What to do if you’re having accidents with your bowels.

What to do if you're having accidents with your bowels.Bowel incontinence is upsetting and distressing but you may be surprised to know that figures from the National Libraries of Medicine and Institutes of Health say that more than 5.5 million Americans and 2% of the UK population suffer from it on a daily or weekly basis.  And this is probably an underestimate as many people are too embarrassed to report it to their doctor.

It affects people of all ages but is more common in older people and women.  But it is not a normal part of getting older.

What is bowel incontinence?

Simply put, bowel incontinence is the inability to control your bowels so that, when you feel you want to have a bowel movement (go to the toilet to poo/poop) you can’t hold it until you get to the toilet.

Sometimes people may have a ‘wet fart’ which is when you leak fecal matter as you break wind/pass flatus.  This is usually occasional and may happen when you’ve had some diarrhea or taken stimulant laxatives.

What causes bowel incontinence?

Main causes are:

  • Constipation
  • Diarrhea
  • Pelvic floor muscle problems
  • Nerve damage to the anal/rectum area, for example in MS, Parkinson’s Disease, spinal cord damage, damage to the anal sphincters (muscles controlling the anal opening)
  • People with cognitive/understanding problems caused by learning difficulties or dementia
  • People with mobility problems who can’t get to the toilet in time.

We’re going to look at the first 3 of these causes and possible management for bowel incontinence.

Constipation causing bowel incontinence.

The bowel’s job is to process and digest the food we eat.  Starting at the mouth, the digestive systems grinds, and pulps the liquid food using chemicals called enzymes.  This extracts the nutrients so that the body can use them.  But then it’s left with the waste products.

This passes into the large bowel (also called the large intestine or colon) and then into the rectum.  See these on the picture here.

At this later stage of digestion water is re-absorbed by the body and the stool/poo/poop dries out a little.  Constipation happens when this passage is too slow, making the stool drier and more difficult to pass.

There is more detail on constipation and constipation remedies in these articles.

As the fecal matter in the lower part of the bowel hardens, causing a plug, the more liquid feces further up the digestive system spill round the sides of the plug.  This is called ‘over flow’ and can cause soiling that looks like diarrhea, although the problem is actually constipation.

Stool chart doctors use to help patients describe their bowel motions.

If you haven’t had a good bowel motion for some days or weeks – perhaps you’ve passed little bits of stool and still feel you need to go ‘properly’ – then this may be what’s causing your soiling problem.

See the Bristol Stool Chart here to gauge stool consistency.

You should see your doctor about this.  S/he will feel your abdomen, do a rectal test (putting a gloved finger into the rectum to see if the stool can be felt) and will be able to discuss a solution to the problem with you.

You may feel very embarrassed about these intimate tests and discussions, but are they more embarrassing than the soiling you’ve experienced?  Remember that your doctor will be sympathetic and this won’t be the first time s/he has seen the problem.

Constipation needs to be managed in the long term if you’re prone to it.  Do this by:

  • Eating more fruit and vegetables, roughage and fibre
  • Drinking plenty of water and other non-alcoholic fluid
  • Getting some exercise daily
  • Taking time to go to the toilet when you need to – not holding it in
  • Using laxatives with your doctor’s guidance
  • Discussing whether any other meds that you might be taking could cause constipation.

Diarrhea causing bowel incontinence.

Diarrhea is a watery, loose stool and you may have it 3 or more times each day.

Other symptoms that commonly come along with diarrhea include abdominal bloating, cramps and the urgent need to go to the toilet.

The urgent need to go to the toilet when you have diarrhea can cause the soiling problem.

There are many causes of diarrhea which, if they’re cause your soiling problem, need to be put right.  These include:

  • Infection
  • Digestive tract disorders such as Crohn’s Disease, inflammatory bowel disease, irritable bowel syndrome
  • Medication side effects
  • Food intolerances
  • Anxiety.

Depending on the problem, the cure for the diarrhea should resolve the fecal soiling.  Look at our article on diarrhea for more detail and diarrhea remedies.

Pelvic muscle problems causing diarrhea.

