How to Conquer Bowel Control Problems

It’s not a comfortable topic. Problems with bowel control can be embarrassing and demoralizing. They may interfere with social activities, work or even personal relationships. Surprisingly, an estimated one in 12 adults has fecal incontinence, an inability to control bowel movements.

Leaking stool from the rectum is twice as common among women as it is among men. It is also more frequent as you age, with people over age 65 accounting for 30 percent of all reported fecal incontinence.

If you’re experiencing fecal incontinence, what can you do?

Talk About It

Many topics once considered too shameful or embarrassing to discuss are now addressed with openness. Don’t be ashamed or embarrassed to talk to your doctor about problems with accidentally passing stool. There are many reasons this happens, and your doctor can offer effective solutions to make your life easier and better.

Some questions to ask your doctor include:

• Does diet affect bowel control? Should I eat more fiber?
• Are there exercises to strengthen muscles in the rectum? Does physical activity in general help this problem?
• How do we find the cause of the problem?
• What are treatment options?
• What can I do to prevent embarrassing situations at work or in other public places?

Common Causes

By discussing your medical history and doing a physical examination, your doctor will begin to uncover possible reasons for your bowel control issues.

Some common causes include:

• Diarrhea (looser stools are harder to hold in) or constipation (as stool becomes hardened and enlarged, liquid can leak out around the stool)
• A difficult childbirth with injuries to the pelvic floor— the muscles, ligaments and tissues that support pelvic organs and rectum
• Hemorrhoids
• Inflammation of the colon and rectum from colitis or Crohn’s disease
• Cancer, stroke or chronic illnesses such as diabetes, multiple sclerosis or Alzheimer's disease
• Infection or injury of the spinal cord
• Problems affecting the nerves that control the digestive tract, sometimes occurring from birth
• Complications from surgery in the pelvic floor
• Medication side effects
• Rectal prolapse, in which the rectum drops down through the anus. The anal sphincter muscles cannot close well enough to prevent leakage of mucus or liquid stool
• Rectocele, a condition in which the rectum pushes into the vagina through the thin layer of muscle that separates the two. It may interfere with elimination of stool and cause some stool retention in the rectum

Testing and Treatment

Your doctor may offer a variety of imaging and other tests to confirm whether muscle or nerve function in your rectum or anus are causing you to leak stool. For example, anal ultrasound and magnetic resonance imaging (MRI) produce images of muscles in the anus and rectum, and anal manometry uses a thin tube with an inflatable balloon to measure muscle contractions in the anus. Flexible sigmoidoscopy and colonoscopy are outpatient procedures to examine the lining of the rectum and colon for possible causes of incontinence. Anal electromyography (EMG) tests the nerves in the rectal and anal areas.

By discussing your medical history and doing a physical examination, your doctor will begin to uncover possible reasons for your bowel control issues.

Treatment options vary depending on the cause of your bowel issue. Some of the most common and effective treatments include:  

1. Eat foods or supplements with fiber (20 to 35 grams per day) to help with diarrhea and constipation. Drink eight 8-ounce glasses of water to prevent constipation.
2. Medications — both over-the-counter and prescription — can help with diarrhea and constipation. Inflammatory conditions of the bowel also can be controlled with medication. Ask your doctor for suggestions.
3. Train your pelvic floor muscles through exercises and biofeedback to create better awareness and control of voiding stool.
4. Electrical stimulation can stimulate damaged nerves and promote better muscle control in the rectum and anus.
5. In rare cases, you may need surgery to repair a sphincter muscle in the rectum torn by childbirth or other injury. Artificial devices and bulking agents can help the sphincter work more effectively. For extreme cases, a surgeon can bypass the rectum and redirect stool to an opening created in your abdomen. The stool is eliminated into a pouch.

Tips for Living with Fecal Incontinence

As you are working to gain better bowel control, try these tips to help you feel better physically and emotionally:

• Avoid foods and beverages such as alcohol and caffeine, and eat fruits, vegetables, nuts and other high-fiber foods. Plus, drink plenty of water.
• Keep a food diary to help you establish a pattern between what you eat and incontinent episodes.
• Try to get your body on a schedule and have a bowel movement at the same time each day.
• Talk to a counselor or psychologist if your condition is damaging important relationships in your life or causing you to feel depressed.
• When you go out, pack fresh clothes and a spare bag for dirty items in case of “emergency.”
• Wear pads that absorb leaks and odors and carry cleansing wipes that are gentle on your skin.
• Ask your doctor about medicine that can reduce odors associated with fecal incontinence.

Source: National Institute of Diabetes and Digestive and Kidney Diseases; FamilyDoctor.org; American Society of Colon and Rectal Surgeons