Fecal Incontinence

Publication Date: April 1, 2019
Last Updated: March 14, 2022


Nonsurgical treatments for fecal incontinence are associated with modest short-term efficacy and a low risk of adverse events and are recommended for initial management, except in cases of fistulae or rectal prolapse. (B)

Fiber, antimotility agents, and laxatives can be recommended as useful treatments for fecal incontinence. (B)

Pelvic floor muscle exercises with or without biofeedback can be recommended for the treatment of fecal incontinence to strengthen the anal sphincter and levator ani muscles, but there are insufficient data on the most effective treatment protocol. (B)

Anal sphincter bulking agents may be effective in decreasing fecal incontinence episodes up to 6 months and can be considered as a short-term treatment option for fecal incontinence in women who have failed more conservative treatments. (B)

Surgical treatments should not be considered for the initial management of fecal incontinence (except in cases of fistulas or rectal prolapse) because surgical treatments provide only short-term improvement and are associated with more frequent and more severe complications compared with nonsurgical interventions. (B)

Sacral nerve stimulation can be considered as a surgical treatment option for women with fecal incontinence with or without anal sphincter disruption who have failed conservative treatments. (B)

Sphincteroplasty can be considered in women with anal sphincter disruption and fecal incontinence symptoms who have failed conservative treatments. (B)

Women with risk factors should be screened for fecal incontinence. (C)

Women who report fecal incontinence symptoms should undergo a complete medical history, symptoms assessment, and physical examination of the rectal, vaginal, and perineal areas. No specific laboratory tests are needed for the initial evaluation of fecal incontinence unless diarrheal infectious processes are suspected. (C)

Ancillary diagnostic testing (such as anal sphincter imaging, defecography, anorectal mammography, and pudendal nerve terminal motor latency testing), is not recommended for the routine evaluation of fecal incontinence. (C)

Any woman presenting with fecal incontinence and a change in her bowel habits should be considered for a colonoscopy, especially when accompanied by any “red flag” symptoms, including unexplained weight loss, abdominal pain, rectal bleeding, melena, or anemia. (C)

It is reasonable for obstetrician–gynecologists to initiate conservative interventions, such as dietary manipulation, bowel scheduling, fiber supplementation, and stool-modifying agents. Patients who are candidates for surgical therapy (such as women with rectovaginal fistulas or rectal prolapse) or who do not respond to conservative treatments should receive further evaluation and treatment by a health care provider with expertise in pelvic surgery. (C)

Dietary manipulation (ie, food diaries and dietary changes) and bowel schedules (ie, regular toileting) should be offered to women with fecal incontinence in conjunction with other treatments because these treatments may help improve symptoms and are associated with few adverse events. (C)

Recommendation Grading




Fecal Incontinence

Authoring Organization

Publication Month/Year

April 1, 2019

Last Updated Month/Year

January 9, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital

Intended Users

Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant


Assessment and screening, Management

Diseases/Conditions (MeSH)

D005242 - Fecal Incontinence


fecal incontinence, loose stool, involuntary leakage