Bowel Incontinence - Causes, Symptoms & Treatments
Bowel incontinence or faecal incontinence is when a person has a problem with controlling their bowels. Faecal incontinence can range from the odd leakage of stool while passing gas to a complete loss of bowel control.
This can vary in each person and there are many faecal incontinence causes.
1 in 10 people will be affected by bowel incontinence and it can happen at any age and to any gender, although it’s more common in elderly people and women. Many people can find this embarrassing and upsetting, however, bowel incontinence treatment is available.
The symptoms of bowel incontinence are dependent on the type.
The most common type of faecal incontinence is when a person has a strong urge for bowel movement and they can’t make it to the toilet in time.
Alternatively, other people might suffer from passive faecal incontinence, which happens when you pass stool or mucus without any warning or knowing that you have done so.
Other symptoms can include:
- Loose stool
- Gas and bloating
- Stool or mucus stains in your underwear (soiling)
Diarrhoea is the most common risk factor for bowel incontinence, with loose stools filling your rectum quickly, therefore, making it difficult to hold in.
Constipation weakens the muscle in the rectum. Once the muscles are weakened, they release soft stools that as a result, have built up behind the hard stool.
Haemorrhoids can keep the muscle around your anus from closing fully, allowing small amounts of stool to leak out.
Damaged nerves that control your anus, pelvic floor and rectum can't always work properly, and knowing when you need to go to the toilet becomes difficult. A long-term habit of straining to pass stool, surgery, brain injury or spinal cord injury all cause nerve damage.
Conditions that affect the nerves
Many conditions can affect the nerves, such as:
If the muscles in your anus or rectum become injured or weakened they might not be able to keep your anus closed so stool leaks out. The main causes of muscle damage include trauma and surgery.
Irritable bowel syndrome (IBS) and Inflammatory bowel disease (IBD)
Irritable bowel syndrome and inflammatory bowel disease such as Crohn's disease are common conditions that affect the digestive system. Both irritable bowel syndrome and inflammatory bowel disease have similar symptoms and can cause loss of bowel control.
Childbirth can sometimes cause injury to the anal sphincter muscles and can lead to bowel incontinence.
Loss of storage capacity in the rectum
The rectum usually stretches to accommodate the stool. If the rectum becomes scarred or stiff this means it can’t stretch as much as needed. Not being able to stretch allows excess stool leakage.
Rectal prolapse happens when the rectum drops down into the anus, causing the rectal sphincter to stretch. The longer this lasts, the less chance of recovery for the nerves and muscles.
Rectocele happens when the rectum bulges through the vagina, which can sometimes lead to faecal incontinence.
It’s useful to keep a bowel diary before visiting your GP to record your bowel movements, any accidents, and what you eat and drink on a daily basis.
Your doctor will perform a physical exam including a digital rectal exam or a pelvic exam to check if the female reproductive organs are normal.
Your doctor will also use medical tests to diagnose faecal incontinence. Lab tests including blood tests and urine tests are usually done, in addition to a bowel function test which is used to assess how well the muscles and nerves of your anus, pelvic floor, and rectum are working.
An endoscopy may be carried out to look inside your anus. Imaging tests such as ultrasounds are sometimes used.
There are many treatments for bowel incontinence that can improve the quality of life for anyone suffering from this condition. Managing faecal incontinence is individual to each person, therefore, sometimes multiple treatments might be used.
- Eat lots of fibre: high-fibre foods act as a bulking agent and help bulk up your stool.
- Limit caffeine: caffeine increases the speed your muscles push stool through your colon.
- Up your water intake and make sure you are drinking several glasses of water each day.
- Keep a food journal: by tracking your food and drink you may find specific foods that make your bowel movements looser; make a conscious effort to avoid these foods.
- Kegel exercises: pelvic floor exercises help to strengthen the pelvic floor muscles supporting your bowel, you should complete these several times a day to strengthen the muscles.
- Bowel training and scheduling bowel movements at the same time each day can help prevent accidents in between.
- An occasional water enema can be done. This is more invasive than the other home remedies, however, it can help predict bowel movements.
Incontinence products are available for you to buy such as pads that you wear in your underwear or small plugs that you put inside your bottom.
Medications including Imodium, Lomotil, and hyoscyamine are all used to treat bowel incontinence.
Surgical treatments are usually recommended if bowel incontinence is not relieved by non-invasive options.
These surgeries can include sphincter surgery, sacral nerve stimulation and a sphincter cuff device. When all other treatments have been tried a colostomy is considered.
Living with bowel incontinence
Living with bowel incontinence can be both emotionally and socially challenging, however, it can be managed.
Think ahead of the issues that might arise whilst you are out and plan a solution for them. Take spare pads and clothes with you so that you can change into them if you have an accident.
The ‘Can’t Wait’ card
The ‘Can’t Wait’ card is a free card that clearly states you have a medical condition and must use the toilet urgently. Having this card handy, therefore, avoids embarrassing conversations. Although it doesn’t always guarantee access to a toilet it has been proven to help.
Opt for clothing with velcro or elasticated waists. This will allow easy access when it comes to going to the bathroom. Avoid clothing with buttons or zips as they could make it tricky and more time-consuming.