Bowel Incontinence, Causes, Risks And Treatments

Bowel incontinence is the inability to control bowel movements. It’s also sometimes known as fecal incontinence.

The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence.

Some people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind.

Some people experience incontinence on a daily basis, whereas for others, it only happens from time to time.

It is believed that 1 in 10 people over the age of 50 experience bowel incontinence at least once a year.

Some people don’t realize that they have bowel incontinence, while others find it very distressing. In some cases, it can lead to social isolation and depression.

It can affect people of any age, although it’s more common in older adults and babies and children with constipation. It’s also more common in women than men.

What Are The Causes of Fecal Incontinence?

Bowel incontinence can be caused by a range of factors and is not always due to serious underlying problems.

Many cases of bowel incontinence are thought to be caused by damage to the nerves and muscles around the anus. This can result in a loss of control over passing wind, stool, and sometimes liquid urine.

People frequently refer to this as ‘losing sphincter control.’ The sphincters are normally tightly closed valves that keep the anus closed.

If the sphincters are damaged in any way, it can lead to bowel leakage and/or uncontrolled passing of wind or gas.

In some cases, it’s possible that these symptoms are caused by a blockage further up the digestive system – for example, a large intestinal growth known as a ‘fecaloma’ – which puts pressure on the anus and surrounding sphincters.

Other less common causes of bowel incontinence include:

• Hereditary factors – In some cases, incontinence can run in families.
• Aging – Changes to the digestive system that occur with age, such as narrowing of the anus and a decrease in anal muscle tone, can all contribute to bowel leakage.
• Diabetes-Where the nerves and muscles are damaged as a result of diabetes
• Surgery that’s carried out in or near the anal area
• Constipation – this can result in hard stools that are difficult to push out of the anus
• Chronic diarrhea –this can lead to bowel incontinence because it can be difficult to control the passage of stool if it’s very runny
• Rectocele (prolapse of the rectum into the vagina) – This can cause pressure on the sphincter, making it difficult to control bowel leakage

 

Bowel incontinence in babies and children is usually caused by a mixture of problems, including constipation, stool withholding, and damage to the nerves and muscles around the anus.

For babies, it’s also worth considering whether they have mechanical bowel obstruction – that is, a physical blockage of their bowels such as pyloric stenosis or Hirschsprung disease – or other conditions such as chronic infections in the digestive tract, central nervous system disorders, and congenital abnormalities of the anus.

It’s also possible that bowel incontinence in babies is caused by prematurity or brain damage.

Who Is At Risk For Bowel Incontinence?

Women have a higher chance of developing bowel incontinence than men. This is because the organs in women are located close to one another and support each other, creating more pressure on the pelvic floor muscles.

The risk for bowel incontinence also increases after childbirth. Both vaginal delivery and cesarean section can cause tearing or injury to the muscles.

Depending on how severe the damage is, you may have ongoing problems with bowel incontinence even if you’ve had a successful delivery and didn’t injure yourself during childbirth.

Sometimes it takes time for the injury to show up, but over time you can develop fecal incontinence as a result of childbirth.

The risk for bowel incontinence also goes up significantly as you age. This is because the joints, ligaments, and support structures of your pelvic floor become weaker over time.

Other things that may increase your risk of developing bowel incontinence include:

• Diarrhea or other digestive disorders like irritable bowel syndrome (IBS)
• History of anal and rectal surgery
• History of pelvic, rectal, or vaginal infection
• Urinary tract disease like urinary incontinence (inability to hold urine) or overactive bladder
• Certain diseases like multiple sclerosis (MS), Parkinson’s disease, stroke, and injuries from childbirth
• Medicines also can cause the problem, especially if you take medicine for pain or anti-inflammatory drugs, tranquilizers, sleeping pills, and antidepressants.

If you feel like you may suffer from bowel incontinence, it’s important to be checked out by a doctor so the cause can be determined.

How is Bowel Incontinence Diagnosed?

Determining the cause of bowel incontinence is essential to planning the treatment.

The doctor will ask you questions related to your bowel habits, medical and surgical history, medications, diet, current stress level, and other factors that might be affecting the condition.

A doctor may perform a physical exam before ordering any tests.

This includes a detailed anamnesis by your doctor. An anamnesis is another word for medical history. This may include questions about your bowel habits, diet, stress level, and other factors that might be affecting the condition.

