A Guide to Bowel and Faecal Incontinence

Faecal incontinence is more common than you might think. Here, we discuss causes of faecal incontinence, related bowel conditions and ways to manage symptoms.

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People with poor bowel or faecal control may need to open their bowels at the wrong time or in the wrong place. Many also have problems controlling their "wind" (flatus) or have problems with staining in their underwear.

About one in 20 people experience these issues and although it is more common as people age, it can also affect many younger people.

Causes of faecal incontinence

Causes of faecal incontinence can include:

  • Long term straining when passing stool
  • Medications, e.g. antibiotics, drugs for arthritis and diabetes
  • Lifestyle, e.g. heavy lifting leading to weak pelvic floor muscles, smoking, poor diet
  • Weak anal muscles due to childbirth, ageing, some types of surgery, or radiation therapy diabetes
  • Bowel disease, e.g. Coeliac disease, Crohn's disease
  • Nerve disorders resulting from Multiple Sclerosis and Parkinson's Disease
  • Severe diarrhoea or constipation

Constipation and faecal incontinence

Constipation is when people have hard and dry faeces and can only pass small amounts at a time or have difficulty passing them. Signs can be pain, cramps or swelling in the abdomen or a feeling their bowel is not empty.

It happens because the digestive system absorbs too much water from food or if the food moves through the digestive system too slowly. This causes bowel motions to be too dry and hard.

Some of the things that cause of constipation can be:

  • Not eating enough fibre (fruit and vegetables, wholemeal bread, high fibre cereals)
  • Not drinking enough water
  • Not doing enough exercise
  • Mental health conditions including anxiety, depression, grief
  • Delaying the need to toilet
  • Using laxatives for a long time
  • Side effects of some medicines (even some like pain killers or iron tablets)
  • Pregnancy
  • Being overweight
  • Problems getting to the toilet because of poor mobility
  • Some nerve diseases
  • Bowel problems like haemorrhoids, irritable bowel syndrome, or diverticulitis
  • A slow bowel making it take longer for the faeces and water to be removed from the body, causing constipation. This occurs through nerve damage (eg. stroke, Parkinson's, multiple sclerosis or trauma)

Severe constipation is the most common cause of bowel leakage, especially in older people. This is because hard bowel motions are difficult to pass and can cause a blockage in the bowel, resulting in watery bowel motions going round the constipation without warning. This is sometimes mistaken for diarrhoea.

Constipation can affect bladder control and urinary continence because people leak urine or think they need to visit the toilet often to pass urine. An over-full bowel can press on the bladder and reduce the amount of urine it can hold making people feel like they need to urgently pass urine.

Constipation can also affect the strength of pelvic floor muscles. These muscles, stretching from the pubic bone at the front to the coccyx (tail-bone) at the back, can be weakened by straining, pregnancy and childbirth, or perhaps heavy lifting. Strong pelvic floor muscles are necessary for bladder and bowel control - to be able to 'hold on'.

Absorbency refers to the amount of urine an incontinence product is able to absorb and retain before leaking. Incontinence needs range from light to heavy, with different absorbency levels also serving different activities, such as sports or overnight needs. For light incontinence, pads are generally most useful. For those experiencing moderate to heavy incontinence, pull-up pants or all-in-one slips can provide more coverage and subsequent peace of mind.

Continence products will have notes regarding the levels of absorbency. It’s best to go for a more absorbent option if you’re unsure, creating contingency in the product’s absorbency capacities.

We created a comprehensive guide where you can learn why absorbency matters and how to ensure your continence product’s absorbency exactly matches your needs.

Diarrhoea and faecal incontinence

Diarrhoea is the frequent passing of watery and unformed faeces. Some of the causes of diarrhoea are:

  • bowel or stomach infection
  • food allergies or intolerances such as lactose intolerance
  • alcohol
  • the use of laxatives
  • bowel diseases including diverticulitis, Crohn's disease, ulcerative colitis, or irritable bowel syndrome
  • some medicines, such as antibiotics
  • long lasting constipation
  • a shortened bowel as a result of surgery to remove some of the bowel, and
  • radiotherapy

Treatment for diarrhoea can include:

  • Increasing fluid intake to prevent dehydration, this may involve intravenous (IV) fluids if the case is severe
  • Dietary changes as prescribed by a registered dietitian and/or GP
  • Medications such as anti-diarrhoeal treatment, antibiotics or anti-nausea drugs (which should be prescribed by a doctor, after diagnosing the cause of the diarrhoea)

Bowel conditions that cause faecal incontinence

  • Irritable bowel syndrome (IBS) - which causes abdominal pain, bloating and alternating constipation and diarrhoea. The cause is unknown but things like emotional stress, infection and some foods can make the condition worse. Treatment options include diet and stress management.
  • Inflammatory bowel disease (IBD) - is a medical term describing a group of conditions where the intestines become inflamed (red and swollen). Two major types of IBD are Crohn's disease and ulcerative colitis which affects the large intestine (colon).

Understanding your stool

The type of stool or faeces depends on the time it spends in the colon. The Bristol Stool Chart can be used to check what stools are like. It shows 7 categories of stool and although every person has different bowel habits the important thing is that stools are soft and easy to pass - like types 3 and 4 below.

 

Bristol Stool Chart

Reproduced with kind permission of Dr KW Heaton, formerly Reader in Medicine at the University of Bristol. ©2000-2014, Norgine group of companies.

Reference: Heaton, K W & Lewis, S J 1997, 'Stool form scale as a useful guide to intestinal transit time'. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 - 924. Retrieved on 2/3/2007.

  • Type 1-2 indicate constipation
  • Type 3-4 are ideal stools as they are easier to pass, and
  • Type 5-7 may indicate diarrhoea and urgency.

It is important that people with bowel problems visit their doctor because many bowel or bladder control problems can be prevented, treated, better managed or cured. Improving bowel control needs a continence assessment carried out by a health professional. This assessment should review the person's medical history and current health, including diet and fluid intake, exercise levels and mobility, all the medicines they are currently taking, and any other factors that could affect bowel function. An individual bowel program can then be planned to help solve problems such as constipation, diarrhoea or faecal incontinence. If constipation does not improve, the doctor may organise more tests or a referral to specialists in this area of health.

A doctor should be seen if someone has:

  • Regular bowel accidents
  • A change in their normal bowel habits
  • Pain or bleeding from the back passage
  • A feeling that their bowel is never quite empty
  • Dark or black bowel motions, or
  • Weight loss that can't be explained

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