You’re sitting in the exam room going over what you’ll say. The provider comes in, asks how you’ve been, and you say “fine.” The stain you keep finding in your underwear, the morning you barely made it to the bathroom, the leak you didn’t notice until later. None of it comes up. Many people with these symptoms have had some version of that appointment.

If you decide to speak up this time, the first part is usually just a conversation. Your provider will want to know what the leakage looks like, when it happens, what your bowel habits are like, and how it’s affecting your day-to-day life. You won’t be sent for a series of procedures the moment you mention it.

How is bowel incontinence diagnosed?

Healthcare providers diagnose bowel incontinence, also called fecal incontinence or accidental bowel leakage, by reviewing your medical history, asking detailed questions about your symptoms, and performing a physical exam. Tests may be used when your provider needs more information about the cause or how the muscles, nerves, rectum, or colon involved in bowel control are functioning.1 Which tests are considered depends on your individual symptoms and history.

What Does Bowel Incontinence Mean?

Fecal incontinence means solid stool, liquid stool, or mucus passes from the anus without your intending it to.2 It can look different from person to person, and common symptoms and types of fecal incontinence include:

Urge incontinence

You feel a strong, sudden urge but can’t get to a toilet in time.2

Passive incontinence

Leakage happens without you noticing until later, when the body can’t sense that the rectum is full.2

Soiling

Streaks or stains of stool or mucus on underwear can also be a symptom.3

The rectum is the lower part of the large intestine that holds stool before a bowel movement. If your main concern is “just staining,” it’s still worth mentioning.

Bowel incontinence isn't an unusual concern in a medical office. In fact, The National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK, estimates that:

About 1 in 3

people who see a primary care provider are affected by bowel leakage, although estimates vary among different populations.2

Who Should You See About Bowel Leakage?

For many people, a primary care provider is a reasonable place to start. They can review your symptoms and medical history, begin the evaluation, and decide whether another specialist should be involved.

Some patients first discuss symptoms with an OB-GYN, particularly when leakage began during pregnancy or after childbirth. Depending on the suspected cause and the care available in your area, you may also be referred to:

SpecialistWhat They Focus On
GastroenterologistThe digestive system
Colorectal specialistConditions involving the colon, rectum, and anus
UrogynecologistPelvic-floor and bladder conditions
Pelvic-floor physical therapistImproving the coordination and function of the muscles involved in bladder and bowel control

You don’t have to figure out which specialist you need first. Start with a provider you already see and describe what's been happening.

Mayo Clinic recommends seeking care when bowel leakage happens often, causes emotional distress, affects daily activities, or leads you to avoid spending time with family and friends.4

Contact a physician promptly if you notice bleeding along with a loss of bowel control. Bleeding can point to another condition that needs evaluation.5

What Questions Will Your Provider Ask?

The questions are very specific, and that’s on purpose. The details help your provider understand the pattern of leakage and what may be contributing to it.1

You may be asked:

  • When did the leakage start?
  • Does it involve liquid stool, solid stool, mucus, or mostly staining?
  • Do you feel a sudden urge first, or does it happen without you noticing?
  • How often does it happen, and how much stool passes?
  • Does it happen more with diarrhea or constipation?
  • Did it begin after childbirth, surgery, an injury, a fall, or another illness?
  • Is it worse after eating, or after certain foods?
  • How does it affect work, travel, sleep, exercise, or time with other people?1

Expect to be asked about medicines and supplements, too. Some medicines and supplements can change stool consistency or otherwise contribute to bowel-control symptoms.5,7 Bringing a written list with you is easier than trying to remember everything while you’re in the room.

Childbirth history can also be relevant, even if the delivery was years ago. Injuries to the anal sphincter muscles, the ring of muscles that helps keep the anus closed, or nearby nerves may contribute to symptoms immediately or become noticeable later.5 Your provider may ask about perineal tears, assisted deliveries, episiotomies, and other details from pregnancy and childbirth.

