Bowel incontinence occurs in at least six percent of the population. Even though it affects about 5.5 million Americans, many people are so embarrassed by the condition that they fail to tell their family, friends … even their doctor.

Your family doctor may be able to help you with bowel incontinence treatment, or he or she may refer you to a specialist. Gastroenterologists, proctologists and colorectal surgeons all specialize in conditions affecting the colon, rectum and anus. You can feel comfortable telling them about your incontinence symptoms, knowing that they have heard them many times before.

Medical History
It’s likely that your visit will begin with a medical history. Your doctor will try to figure out the cause of your bowel incontinence based on answers to questions about your condition, such as when loss of control occurs, and how often.

Physical Examination
Next, your doctor will probably do a physical examination of your anus and perineum (the area between your anus and genitals) to rule out hemorrhoids, infections, or other conditions. He or she will use a pin or other instrument to test for nerve damage. Healthy reactions result in the contraction of the anal sphincter, which causes your anus to tighten.

Medical Testing
Based on what was found during the physical exam, your doctor may order one or more tests to narrow down the cause of your bowel incontinence. Among them are:

•    Anal Electromyography (EMG). Tiny needle electrodes are inserted into the muscle tissue surrounding your anus to show signs of nerve damage.

•    Anal Manometry. This common test involves introducing a slender, flexible tube into the anus and rectum. After the tube is inserted, a balloon at the tip of the tube is inflated. This test tells your  doctor not only how tight your anal sphincter is, but can also evaluate rectal sensation.

•    Anorectal Ultrasonography. To assess the structure of your sphincter, a wand connected to a computer and video screen is inserted into your anus and rectum. The wand emits sound waves, which bounce off the walls of your sphincter, giving your doctor video images of these internal structures to assess for scarring, tumors, or other abnormalities.

•    Defecocraphy. Liquid barium, which is highly visible on x-rays, is inserted into the colon and rectum with a small tube while you lie on a table. After the walls of the colon are coated with the barium, you’ll sit on a special toilet where an x-ray video of your bowel functions is made while you cough, squeeze your butt cheeks together, and then defecate. You’ll also be asked to push as though you were having a bowel movement.  The test measures how much fecal matter your colon can hold, and how stool is pushed out of your rectum.

•    Magnetic Resonance Imaging (MRI). Your doctor may elect to order an MRI scan of your bowels. MRI uses magnetic signals inside a large tube to create detailed images of your pelvic area.

•    Proctography. Another name for defecocraphy, above.

•    Proctosigmoidoscopy. A long, slim tube with a miniature video camera at the tip is inserted into the rectum and sigmoid (about the lower two feet of the colon) to check for inflammation, scar tissue or tumors that can be the source of fecal incontinence. In some instances, your doctor may choose to perform a colonoscopy to examine the entire colon.