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Fecal Incontinence — Effective Treatment, Restored Confidence

Accidental bowel leakage affects millions of adults and is one of the most underreported conditions in medicine — most patients suffer in silence for years before seeking help. Dr. Karmina Choi provides compassionate, thorough evaluation and a full range of treatments from pelvic floor rehabilitation to advanced surgical options.

ANORECTAL CONDITION

Expert Colorectal Care | Fort Lee, NJ

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Common questions

1 in 3

patients seen by a primary care doctor have some degree of fecal incontinence

Rarely

discussed — but very common, very treatable, and nothing to be ashamed of

Most

patients improve significantly with the right non-surgical treatment

What is fecal incontinence?

Fecal incontinence is the inability to control bowel movements, resulting in unexpected leakage of stool or gas. It ranges from occasional minor soiling when passing gas to complete inability to reach the bathroom in time. It is not a normal part of aging and it is not something patients must simply accept.

The condition results from one or more disruptions in the complex system that controls defecation — including the anal sphincter muscles, the pelvic floor, the nerves supplying the rectum and anus, and the ability of the rectum to sense and store stool. Identifying which component is impaired is the key to effective treatment.

Many patients don't mention it to their doctor out of embarrassment. Dr. Choi creates a judgment-free environment where this conversation is treated with the clinical seriousness it deserves.

Common causes

Obstetric injury

Childbirth — particularly forceps delivery, prolonged pushing, or third/fourth-degree tears — is the leading cause in women, often presenting decades later.

Chronic diarrhea

Liquid stool is far harder to control than formed stool. IBS-D, SIBO, IBD, and bile acid malabsorption all contribute.

Sphincter damage

Prior anorectal surgery, trauma, or infection can disrupt the internal or external anal sphincter.

Pelvic floor dysfunction

Weakness or discoordination of the pelvic floor muscles impairs the support system for continence.

Rectal prolapse

Prolapsing tissue stretches and weakens the sphincter over time — incontinence often improves significantly after prolapse repair.

Nerve damage

Diabetes, pudendal nerve injury, and neurological conditions impair the sensation and motor control needed for continence.

Constipation and overflow

Severe constipation with impaction can cause liquid stool to leak around a hard blockage — overflow incontinence.

Rectal capacity issues

Reduced rectal compliance from radiation, IBD, or surgery means less warning time between sensing stool and needing to defecate urgently.

How Dr. Choi evaluates fecal incontinence?

Thorough symptom history. Type of leakage (gas, liquid, solid), frequency, urgency, prior deliveries and obstetric injuries, prior surgeries, bowel habits, and quality-of-life impact — reviewed in detail at your first visit.

Physical examination. Assessment of sphincter tone, squeeze pressure, pelvic floor coordination, and perianal sensation — providing an immediate clinical impression of whether the sphincter, the nerves, or both are involved.

Anorectal manometry. Objectively measures internal and external sphincter pressures, rectal compliance, and the rectoanal inhibitory reflex — the most informative single test for identifying the functional deficit driving incontinence.

Endoanal ultrasound. Visualizes the sphincter complex in cross-section, identifying structural defects — tears or thinning — that may be amenable to surgical repair.

Pudendal nerve testing when indicated. Measures the integrity of the nerve supply to the sphincter — impaired nerve function predicts lower success with sphincter repair and guides surgical decision-making.

Evaluation and treatment of contributing factors. Diarrhea, constipation, prolapse, and rectal capacity are assessed and treated alongside the sphincter evaluation — because incontinence rarely has a single cause.

Treatment — from conservative to surgical

Bowel habit regulation and dietary modification

Forming bulkier, more predictable stools is the single most effective first step. Soluble fiber (psyllium), adequate hydration, anti-diarrheal agents (loperamide) when urgency is prominent, and consistent meal timing all reduce the unpredictability that drives incontinence. Dr. Choi tailors these recommendations to your specific bowel pattern.

