Many women with ABL find it difficult to discuss with their physicians. Although it may be embarrassing and upsetting, you are not alone. Up to 15% of women in the general population suffer from ABL. ABL is most often due to injury to pelvic floor nerves and the muscle of the anal sphincter. This circular muscle normally functions to keep stool and gas from escaping. Childbirth and or anal surgery can cause injuries that lead to ABL over time.  Post evacuation staining is common if stools are loose or incomplete evacuation occurs.

Treatment

Behavioral therapies: Includes a stool diary to identify possible dietary causes, timing bowel movements and possible addition of insoluble fiber (food and supplements)

Pelvic Floor Physical Therapy: Strengthens the muscles of the pelvic floor which surround the anal opening. Biofeedback can be also be incorporated.

Sacral Nerve Neuromodulation: Outpatient surgical implantation of a small device which reduces stool loss by stimulating the nerves which control the rectum, anus and pelvic floor.

Anal Sphincter Repair: Surgical repair of an injured (torn) anal sphincter muscle. This is most effective when done immediately following the injury. In the first year success is around 80%, but unfortunately often decreases over time. Many women will continue to have issues controlling flatus, even after successful repair.

Other therapies: Other therapies including a posterior anal sling, artificial anal sphincters and anal bulking agents have been used to treat fecal incontinence. Complications with these therapies have prevented their widespread adoption.