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How can I manage diarrhea to help treat fecal incontinence?

Anthony L. Komaroff, MD
Internal Medicine
Diarrhea is a very common aggravating factor in fecal incontinence (unintended passage of stool). If you tend to have loose stools, you may be able to make them firmer and easier to control by adding fiber to your diet or by taking a bulking agent or fiber supplement. High-fiber diets can be helpful for both constipation and diarrhea. Dietary fiber can absorb up to 30 times its weight in water. It produces formed but soft stools, and may "normalize" your bowels. Good sources of dietary fiber are bran cereals, uncooked fruits and vegetables, whole-grain breads and pasta, and brown rice.

Specific foods may trigger diarrhea in some people. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has identified a number of foods you might try eliminating from your diet to see if your symptoms improve. According to the NIDDK, potential sources of trouble include caffeine, cured or smoked meats, spicy foods, alcohol, dairy products, fruits, fatty and greasy foods, and sweeteners (such as sorbitol, xylitol, mannitol, and fructose) that are found in many diet drinks, fruit drinks, sugarless gum, and candies.

Your physician may advise a change in the medications you take for other conditions, in case they are contributing to diarrhea and incontinence problems. As an example, the antidiabetic drug metformin (Glucophage) sometimes results in chronic diarrhea, long after starting the drug. Orlistat (Xenical), a medication used to treat obesity, decreases the absorption of fat from the digestive tract. Side effects may include several distressing bowel symptoms, including oily seepage from the rectum, fecal urgency, and, for a few people, fecal incontinence.

If food seems to move through your digestive system rapidly, your doctor may suggest an antidiarrheal medicine such as loperamide (Imodium) or diphenoxylate and atropine (Lomotil). This can solidify your stools and make them less frequent. Loperamide has the side benefit of increasing muscle tone in the internal anal sphincter, which can also help with incontinence. Another medication, the tricyclic antidepressant amitriptyline, also reduces the number of bowel movements. Some doctors have used it successfully to improve fecal incontinence, although the effectiveness of this treatment has not yet been confirmed in a controlled study.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.