Patients may be treated by the following types of physicians who specialize in conditions that affect the colon, rectum and anus:

• Gastroenterologists. Physicians specializing in the diagnosis and treatment of diseases of the digestive tract.
  
  
• Proctologists. Physicians specializing in diseases of the colon, rectum and anus.
  
  
• Colorectal surgeons. Physicians specializing in the diagnosis and surgical treatment of benign (noncancerous) 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 or surgery. In cases where fecal impaction (due to constipation) is the cause of incontinence, a physician may need to first manually break up the hardened stool by inserting a lubricated, gloved finger into the rectum.

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 incontinence related to diarrhea or constipation. Recommended diet modification techniques include:

• Keep 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, indicating certain foods that may be troublesome and should be avoided.
  
  
• Eat small, frequent meals. Large meals cause bowel contractions in some people, speeding digestion and causing diarrhea. Eating six small meals a day instead of three large ones may reduce fecal incontinence.
  
  
• Drink plenty of fluids. Drinking eight 8-ounce glasses of water a day prevents dehydration and keeps stool soft and formed. Drinks with alcohol, milk or carbonation should be avoided since they may cause diarrhea and fecal incontinence.
  
  
• Separate eating and drinking. Liquid helps move food through the digestive system, which may cause diarrhea. To slow the process, drink fluids a half hour before meals and avoid fluid consumption while eating.
  
  
• Consume 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.
  
  
• Avoid caffeine. Beverages and food containing caffeine (e.g., coffee, tea, soft drinks, 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 include:

• Bulking agents. A type of laxative that increases fecal volume, making stool easier to control and stimulating bowel movements. Bulking agents 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.
  
  
• Antispasmodics. Medications that reduce the spontaneous motions of the bowels.
  
  
• Antidiarrheals. Medications that slow digestion, helping to prevent diarrhea.

Bowel training can help some people manage fecal incontinence. This may involve muscle strengthening or training the bowel to empty at a specific time during the day. Bowel training techniques include:

• 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. 

Recent research also shows that sacral nerve stimulation may be very effective in relieving fecal incontinence. This procedure involves the implantation of an electrical device which sends signals to nerves that are connected to the lower back.

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

• Sphincteroplasty. Surgical repair of damaged or weakened sphincter muscles. Sphincter muscles are tightened by reinforcing the edges of injured muscle tissue. This type of surgery is effective for patients with sphincter muscle damage in a single location.
  
  
• Repair of complications that result from damaged pelvic floor muscles. When the rectum extends through the anus (rectal prolapse), it can weaken the anal sphincter muscles and cause fecal incontinence. Protrusion of the rectum into the vaginal wall (rectocele) may also cause fecal incontinence. Surgery to repair rectal prolapse or rectocele can correct incontinence. Sphincteroplasty may also be necessary to repair weakened sphincter muscles.
  
  
• Hemorrhoid surgery. 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). The presence of internal hemorrhoids can lead to failure of the anal sphincter to close properly, which can lead to fecal incontinence.
  
  
• Sphincter replacement. An inflatable device (artificial anal sphincter) is implanted around the anal canal. As long as the device is inflated, the anal sphincter remains closed to retain stool. Patients may temporarily deflate the device (using a small external pump) to release stool.
  
  
• Gracilis muscle transplant. Surgical repair of the anal sphincter to restore muscle tone. Tissue is taken from another part of the patient’s body (the inner thigh) and is used to strengthen the anal 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 the sacral nerves involved in bowel and anal sphincter control. Through the wire, the device emits electrical pulses that control bowel and anal sphincter functioning. This procedure may help eliminate fecal incontinence due to nerve damage.
  
  
• Colostomy. Surgery in which the normal process of stool is diverted so that it exits the body through an opening in the abdomen instead of through the anus. A special bag (colostomy bag) is attached to the abdomen to collect 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, which can worsen irritation.
  
  
• 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 the 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.