Faecal or Bowel Incontinence

Faecal or Bowel Incontinence

People with poor bowel control have difficulty controlling their bowels and may need to open their bowels at 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 have this problem and although it is more common as people age it can also affect many younger people.

Faecal incontinence can be from many causes but the most common are:

  • long term straining
  • medications, e.g. antibiotics, drugs for arthritis and diabetes
  • lifestyle, e.g. heavy lifting leading to weak pelvic floor muscles
  • 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

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
  • not doing enough exercise
  • anxiety, depression, grief
  • delaying the need to toilet
  • using laxatives for a long time
  • the 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
  • pain caused by haemorrhoids, fissures (tear in the skin of the anus) or birth trauma, or
  • a slow bowel so it takes longer for the faeces and water is removed 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'.

Diarrhoea

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.

Treatments for diarrhoea may include:

  • fluids to prevent dehydration
  • intravenous fluids, or
  • 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)

Other bowel related health problems are:

  • 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)

Appearance of stools or bowel motions

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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