Some of these questions can feel very personal. NIDDK is direct about it: your provider won’t be shocked, and the more concrete details and examples you give, the better they can help.1

Too vague

“I have some issues sometimes.”

More helpful

“I leaked in the car on the way home from work last Tuesday.”

How Can a Stool Diary Help?

Your provider may ask you to keep a stool diary, which is a simple record of your bowel movements and episodes of leakage.1 They may give you a form, or you can use a notebook or notes app on your phone.

A few days or a week of notes may reveal patterns that are difficult to recall during an appointment. You might notice that leakage tends to occur on days when your stool is loose, after certain meals, during particular activities, or without any warning.

Useful details to write down:

  1. The time of each bowel movement or leakage episode
  2. Whether the stool was watery, soft, formed, or hard
  3. Whether you felt an urge first
  4. What you had eaten or drunk recently
  5. What you were doing when it happened
  6. Constipation, diarrhea, abdominal discomfort, or trouble emptying
  7. Medicines, supplements, or changes in your routine

If you have time before your appointment, start one now. Even a few days of notes can help.

A stool diary can’t diagnose the cause by itself, but it gives your provider a clearer picture of the pattern so they can decide what should be evaluated next. A bowel diary can also help your care team compare your symptoms before and after treatment.5

Get Organized Before Your Visit

Use the StaySure® Bowel Assessment Guide to organize information you may want to discuss at your appointment.

Download the Bowel Assessment Guide

What Might the Physical Exam Include?

This is the part many people worry about, so it helps to know what may happen.

Your provider may examine the area around the anus and perform a digital rectal examination. This involves gently inserting a lubricated, gloved finger into the rectum. The exam can help your provider estimate how well the anal muscles tighten and relax, check for hard stool, and look for injuries, masses, or other problems.1,5,6

Depending on your symptoms and medical history, the evaluation may also include a pelvic examination or a basic neurological examination.

A neurological examination checks how your nerves are working. It may include checks of sensation, reflexes, coordination, or balance because the nerves involved in sensation and muscle control also help the body recognize and hold a bowel movement.6

You can speak up during the exam. A rectal examination can feel awkward or uncomfortable, and you can say so. You may ask the provider to explain each step before it happens. You can also ask whether a chaperone will be present or request one if that would make you more comfortable.

Which Bowel Incontinence Tests May Be Considered?

The history and physical exam may give your provider enough information to begin a management plan. If more information is needed, testing is selected according to your symptoms.

Good to know: Most people don’t need every test described below.

Laboratory Tests

Blood tests may be used to look for anemia, inflammation, or infection. Stool tests can help identify blood or signs of infection and inflammation. Urine testing may be used when another condition, such as diabetes, could be relevant to the symptoms.1

These tests help look for conditions that could be causing or worsening the leakage rather than measuring bowel control directly.

Tests of Muscle, Nerve, and Rectal Function

TestWhat It Involves
Anorectal manometryA narrow, flexible tube placed in the anus and rectum measures how well the muscles and nerves involved in bowel control are working, how well the rectum senses filling, and how much it can stretch to hold stool.1,5 Not everyone with bowel leakage needs this test.
Balloon expulsion testA small balloon is placed in the rectum and filled with water, and you are asked to pass it on a toilet. It provides information about your ability to empty the rectum.6
ElectromyographyMeasures the electrical activity of the muscles and nerves of the anus and pelvic floor, the group of muscles that supports the bladder, bowel, and other pelvic organs.1,7

Imaging Tests

TestWhat It Shows
Endoanal ultrasoundA small probe placed in the anal canal creates images of the anal sphincter muscles. It may help identify a muscle injury, particularly when there’s a history of childbirth or surgery.5
Anorectal MRIDetailed images of the muscles and other structures surrounding the anus and rectum.6
DefecographyX-ray or MRI images taken while you pass a stool-like contrast material, showing how the rectum and pelvic-floor muscles work during a bowel movement.1,6

Tests That Look Inside the Rectum or Colon

Anoscopy, flexible sigmoidoscopy, colonoscopy, or another form of endoscopy may be considered when a provider needs to look for inflammation, bleeding, abnormal tissue, or another digestive condition.1 These tests use a small viewing instrument or flexible camera to look inside different portions of the anus, rectum, or colon. Which type is considered depends on the area your provider needs to examine.