Pelvic floor physical therapy and biofeedback

Biofeedback-guided pelvic floor therapy improves sphincter squeeze strength, rectal sensation awareness, and the coordination needed to respond to urgency — achieving meaningful improvement in 60–80% of motivated patients. This is the cornerstone of non-surgical treatment and is coordinated with experienced pelvic floor physiotherapists.

Sphincteroplasty — repair of structural sphincter defects

When endoanal ultrasound identifies a discrete sphincter tear — most commonly from obstetric injury — overlapping sphincteroplasty surgically reconstructs the external sphincter. Best outcomes occur in patients with intact nerve function and a well-defined anatomical defect. Dr. Choi performs sphincteroplasty as an outpatient procedure and counsels patients realistically about expected outcomes based on nerve integrity.

Foundation

Surgical

Sacral neuromodulation — for refractory incontinence

For patients who have not achieved adequate control with conservative measures and who are not candidates for sphincteroplasty — or whose sphincter is intact but poorly functional — sacral nerve stimulation (SNS) involves implanting a small device that modulates the sacral nerves controlling the bowel. Dr. Choi provides evaluation and referral coordination for sacral neuromodulation with appropriate surgical partners.

Rehabilitation

There is no single treatment for chronic diarrhea — the right intervention depends entirely on the underlying mechanism. Dr. Choi's approach starts with the most natural and least invasive options and escalates only based on what the diagnosis requires.

Surgical

If you also have urinary incontinence or pelvic prolapse: These conditions share the same pelvic floor support system and frequently coexist. Dr. Choi evaluates for associated pelvic organ prolapse and coordinates multidisciplinary care with urogynecology when needed — so that all components of pelvic floor dysfunction are addressed together rather than in isolation.

Why choose Dr. Karmina Choi?

Judgement-free care

Fecal incontinence is deeply personal. Dr. Choi approaches every patient with sensitivity and creates space for an honest, thorough conversation.

Biofeedback coordination

Referral to experienced pelvic floor therapists with close follow-up — not a referral into a void.

Pelvic floor coordination

Associated prolapse and urinary incontinence identified and coordinated with urogynecology when present.

Surgical expertise

Sphincteroplasty performed with realistic counseling on expected outcomes based on nerve integrity and defect characteristics.

Female physician option

Particularly important for women with obstetric injuries — a sensitive, experienced environment for a difficult conversation.

Common Questions

Is fecal incontinence a normal part of aging?

No — it becomes more common with age but is not inevitable or untreatable. Many patients assume nothing can be done and live with it for years unnecessarily. Effective treatments exist for most patients, and even partial improvement in continence can dramatically change quality of life.

Will I definitely need surgery?

Most patients do not. The majority of fecal incontinence cases improve significantly with bowel habit regulation, dietary changes, and pelvic floor therapy — without any surgical intervention. Surgery is considered when a specific anatomical defect is identified or when conservative measures have been genuinely exhausted.

I had a difficult childbirth 20 years ago. Could that be causing this now?

Yes — and this is one of the most common scenarios Dr. Choi encounters. Obstetric sphincter injuries may remain compensated for decades, with incontinence appearing or worsening as pelvic floor muscle strength naturally declines with age or hormonal change. The injury is old; the symptoms are new. Both are real, and both are treatable.

How effective is biofeedback therapy?

For patients who engage consistently, biofeedback achieves meaningful improvement — reduced frequency, reduced urgency, improved confidence — in the majority of cases. It works best when the sphincter is structurally intact and the problem is functional rather than due to a major anatomical defect. Dr. Choi sets realistic expectations at the outset based on your specific evaluation findings.

Related conditions

Pelvic floor dysfunction

You don't have to keep managing this alone.

Fecal incontinence is treatable — and the conversation is easier than you think. Dr. Choi is ready to help.

Book a Consultation

Call (551) 321-1388

1625 Anderson Avenue, Suite 203, Fort Lee, New Jersey 07024

This page is for informational purposes only and does not constitute medical advice. Individual results vary. Please consult Dr. Choi for a personalized evaluation and treatment plan.

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1625 Anderson Ave, Ste 203

Fort Lee, New Jersey 07024

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