Bowel or faecal incontinence is an inability to control bowel movements, resulting in involuntary soiling. The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence. Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind.
Some people experience incontinence on a daily basis, whereas for others it only happens from time to time. It can affect people of any age, although it's more common in elderly people and is more common in women than men.
The most common problems are:
- problems with the rectum – the rectum is unable to retain poo properly until it's time to go to the toilet
- problems with the sphincter muscles –the muscles at the bottom of the rectum don't work properly
- nerve damage – the nerve signals sent from the rectum don't reach the brain
It's important to discuss any bowel problems with your GP as there's a small chance they could be a sign of a more serious condition, such as bowel cancer.
Constipation is a leading cause of bowel incontinence.
In cases of severe constipation, a large, solid stool can become stuck in the rectum. This is known as faecal impaction. The stool then begins to stretch the muscles of the rectum, weakening them.
Watery stools can leak around the stool and out of the bottom, causing bowel incontinence. This is called overflow incontinence and happens most commonly in elderly people.
It is difficult for the rectum to hold liquid stools (diarrhoea), so people with diarrhoea can develop bowel incontinence.
Conditions that can cause recurring diarrhoea include:
- Chrons disease – inflammation of the digestive system
- Irritable bowel syndrome– a condition that causes a range of digestive problems, such as diarrhoea and bloating
- ulcerative colitis – inflammation of the large bowel
These conditions can also cause scarring of the rectum, which can lead to bowel incontinence.
Problems with the sphincter muscles
The sphincter muscles at the bottom of the rectum control the bowel. Bowel incontinence happens if these muscles become weakened or damaged.
Childbirth is a common cause of damage to the anal sphincter muscles and a leading cause of bowel incontinence. During a vaginal birth, the sphincter muscles can become stretched and damaged, particularly as a result of a forceps delivery. Other causes include a large baby, the baby being born with the back of their head facing the mother's back (occipitoposterior position) and a long labour.
Sphincter muscles can also become damaged through injury, or damage from bowel or rectal surgery.
Bowel incontinence can also be caused by a problem with the nerves connecting the brain and the rectum. A nerve problem can mean your body is unaware of stools in your rectum, and may make it difficult for you to control your sphincter muscles.
Damage to these nerves is related to a number of conditions, including:
- multiple sclerosis (a condition of the central nervous system)
- spinal injury
Women's health physiotherapy
Anal sphincter strengthening
People who have faecal incontinence or bowel leakage may be helped by doing some specific exercises for the sphincter and pelvic floor muscles. These exercises could help improve the strength of the sphincter and pelvic floor muscles and improve bowel control. An ano-rectal or vaginal examination may be recommended.
Bowel retraining is a type of treatment for people with reduced sensation in their rectum as a result of nerve damage, or for those who have recurring episodes of constipation.
There are three goals in bowel retraining:
- to improve the consistency of your stools
- to establish a regular time for you to empty your bowels
- to find ways of stimulating your bowels to empty themselves
Bowel incontinence associated with diarrhoea or constipation can often be controlled by making changes to your diet. It may be beneficial to keep a food diary to record the effect of your diet on your symptoms.
The National Institute for Health and Care Excellence (NICE) includes the following:
- limit fibre intake from wholegrain breads, bran, cereals, nuts and seeds (except golden linseeds)
- avoid skin, pips and pith from fruit and vegetables
- limit fresh and dried fruit to three portions a day and fruit juice to one small glass a day (make up the recommended ‘five a day’ with vegetables)
- limit how often you have fizzy drinks and drinks containing caffeine
- avoid foods high in fat, such as chips, fast foods and burgers
A high-fibre diet is usually recommended for most people with constipation-associated bowel incontinence.
Fibre can soften stools, making them easier to pass. Foods that are high in fibre include:
- fruit and vegetables
- wholegrain rice
- wholewheat pasta
- wholemeal bread
- seeds, nuts and oats
Drink plenty of fluids because this can help to soften your stools and make them easier to pass.
The Bristol stool chart is a useful way to monitor your stool type. Stool type 4 is the perfect poo! Stool type 1 and 2 tend to suggest dehydration as the stool is very hard, dry and difficult to pass. Stool type 6/7 is lacking fibre.
Biofeedback is a type of bowel retraining exercise that involves placing a small electric probe into your bottom.
The sensor relays detailed information about the movement and pressure of the muscles in your rectum to an attached computer.
You're then asked to perform a series of exercises designed to improve your bowel function. The sensor checks that you are performing the exercises in the right way.
Medication can be used to help treat soft or loose stools or constipation associated with bowel incontinence.
Loperamide is a medicine widely used to treat diarrhoea. It works by slowing down the movement of stools through the digestive system, allowing more water to be absorbed from the stools. Loperamide can be prescribed in low doses to be taken regularly over a long period of time.
Laxatives are used to treat constipation, they help you to pass stools. Bulk-forming laxatives are usually recommended. These help your stools to retain fluid. This means they're less likely to dry out, which can lead to faecal impaction.
Always discuss any medication with your GP.