Maintaining bowel control


Incontinence is a common problem which occurs when you pass urine or faeces without intending to. Millions of people suffer from incontinence in the developed world. There are different types of incontinence, including urinary and faecal incontinence. Faecal incontinence occurs when you pass stools without intending to, while urinary incontinence relates to passing urine.

Urinary incontinence

Urinary incontinence occurs when the processes of storing and releasing urine are not working properly. This can be due to stress and cause increased pressure on the bladder or a condition whereby the bladder becomes overactive. Stress incontinence occurs when pressure is applied to the bladder and the urethra is unable to stay closed, which may be caused by weak pelvic floor muscles or damage to the urethral sphincter. Sudden bursts of pressure may cause small amounts of urine to escape from the urethra; for example, when you sneeze or cough. The sphincter can become weaker in the following instances:

  • Pregnancy.
  • Nerve damage during birth.
  • Being overweight or obese.
  • Taking certain medications.

Faecal incontinence

Digestion and passing stools are processes most of us don't think about and take for granted, but if the processes are not working properly they can cause stools and wind to escape at unsuitable times. This can be embarrassing and have a major impact on the way people live their lives. Faecal incontinence, sometimes known as bowel incontinence, is much more common than people think and can affect people of all ages. However, it is most common among older people.

The normal function of the bowel

Normally, the bowel and the sphincter muscles work to ensure that the body is ready to pass stools before the stools are released, however, if the processes are disrupted or not working properly, the stools may be released before the body is ready. There are various reasons why the processes may be disrupted and these are outlined below:

Causes of faecal incontinence

There are three main causes of faecal incontinence:

  • Damage to the sphincter muscles.
  • Problems associated with the rectum.
  • Damage to the nerves.

Damage to the sphincter muscles

The sphincter muscles in the rectum act like gates and open and close to allow stools to pass. If the sphincter muscles are not working properly, stools may pass without you being able to control the movement. Giving birth is a major cause of damage to the sphincter muscles.

Rectal problems

There are various problems with the rectum that may contribute to faecal incontinence, which include constipation, diarrhoea and rectal cancer. Constipation can cause a large, dry stool to collect in the rectum, which is known as faecal impaction and causes the muscles in the rectum to become stretched and weaker, allowing watery stools to pass out of the bottom.

Diarrhoea makes it more difficult for the rectum to hold the stools, since they are loose and watery. People with conditions such as Crohn's disease, ulcerative colitis and irritable bowel syndrome sometimes suffer from chronic diarrhoea, which means they are prone to faecal incontinence.

Nerve damage

Nerve damage disrupts the process of delivering messages from the brain to the rectum and this can cause bowel incontinence. Conditions including diabetes, strokes and spina bifida can cause damage to the nerves.

In some cases, health conditions can cause individuals to completely lose control of their bowel movements, which may include learning difficulties and disabilities, dementia and Alzheimer's disease.

What tests may be carried out?

Many people feel embarrassed about being incontinent but it is important that you see your GP because they can provide effective treatment. It is important not to feel embarrassed or ashamed to see your doctor, as they are there to help and it is likely that they have seen many people in the same situation. When you visit your doctor they will ask you a series of questions about your diet, your symptoms and your medical history. It is important to tell your doctor if you have noticed blood in your stools, you have changed your diet, you are taking medication or you have had stomach pains.

Your GP will probably carry out a physical examination and will check for damage and signs of constipation and tumours. Your GP may refer you for further tests, including:

  • Endoscopy
  • Anal manometry
  • Ultrasound
  • Defecography

Treatment for incontinence

In many cases, changing your diet can be effective and you may be advised to try different foods to see if they affect your bowel habits. Often, caffeine, alcohol and foods that are high in fibre make symptoms worse, so cutting them out can be beneficial.

Taking medication may also be beneficial. Medication can help to treat diarrhoea and constipation, which often contribute to faecal incontinence. Loperamide is usually prescribed for diarrhoea, while laxatives are used to treat constipation.

Pelvic floor exercises are effective, especially after childbirth as these exercises strengthen the muscles usually weakened as a result of giving birth. A physiotherapist can help to teach you the exercises. Exercises can also be carried out to strengthen the anal sphincter muscles.

In rare cases, surgery may be carried out to repair damage to the sphincter muscles, but surgery is usually only recommended if other treatments have been unsuccessful.

Many people who have incontinence find continence products helpful, which include anal plugs and removable pads. Most products are available on the NHS free of charge.

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