A colonoscopy isn’t automatically required simply because someone reports bowel leakage. Your age, colorectal cancer screening history, symptoms, and possible warning signs help determine whether it’s appropriate.5

Keep in mind: Seeing all these tests listed together can make the process look much more involved than it usually is. For many patients, the evaluation begins with a conversation and physical examination. Specialized testing is added only when it could clarify the cause or help guide care.

Why Might Your Evaluation Look Different From Someone Else’s?

Bowel leakage can have more than one contributing factor. Common causes include diarrhea, constipation, and muscle or nerve injury.3,5 Someone with frequent loose stool may need a different evaluation than someone whose symptoms began after childbirth, pelvic surgery, or a neurologic condition.

The diagnostic workup typically begins with the medical history and physical examination. Specialists may add testing such as anorectal manometry or endoanal ultrasound when the results could help explain the symptoms or guide treatment.5

There’s no standard package of tests that every person receives. Your provider should be able to explain why a particular test is being recommended and what information it may provide.

How Do the Findings Guide Your Care?

The evaluation isn’t only about putting a name on the problem. It’s meant to find what may be causing or worsening the leakage so those factors can be addressed.

Treatment depends on the cause, stool pattern, severity of the symptoms, and your overall health and goals. Options may include changes to diet or medication, managing diarrhea or constipation, bowel training, pelvic-floor therapy, biofeedback, symptom-management products, prescription devices, nerve stimulation, or surgery.5

Biofeedback

A type of training that uses feedback from sensors to help a person improve muscle control, coordination, and awareness of when stool is ready to pass.5,6

Nerve stimulation

Uses mild electrical signals to influence the nerves involved in bowel control. Different types may be considered depending on your symptoms and response to other treatments.5,6

Not everyone will need or benefit from the same approach. A person whose leakage is connected to diarrhea may need something different from someone with an anal sphincter injury or difficulty sensing when the rectum is full.

Some people improve with one approach. Others use a combination of treatments and day-to-day management strategies. The useful question isn’t only what the tests show, but also what’s disrupting your daily life and what you hope will improve.

How Can You Prepare for Your Appointment?

Some preparation can make the visit feel less like being put on the spot. NIDDK suggests writing down how long you’ve had symptoms, what they are, and the questions you want to ask.1

Before you go:

  • Keep a few days of stool diary notes if you can
  • Make a list of your medicines, vitamins, and supplements, including laxatives, stool softeners, fiber products, and antidiarrheal medicines
  • Note any past surgeries, childbirth injuries, accidents, or new health conditions
  • Write one or two sentences describing the problem, so you can read them out if saying it feels hard
  • Bring information about your family medical history if your provider has asked for it

Scheduling tip: When you book, you can say you want to discuss “a bowel-control concern.” That may help ensure there is enough time for the conversation rather than trying to bring it up in the final minutes of an unrelated appointment.

If you’re concerned about leakage during the visit, tell the care team. You won’t be the first patient who’s needed that consideration.

What Questions Should You Ask?

If something about your diagnosis or treatment plan isn’t clear, ask your provider to explain it.1

You might ask:

  1. What do you think may be causing my leakage?
  2. Do I need any tests, and what will each one tell us?
  3. Should I see a specialist?
  4. Could any of my medicines or supplements be contributing?
  5. What should we address first, and how will we know if the plan is helping?
  6. Which symptoms should prompt me to call sooner?
  7. Are there any options that can help manage daily leakage while we address the cause?

It’s also reasonable to ask what the provider wants you to track before a follow-up appointment.

What If You Still Need Help Managing Leakage?