The pelvic floor muscles and ligaments are like a sling, or hammock of muscle at the base of the pelvis and support the lower pelvic organs.  The urethra (for passing urine), vagina (in women) and bowel all pass through the pelvic floor muscles and they help to control when you pass urine or have a bowel movement.  The other muscles that do this are the bowel and urinary sphincter muscles.

You can see the position of the pelvic floor muscles in women in the picture.

If these muscles get flabby or weak, then it becomes more difficult to control both the bladder and bowel function.  This can be caused by:

  • Pregnancy and childbirth
  • Weight gain
  • Gynaecological surgery

Kegel exercises are designed to help make the pelvic floor muscles stronger and prevent the leakage of urine or stools.  You can buy Kegel exercise weights that can give a little resistance and help you focus on the muscles you need to be working.

Here are instructions for doing pelvic floor exercises.

  1. Sit with the legs apart and close the front and back passages as if ‘zipping’ them up inside – imagine you’re trying to stop the flow of urine or bowel gas from escaping.
  2. Hold for the count of 4 and then relax slowly.
  3. Repeat 4 times each hour.
  4. Consider doing these after passing urine.

You can increase the exercises after 3 months by

  1. When going to the pass water (when there is not a strong sensation to go) pass the first part of the stream,
  2. repeat steps 1 and 2 above – close the front passage and count to 4 then release

You can practise these exercises whenever you are sitting down – no one can tell that you’re doing them.

If fecal soiling has been a persistent problem you should notice an improvement in the symptoms as the exercises take effect.

What tests are done for bowel incontinence?

  • A proctology scope of the rectum to look inside it – you are given a sedative and won’t remember what happens.

    proctoscopy

    Proctoscopy

  • Anorectal manometry measures the strength of the anal muscles – a small probe is put in the rectum and records changes in pressure as you tighten and relax the anal muscles.
  • Proctography looks at the rectum and its function in holding and expelling the stool.

Nerve tests to see if the nerves feeding the anus and rectum are working correctly.

Depending on the history of your problem and the possible cause, your doctor will refer you to the appropriate specialist.  Successful treatment will depend on the cause.

Managing a long term problem with fecal soiling.

If specialists have been unable to completely solve the problem and you are following a recommended diet etc, here are some other ways to manage the problem.

  • Incontinence pads are useful for urinary and faecal incontinence but good skin care is essential as fecal material can be very irritating to the skin.  Use a skin barrier cream – ask your healthcare provider for a recommendation – and wash and dry the skin regularly.

Abena UK Ltd make the brand Abri-Soft which do a range of products for day time use and bed protectors.

The Tena by Allanda Ltd are also experienced producers for incontinence aids and pads, as are Attends Ltd and Coloplast Ltd.

If you’re buying online start with a small or single order and when you find a brand you like then make larger orders.

  • Carry a bag with clean-up items and a change of clothes if you need to
  • Before you go out, check your route and destination for public toilets/restrooms.  If you have a ‘smart phone’, look for an app that may be able to help with this.
  • Use disposable underwear as well as your pads, and disposable gloves if you need them – these are also available online.
  • Use faecal deodorants which reduce the smell of the stool and flatus.  Ask at the pharmacy and look at reputable sites online.  Again, if you’re ordering online, make a single purchase and when you’re confident that it’s the right product for you, go back to the site.
  • Other devices for long term faecal incontinence include those with a drainable pouch which is attached to an adhesive wafer, which works well when proper application.  It is best applied by another person and can stay in place for 24 hours.
  • A sacral nerve stimulator may be implanted if there is nerve damage that’s causing the problem.  Specialist practitioners with experience in this field will be able to advise you.
  • Surgery for faecal incontinence is commonly called a sphincteroplasty.  It reconnects the ends of the sphincter if it’s been damaged by trauma such as childbirth.  Another surgery involves implanting an inflatable cuff – an artificial sphincter – under the skin that you can inflate and deflate when you want to go to the toilet.  It is done by a specially trained surgeon.

If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault, read this page now:  How to talk to a doctor about an embarrassing problem.

Elspeth Raisbeck

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