Diagnosis of Fecal Incontinence

How do doctors diagnose fecal incontinence?

Doctors use your medical history, a physical exam, and medical tests to diagnose fecal incontinence and its causes.

Medical history

In addition to reviewing your general medical history, your doctor may ask the following questions:

• When did your fecal incontinence start?
• Did your fecal incontinence start after
  • the birth of your child?
  • a motor vehicle accident?
  • a fall?
  • the start of another illness?
• How often does your fecal incontinence happen?
• How much stool passes?
• Do you pass liquid or solid stool?
• Do you have a strong urge to have a bowel movement before your fecal incontinence happens?
• Do you know when you need to have a bowel movement before it happens?
• Does your fecal incontinence happen without you knowing?
• Do you leak liquid stool or mucus?
• Do you have fecal incontinence when you have diarrhea or constipation?
• Is your fecal incontinence worse after eating?
• Do certain foods seem to make your fecal incontinence worse?
• How does fecal incontinence affect your daily life?

Your doctor may ask you to keep a stool diary to help answer these questions. A stool diary is a chart for recording details of your daily bowel movements. Your doctor may give you a stool diary form that he or she has created. Or, you can create your own stool diary form or record your bowel movement details in a notebook.

You may feel embarrassed or shy about answering your doctor’s questions. However, your doctor will not be shocked or surprised. The more details and examples you can give about your problem, the better your doctor will be able to help you. You can play an active role in your diagnosis by talking openly and honestly with your doctor.

Physical exam

Your doctor will perform a physical exam, including a

• digital rectal exam
• pelvic exam—an exam to check if internal female reproductive organs are normal by feeling their shape and size

What medical tests do doctors use to diagnose fecal incontinence?

Lab tests

Your doctor may use one or more of the following lab tests to look for signs of certain diseases and conditions that may be causing your fecal incontinence.

• Blood tests can show signs of anemia, inflammation, and infection.
• Stool tests can show the presence of blood and signs of infection and inflammation.
• Urine tests can show signs of diseases such as type 2 diabetes.

Bowel function tests

Your doctor may perform one or more of the following tests to see how well the muscles and nerves in your anus, pelvic floor, and rectum are working:

• anorectal manometry—a test that checks how sensitive your rectum is, how well it works, and how well the anal sphincters work
• defecography—an x-ray of the area around the anus and rectum to see how well you can hold and release stool
• electromyography—a test that checks how well the muscles and nerves of your anus and pelvic floor are working

Endoscopy

Your doctor may perform an endoscopy to look inside your anus, rectum, and colon for signs of inflammation and digestive tract problems that may be causing your fecal incontinence. Endoscopies for fecal incontinence include

• anoscopy
• colonoscopy
• flexible sigmoidoscopy
• rectoscopy—a procedure similar to an anoscopy to look inside your rectum

Imaging tests

To look for problems in the anus, pelvic floor, or rectum that may be causing your fecal incontinence, your doctor may perform an imaging test such as

• lower GI series
• magnetic resonance imaging
• ultrasound