After your provider has evaluated the leakage pattern and factors that may be contributing to it, the conversation may turn to options that can make daily symptoms easier to manage.

For an appropriate adult, one option a provider may discuss is StaySure®, a prescription anal insert adults age 18 and older.8

StaySure® is a soft, flexible silicone insert that helps prevent stool from leaking out. It’s placed using a disposable applicator and may be worn for up to 24 hours or until the next bowel movement. It may be removed before a bowel movement or come out naturally during one.8

Ask whether StaySure® may be appropriate for you

If bowel leakage continues to interfere with daily activities, talk with your provider about the options available to you. A healthcare provider can review your symptoms, medical history, current treatments, and the StaySure® safety information to determine whether it may be appropriate. A prescription is required to receive StaySure®.

Request a StaySure® Evaluation Kit

StaySure® is available by prescription. Review the current StaySure® Instructions for Use.

Frequently Asked Questions

What kind of doctor treats bowel incontinence?

Many people begin with a primary care provider or OB-GYN. Depending on the symptoms and suspected cause, the provider may refer you to a gastroenterologist, colorectal specialist, urogynecologist, or pelvic-floor physical therapist.

Will I need a colonoscopy for bowel leakage?

Not necessarily. A colonoscopy or another form of endoscopy may be recommended when a provider needs to investigate bleeding, changes in bowel habits, inflammation, abnormal tissue, or another digestive condition. Your symptoms, age, medical history, and colorectal cancer screening history help determine whether one is appropriate.1,5

Is anorectal manometry painful?

Anorectal manometry uses a narrow, flexible tube placed in the anus and rectum.6 Experiences vary, and some people find the test uncomfortable. Ask the testing center what the procedure involves, how to prepare, and what you may feel during it.

Should I mention stool staining if I haven’t had a full bowel accident?

Yes. Streaks or stains of stool or mucus can be part of a bowel-leakage pattern.3 Tell your provider what you have noticed, how often it happens, and whether you feel an urge beforehand.

Can bowel incontinence be diagnosed without testing?

 

Sometimes the medical history and physical exam provide enough information to begin a management plan. Additional testing may be recommended when your provider needs more information about the cause or how the muscles, nerves, rectum, or colon are working.1,5

This article is for general education and isn’t a substitute for medical advice. Talk with a qualified healthcare provider about your symptoms.

References

  1. National Institute of Diabetes and Digestive and Kidney Diseases. (2017, July). Diagnosis of fecal incontinence. Retrieved September 7, 2026, from https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/diagnosis
  2. National Institute of Diabetes and Digestive and Kidney Diseases. (2017, July). Definition & facts of fecal incontinence. Retrieved September 7, 2026, from https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/definition-facts
  3. National Institute of Diabetes and Digestive and Kidney Diseases. (2017, July). Symptoms & causes of fecal incontinence. Retrieved September 7, 2026, from https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/symptoms-causes
  4. Mayo Clinic Staff. (2024, November 26). Fecal incontinence: Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397
  5. Bordeianou, L. G., Thorsen, A. J., Keller, D. S., Hawkins, A. T., Messick, C., Oliveira, L., Feingold, D. L., Lightner, A. L., & Paquette, I. M. (2023). The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of fecal incontinence. Diseases of the Colon & Rectum, 66(5), 647–661. https://doi.org/10.1097/dcr.0000000000002776
  6. Mayo Clinic Staff. (2024a, November 26). Fecal incontinence: Diagnosis and treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/diagnosis-treatment/drc-20351403
  7. Pehl, C. (2024). Management of fecal incontinence: Etiology, diagnostic approach, and conservative therapy. Visceral Medicine, 40(6), 310–317. https://doi.org/10.1159/000541600
  8. Minnesota Medical Technologies Corporation. (2025, August). StaySure® fecal incontinence insert: Instructions for use (Document No. 540002[R6]). https://www.staysuretoday.com/uploads/userfiles/files/documents/120133-StaySure-Instructions.pdf