1) Dietary Changes

Food affects the consistency of stool and how quickly it passes through the digestive system. If your stools are hard to control because they are watery, you may find that eating high-fiber foods adds bulk and makes stool easier to control. But people with well-formed stools may find that high-fiber foods act as a laxative and contribute to the problem. Foods and drinks that may make the problem worse are those containing caffeine - like coffee, tea, or chocolate - which relaxes the internal anal sphincter muscles.

You can adjust what and how you eat to help manage bowel incontinence.

• Keep a Food Diary. List what you eat, how much you eat, and when you have an incontinent episode. After a few days, you may begin to see a pattern involving certain foods and incontinence. After you identify foods that seem to cause problems, cut back on them and see whether incontinence improves. Foods and drinks that typically cause diarrhea, and so should probably be avoided, include:
  • Drinks and foods containing caffeine
  • Cured or smoked meat such as sausage, ham, or turkey
  • Spicy foods
  • Alcoholic beverages
  • Dairy products such as milk, cheese, or ice cream
  • Fruits such as apples, peaches, or pears
  • Fatty and greasy foods
  • Sweeteners, such as sorbitol, xylitol, mannitol, and fructose, which are found in diet drinks, sugarless gum and candy, chocolate, and fruit juices
• Eat Small Meals More Frequently. In some people, large meals cause bowel contractions that lead to diarrhea. You can still eat the same amount of food in a day, but space it out by eating several small meals.
• Eat and Drink at Different Times. Liquid helps move food through the digestive system. So if you want to slow things down, drink something half an hour before or after meals, but not with meals.
• Eat the Right Amount of Fiber. For many people, fiber makes stool soft, formed, and easier to control. Fiber is found in fruits, vegetables, and grains, like those listed below. You need to eat 20 to 30 grams of fiber a day, but add it to your diet slowly so your body can adjust. Too much fiber all at once can cause bloating, flatulence (gas), or even diarrhea. Also, too much insoluble, or undigestible, fiber can contribute to diarrhea. If you find that eating more fiber makes your diarrhea worse, try cutting back to two servings each of fruits and vegetables and removing skins and seeds from your food.
• Eat Foods that Make Stool Bulkier. Foods that contain soluble, or digestible, fiber slow the emptying of the bowels, including bananas, rice, tapioca, bread, potatoes, applesauce, cheese, smooth peanut butter, yogurt, pasta, and oatmeal.
• Get Plenty to Drink. Drink eight 8-ounce glasses of liquid a day to help prevent dehydration and keep stool soft and formed. Water is a good choice. Avoid drinks with caffeine, alcohol, milk, or carbonation if you find they trigger diarrhea.

Over time, diarrhea can keep your body from absorbing vitamins and minerals. Ask your doctor if you need a vitamin supplement.

2) Medication

If diarrhea is causing your incontinence, medication may help. Sometimes doctors recommend using bulk laxatives to help people develop a more regular bowel pattern. Or the doctor may prescribe antidiarrheal medicines such as loperamide or diphenoxylate to slow down the bowel and help control the problem.

3) Bowel Training

Bowel training helps some people relearn how to control their bowel movements. In some cases, bowel training involves strengthening muscles, in others, it means training the bowels to empty at a specific time of day.

• Use Biofeedback. Biofeedback is a way to strengthen and coordinate the muscles and has helped some people with incontinence. Special computer equipment measures muscle contractions while you do exercises - called Kegels - to strengthen the rectum and improve rectal sensation. These exercises work muscles in the pelvic floor, including those involved in controlling stool. Computer feedback about how the muscles are working shows whether you're doing the exercises correctly and whether the muscles are getting stronger. Whether biofeedback will work for you depends on the cause of your bowel incontinence, how severe the muscle damage is, and your ability to do the exercises.
• Develop a Regular Pattern of Bowel Movements. Some people - particularly those whose bowel incontinence is caused by constipation - achieve bowel control by training themselves to have bowel movements at specific times during the day, such as after every meal. The key to this approach is persistence- it may take awhile to develop a regular pattern. Try not to get frustrated or give up if it doesn't work right away.

4) Surgery

Surgery to repair the anal sphincter may be an option for people who have not responded to dietary treatment and biofeedback and for those whose bowel incontinence is caused by injury to the pelvic floor, anal canal, or anal sphincter.

People who have severe bowel incontinence that doesn't respond to other treatments may benefit from injection of bulking agents in the anus or nerve stimulation in the lower pelvic area.

A colostomy may be indicated for people with severe bowel incontinence who haven't been helped by other procedures. This procedure involves disconnecting the colon and bringing one end through an opening in the abdomen - called a stoma - through which stool leaves the body and is collected in a pouch. The colostomy may be temporary or permanent.