines slow down the bowels and prevent diarrhea.

Bowel training can help some people control their bowels. In some cases, it involves strengthening the muscles. In others, it involves training the bowels to empty at a specific time during the day. There are two techniques:

• Develop a regular pattern of bowel movements. Establishing a pattern of defecation during specific times of the day (e.g., upon awakening, after meals) can help regulate bowel functioning and may be beneficial for patients with fecal incontinence caused by constipation.
• Biofeedback. A treatment technique in which people are trained to improve their health by using signals from their own bodies. Special computer equipment measures muscle contractions while exercises are performed to strengthen the rectum. Computer feedback demonstrates whether the exercises are effective. 

In some cases of fecal incontinence, surgery is necessary to treat the underlying problem. Some common surgical options include:

• Sphincteroplasty. Surgery to repair a damaged or weakened anal sphincter. During this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscles, tightening the sphincter. This is most effective for people with a single site anal sphincter injury.
• Repair of rectal prolapse (which weakens the anal sphincter). In certain circumstances, such as chronic constipation and straining, the rectum ligaments can become stretched and lose their ability to hold the rectum in place. Surgical correction of rectal prolapse may be needed along with sphincter muscle repair.
• Repair of a rectocele (protrusion of the rectum through the vagina). This may need to be treated surgically to correct fecal incontinence.
• Hemorrhoidectomy. Surgery to remove hemorrhoidal tissue. Hemorrhoids may be internal (near the beginning of the anal canal) or external (at the lower portion of the anal opening). Prolapsed internal hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence.
• Sphincter replacement. An artificial anal sphincter is used to replace a damaged one. The device is an inflatable cuff implanted around the anal canal. When inflated, it keeps the anal sphincter closed. To release stool, a small external pump is used to deflate the device, which reinflates on its own 10 minutes later.
• Gracilis muscle transplant. Surgical repair of the anal sphincter in which a muscle is taken from the inner thigh and wrapped around the sphincter. This restores muscle tone to the sphincter.
• Sacral nerve stimulation. A small device called a sacral nerve stimulator is implanted under the skin in the abdomen. A wire from the device is connected to a sacral nerve, a nerve involved in bowel and anal sphincter control. Through the wire, the device emits electrical pulses that control bowel and anal sphincter function. Recent research shows sacral nerve stimulation to be very effective in relieving fecal incontinence.
• Colostomy. Surgery performed to divert stool through an opening in the abdomen instead of through the rectum. A special bag (colostomy bag) is attached to the opening to collect the stool. Performed as a last resort, this may be the only definitive way to correct fecal incontinence, particularly in older adults.

Treating anal discomfort (e.g., pain, itchiness) that can accompany fecal incontinence involves keeping the anal area clean and dry. Some tips include:

• Wash area with water, but no soap. Soap can dry out the sensitive skin around the anus, worsening any discomfort in the area. The anal area should be washed with water after each bowel movement. This can be done in the shower or via a sitz bath. Let the anal area air-dry after washing.
• Use premoistened, alcohol-free towelettes instead of toilet paper. Wiping the anal area with these towelettes keep the area clean without the irritation of dry toilet paper against the skin.
• Protect area with special creams and powders. Moisture barrier creams protect skin from contact with stool. Non-medicated talcum powder or cornstarch may relieve anal discomfort. The anal area should be cleaned prior to application to prevent trapping bacteria in the area. Patients should consult their physician before using anal ointments because some may irritate the skin.
• Wear cotton underwear. Cotton absorbs moisture, letting the skin breathe and preventing the area from staying wet and worsening irritation of the area.
• Buy disposable products with a protective top layer. Protective pads or disposable underwear should have an absorbent wicking layer on top that pulls moisture away from your skin.
• Change soiled garments immediately. Removing soiled garments as soon as possible after an incident of fecal incontinence limits the amount of contact between stool and skin.