A colonoscopy is a routine screening procedure used to check for abnormalities in the large intestine (colon) and rectum. It involves inserting a long, flexible tube with a camera on the end (colonoscope) into the rectum so the doctor can view the entire colon.
One of the most common concerns people have about getting a colonoscopy is whether they will experience any leakage or stool incontinence after the procedure. Here is a detailed look at what to expect and how to manage any potential leaks after a colonoscopy.
What causes leaking after a colonoscopy?
There are a few reasons why some leakage or stool incontinence can occur after a colonoscopy:
- The bowel prep – To get a clear view during the colonoscopy, your colon must be completely emptied out. The bowel preparation involves taking strong laxatives and/or enemas which cause significant diarrhea in order to flush out the bowels. This can leave the rectum and anus irritated after the frequent bowel movements.
- Insertion of the scope – As the colonoscope is inserted and maneuvered up into the colon, it can cause some irritation and inflammation of the rectal lining. The inflated colon can also stimulate a reflex that makes you feel like you need to pass stool.
- Removal of polyps – If any precancerous polyps are found and removed during the colonoscopy, this can irritate the bowel lining and cause some drainage later.
- Gas – During the procedure, the doctor pumps air into the colon to inflate it and get a better view. This can lead to cramps and the feeling of needing to pass gas or stool afterward.
The stimulant effects of the procedure itself can weaken the anal sphincter muscles and nerves that control stool containment after the colonoscopy. This is why some leakage can occur for a brief period.
What is the incidence of leaking after colonoscopy?
Most people do not experience any significant leaking or bowel incontinence after a colonoscopy. Here are some statistics on reported leakage rates:
- One study found that up to 25% of patients reported some amount of stool or mucus leakage in the days after their colonoscopy. But for most, it was only a small amount of drainage described as spotting or minimal leakage.
- About 5-10% of patients have more bothersome rectal discharge that requires use of pads for a day or two.
- Less than 1% had severe fecal incontinence after colonoscopy requiring hospitalization and additional treatment.
So while minor leakage can be common, significant and ongoing bowel incontinence after colonoscopy is very rare.
How long does the leaking last?
For those who do experience some leakage or lack of bowel control after their colonoscopy, here is an overview of how long it typically lasts:
- Mild spotting or staining may last anywhere from a few hours to 2-3 days after the colonoscopy.
- Moderate leakage requiring a pad typically resolves within 48 hours but can occasionally last up to 4 days.
- Severe fecal incontinence is very rare after colonoscopy. But if it occurs, symptoms usually resolve within a week. Ongoing incontinence for more than 1-2 weeks is very unlikely from the procedure alone.
The effects of the colonoscopy prep on bowel control usually start to improve within the first day and are significantly better by day two or three. Each day that passes should result in less and less leakage.
What can you do to manage leakage after a colonoscopy?
If you do experience some leakage or lack of bowel control after your colonoscopy, here are some tips to manage it:
- Wear an absorbent pad – Pads can protect your clothing and make you more comfortable until symptoms resolve.
- Take anti-diarrheal medication – Over-the-counter medicines like Imodium can help slow down bowel movements.
- Avoid foods that irritate the colon – Steer clear of spicy, greasy, or gas-producing items until your colon has recovered.
- Stay well hydrated – Drink plenty of water and electrolyte drinks like Gatorade to replace fluids lost from bowel prep.
- Use witch hazel pads – Witch hazel can soothe irritated anal and rectal tissues.
- Try an ointment like Preparation H – Using topical ointments can reduce inflammation and discomfort.
- Avoid strenuous activity – Take it easy for 24 hours to give your colon time to heal.
- Call your doctor if symptoms persist – If leakage lasts more than 3-4 days or you have signs of an infection like fever, contact your physician.
Make sure to follow all discharge instructions from your doctor. Report any concerning symptoms like large amounts of bleeding. With some simple self-care measures, minor bowel leakage usually resolves quickly after a colonoscopy.
What causes prolonged or severe leakage?
