We never expect stool or urine to be expelled unless we want to purposely evacuate it. The act of passing urine or passing stool is usually controlled to the point where we can get to a toilet and relieve ourselves. Sometimes accidents do happen when a person has a bowel disease but this is usually short-lived. With advancing age the chances of having ‘accidents’ increases and can be due to a chronic ailment. However, when small volumes of stool stain the undergarments without an actual bowel movement or urging to pass stool then it is important to investigate it further.
What is anal leakage?
Anal leakage is a colloquial term for fecal incontinence. It is also sometimes referred to as a leaky anus. Most people understand fecal incontinence. It is a condition where the feces uncontrollably leak out of the anus. In severe cases it can become a complete loss of bowel control. However, anal leakage goes a bit further in that it may include other discharges such as fluid that does not seem to be liquid feces, mucus and sometimes even blood.
While the source of feces, the origin of these other fluids can be perplexing. It is not always clear if the fluid, mucus or blood may be originating from the anus as it may not always have the strong offensive odor of feces. The causes and treatment of anal leakage can vary significantly. Often the cause of anal leakage is not serious but more of an embarrassment. However, given that sometimes it can occur in conditions like cancer it is important to have it assessed by a medical professional.
Causes of Anal Leakage
The term anal leakage would imply that the rectal contents are leaking out through the anus. However, fluid and mucus in the buttock area may not always be originating from the anus.
Fecal incontinence is the main condition where feces may leak out of the anus. The condition can vary from occasional episodes where feces leak out of the anus to complete loss of bowel control. In the latter a person may have a full bowel movement in their undergarments despite attempting to restrain themselves. Fecal incontinence may be caused by:
- Severe gastroenteritis.
- Chronic constipation, particularly where there is fecal impaction.
- Severe hemorrhoids.
- Bowel conditions like inflammatory bowel disease (IBD) and severe irritable bowel syndrome (IBS).
- Anatomical anomalies of the rectum and anus since birth (congenital anorectal anomalies).
- Gynecological injuries during childbirth or after a hysterectomy.
- Nerve disorders like diabetic neuropathy, spinal cord injury, stroke, nerve injury to the anus following surgery, dementia and multiple sclerosis.
Sometimes feces may be found in the undergarments due to incomplete wiping and cleaning after a bowel movement. Remnants of feces may still be present around the anus and then soil the undergarments over time. This soiling is not considered to be anal leakage but rather an issue with personal hygiene.
Fluid and Mucus
Fluid and mucus that does not seem to originate from the anus could be perspiration and discharge from the genitalia. Mucus may also originate from the genitalia and be mistaken for anal leakage. However, when the fluid or mucus seems to have arisen from the rectum or anus then the following conditions could be the cause:
- Anal fissures
- Celiac disease
- Colorectal cancer or anal cancer
- Fecal impaction
- Food intolerance like lactose intolerance
- Inflammatory bowel disease
- Irritable bowel syndrome
- Rectal ulcers
Although mucus may be produced and passed out in the stool with these conditions, anal leakage may not necessarily be present in every case. Read more on mucus in the bowel movement.
Any sign of blood in the stool or blood with anal leakage is a concern. However, it may not always be due to serious conditions. Bleeding from the rectum or anus can occur for many of the same reasons as discussed above. Hemorrhoids is by far one of the most common causes for bleeding from the anus. The bleeding may occur internally within the digestive tract or from the exterior like the anus or buttock.
Although bleeding is not considered as a life-threatening condition when it occurs with common conditions like hemorrhoids, it is important to remember that bleeding from the anus may also occur with cancers of the bowel. For this reason bleeding with anal leakage should not be ignored. Bleeding from the lower parts of the gut may appear as fresh blood but when it occurs higher up in the gut then it may cause black tarry stools known as melena.
Other Signs and Symptoms
A leaky anus is a symptom that may occur along with other symptoms. Some of the other symptoms that may also be present includes:
- Itchy anus
- Itchy buttocks
- Burning anus
- Anal pain
- Urging to pass stool (bowel urging) even after a bowel movement
- Altered bowel movements like diarrhea or constipation
There are many other symptoms that may also occur along with anal leakage and it largely depends on the underlying cause.
Treatment of Anal Leakage
The treatment for anal leakage and vary significantly dependent on the cause of the leaking. It may require the use of topical applications, oral medication or even surgery. There is no single treatment that can be applied to all causes of anal leakage. Therefore it is important for anal leakage to be assessed by a medical practitioner and various diagnostic investigations to be conducted if necessary. Treatment can then be prescribed once the underlying cause is diagnosed.
Some of the non-surgical treatments include:
- Fecal incontinence: antidiarrheal drugs, laxatives, enemas for fecal impaction, diet and exercises.
- Hemorrhoids: hydrocortisone ointments and other applications, oral pain relievers, sitz bath and lifestyle changes.
- Gastroenteritis: supportive measures like bed rest and rehydration till the diarrhea resolves, antidiarrheal medication, antibiotics.
- Constipation: Fiber supplements, stool softeners and other laxatives, dietary changes and exercise.
- Inflammatory bowel disease: anti-inflammatory drugs, immune system suppressants, antidiarrheal medication, antibiotics, pain relievers.
- Irritable bowel syndrome: antidiarrheals or laxatives, antispasmodic medication, drugs to slow down bowel motility, antibiotics, antidepressants, fiber supplements, dietary and lifestyle changes.
These are just some of the medication, dietary and lifestyle changes that may be used in the treatment of these conditions that can lead to a leaky anus. However, the exact prescription should be determined by a medical professional after a clinical examination and any necessary diagnostic investigations.