Conditions

What is bowel incontinence?

Bowel or faecal incontinence is the inability to control bowel movements, resulting in faeces leaking from the anus. It is more common then you might think, affecting up to 10% of the UK adult population at some point in their life. More women are affected than men. Bowel incontinence has a significant effect on a person’s confidence, social interaction and overall quality of life. Often people hide their symptoms, even from their GP, due to embarrassment and are unaware of the effective treatments available.

What causes bowel incontinence?

Bowel incontinence can occur because of a weakening of the muscles that controls the opening of the anus (sphincter muscles). In women, damage or tears to the anal sphincter muscles can occur during childbirth, particularly if there has been a complicated delivery requiring the use of forceps or an episiotomy. Previous surgery around the anus for anal fistula can also result in anal sphincter muscle damage resulting in bowel incontinence. Prolapsing haemorrhoids or piles can also cause seepage of stool.

Damage to the nerves that control sensation and the anal sphincter muscles can also occur during childbirth and as a consequence of other conditions such as diabetes, multiple sclerosis and spinal cord injuries.

Bowel incontinence can sometimes be a symptom of an underlying medical condition that causes diarrhoea or constipation. It can also occur as a side effect of medications that cause diarrhoea or constipation.

Symptoms

The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet (urgency) but are unable to reach a toilet in time. This is known as urge incontinence. Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling. There may also be slight soiling when passing wind. Some people experience bowel incontinence on a daily basis, whereas for others it only happens from time to time. It often is intermittent, with symptoms developing for a few days and then improving again, for no obvious reason.

Investigations

During your appointment your Consultant will ask questions regarding your symptoms, bowel habit, diet, medical and medication history. Even though it may feel embarrassing it is vital that the individual talk as openly, honestly and comprehensively as possible. This will be followed by an examination including and examination of the back passage.

As bowel incontinence can sometimes be a symptom of an underlying medical condition that causes diarrhoea or constipation you may require further investigation of your bowel by a colonoscopy. If your Consultant feels the cause of your incontinence is due to weakness of the sphincter muscles of the anus it may be helpful for you to undergo further tests to assess the structure and function of the anal sphincter muscles (anal ultrasound scan and manometry, a test that measures pressure in the anus)

Treatment

Treatment for bowel incontinence is often effective and can result in an improvement in a person’s quality of life. Treatment is directed towards the cause of the problem but may involve

Diet

  • Changes to your water, caffeine and fibre intake. A lower fibre diet is often beneficial

Medication

  • If loose stools, anti-diarrhoeal medication such as loperamide may be helpful
  • If constipated, bulking laxatives can make the stool easier to evacuate.

Pelvic floor exercises / Biofeedback

  • Help to improve anal sphincter muscle strength, sensation and coordination.

Surgery

  • May be appropriate in certain cases to repair damaged sphincter muscles.

Sacral nerve stimulation

  • A small implant like a “pacemaker” that can improve bowel incontinence by sending electrical impulses to the nerves that control bowel function

It's important to remember that:

  • Bowel incontinence isn't something to be ashamed of –it's simply a medical problem that's no different from diabetes or asthma.
  • It can be treated –there's a wide range of successful treatments.
  • Bowel incontinence isn't a normal part of ageing.
  • It won't usually go away on its own – most people need treatment for the condition.

Further information

www.bladderandbowelfoundation.org