While minor temporary leakage is common, very severe or ongoing bowel incontinence after colonoscopy is rare. Here are some potential causes of prolonged, bothersome leakage:
- Infection – A colonoscopy can rarely cause an infection like C. difficile colitis which leads to significant diarrhea.
- Bowel perforation – A perforated bowel from the colonoscope can cause serious leakage of stool into the abdominal cavity.
- Hemorrhage – Heavy rectal bleeding from a colonoscopy complication can appear like a stool leak.
- Nerve injury – For men, very rarely the colonoscope can damage nerves that control bowel movements.
- Underlying condition – Some chronic condition like inflammatory bowel disease could cause fecal incontinence.
- Rectal prolapse – Part of the rectal lining protruding from the anus after a colonoscopy may prevent solid stool from being contained.
Make sure to follow up with your gastroenterologist if you have severe, persistent leakage or other concerning symptoms after your procedure. Evaluation and treatment can help identify if there are any complications or other colon conditions contributing to the bowel incontinence.
Will leaking after colonoscopy affect the results?
Having some leakage after your colonoscopy should not significantly affect the accuracy of your test results. Since all of the stool is flushed out before the procedure, any subsequent leakage just contains:
- Fluid and mucus discharge from irritation of the bowel
- A small amount of blood from biopsy sites or polyp removal
- Excess lubricating gel or cleaning solution used during the colonoscopy
The doctor is still able to get a complete view of your colon during the procedure before any leakage occurs. The amounts are also typically small.
So you should be able to have confidence in your colonoscopy results. However, if you have severe diarrhea, bleeding or suspect a perforation from symptoms, you should contact your doctor, as this may affect the accuracy of the scope and require repeat testing or additional treatment.
Results should not be affected by minor leakage
In summary, minor or mild fecal spotting and leakage after your colonoscopy should not interfere with the accuracy of your results or your doctor’s ability to make a diagnosis. Don’t hesitate to discuss any concerns about your results at your follow-up appointment.
Can you prevent leaking with diet after colonoscopy prep?
Making smart dietary choices after completing your colonoscopy prep can help minimize the chances of leakage, diarrhea or constipation as your bowel function returns to normal.
Here are some best practice diet tips for the 1-2 days after finishing your prep solution:
Avoid harsh foods at first
After the colonoscopy, the lining of your bowel will be irritated and inflamed from the effects of the strong laxatives. Avoiding foods that can further aggravate or stimulate the colon is wise for at least 24 hours post-procedure. Restrict foods like:
- Fresh fruits and vegetables with skins, seeds or stems
- Whole grains and bran cereals
- Nuts, seeds, popcorn
- Spicy, heavily seasoned, or fried foods
Stick to a bland, low-fiber diet
Until your colon starts to recover, give it a rest by sticking to a light diet of low-fiber, bland foods like:
- White bread, white rice, crackers, noodles
- Eggs, skinless poultry, fish, tofu
- Cottage cheese, yogurt
- Canned fruits like peaches, pears, apple sauce
- Clear broths and soups
- Tea, electrolyte drinks, juices without pulp
Drink plenty of fluids, at least eight 8-ounce glasses per day. Water, electrolyte sports drinks, clear sodas, juices without pulp, weak tea, and broths are good options. Avoid milk, prune juice, and alcoholic drinks in the recovery period.
Get your fiber back gradually
Once your colon has had 24-48 hours to heal, you can start adding some higher fiber foods like cooked oatmeal, soft cooked vegetables, canned fruit with skins and seeds, shredded wheat cereal, and whole grain bread.
Over 3-5 days, gradually work fiber back into your regular diet to get your bowel movements back on track without flare ups.
Take anti-diarrheals if needed
If you have ongoing loose stools or diarrhea after your procedure, over-the-counter anti-diarrheal medication can help firm up your bowel movements. Imodium AD is commonly recommended after a colonoscopy.
Some minor bowel leakage in the day or two after a colonoscopy is quite common and expected as the colon recovers. While it can be concerning, it is usually temporary. Stay well hydrated, follow diet recommendations, keep the area clean, and use pads if needed. Call your doctor if you have persistent or severe fecal incontinence after your colonoscopy.