A thorough physical exam will focus on your abdomen and pelvic area. The doctor will test the strength of your pelvic floor muscles by asking you to tighten them as if you are trying hard not to urinate or trying to tighten up the sphincter muscles.

Your doctor will also test your anal sphincter muscles by having you squeeze together as if you are holding in a bowel movement. Your doctor will also perform a rectal exam with your gloved finger. This is to look for blood or other abnormalities that may be causing your condition.

Some other Tests include:

A digital Rectal exam: Your doctor inserts a gloved and lubricated finger into the rectum to feel your anal sphincter muscle. This can help determine if the muscle is too weak, too tight or if any other conditions are affecting it.

Stool culture:  This lab test measures the number of bacteria that grow from your stool sample. It also looks for any abnormal growths or unusual substances in the stool, such as blood, worms, and parasites.

Abdominal x-ray:   This test uses small amounts of radiation to produce images of your internal organs (such as the bladder, appendix, colon, and rectum) on film or a computer monitor to confirm the presence of impacted hard stool.

Anal manometry:   This test measures the pressures in your pelvic floor as well as how tightly you are able to close your sphincter muscles.

MRI:  MRI is a non-invasive and painless test that uses magnetic fields, radio waves, and computers to create images of the affected area (the colon). This is done with a special cream applied to the skin. This test can help your doctor to find a structural cause for your incontinence.

Barium enema:   This is a special test using barium, which is a liquid that coats the inside of your colon and rectum. Barium enema x-rays provide valuable images of internal organs in action. If you have trouble moving your bowels when given only a laxative, this test will help determine if there is an obstruction (blockage) in your colon.

Proctosigmoidoscopy:   This is a diagnostic test that allows your doctor to see the inside of the rectum, sigmoid colon, and anus using an endoscope (a long, flexible tube with a light and camera on it). A biopsy (removal of cells or tissues for examination under a microscope) may also be taken during this procedure.

Colonoscopy:  During this test, your doctor inserts a flexible, lighted tube with an attached camera through the anus and into the colon to look for any abnormal growths or problems that may be causing or worsening your incontinence. During the procedure, tissue samples can also be removed using a small instrument to confirm the diagnosis.

Balloon capacity test:   This test helps to determine if there is a blockage in your colon. It involves the insertion of a small balloon into your rectum. The balloon is then inflated to feel for any obstruction that may be causing the problem.

Balloon evacuation study:  This test is similar to the capacity test with one exception–the balloon is inflated and then deflated to see whether or not it can be removed. A device called a stapler may also be used to help remove any obstructions found in the colon during this test.

Exercise And Other Therapies For Cecal Incontinence

If you have fecal incontinence because of an overactive bladder, your doctor may recommend a program of exercise and other therapies to restore muscle tone in the pelvic floor. These treatments can improve anal sphincter control.

If you have urge incontinence, you might also try limiting how much fluid you drink during the day or avoid drinking altogether for a few hours before going to bed.

The following treatments can improve anal sphincter control and the awareness of the urge to defecate:

Kegel exercises

Kegel exercises are used to strengthen the pelvic floor muscles. They can also reduce stress, increase awareness of the pelvic floor muscles, and improve coordination between the brain and these muscles, possibly helping people with fecal incontinence learn to contract them when needed.

Exercise is generally done during therapy sessions, but some patients continue at home—with the help of a physical therapist—after they leave.

The exercises involve:

Squeezing the muscles you use to stop urine flow, but not lifting your bottom off the chair or tightening your abdominal muscles. 

Holding this contraction for 2 seconds and then relaxing for 2 seconds while breathing normally.  

You can do 10 to 15 repetitions three times a day. Your physical therapist may have you do two other exercises that strengthen the anal sphincter.

Repetition: Repeat the exercise 10 to15 times, 3 or 4 times a day (at first). Increase your repetitions as it gets easier, and you get stronger. 

Biofeedback

Biofeedback can help you learn how to strengthen pelvic floor muscles, sense when stool is ready to be released, and contract the muscles if having a bowel movement at a certain time is inconvenient. Special devices are sometimes used to help you learn how to contract muscles (for example, anal electromyography).

Biofeedback is often used in combination with Kegel exercises and other therapies. It helps:

• Improve your ability to contract muscles.
• Tone pelvic floor muscles and correct posture.
• Increase awareness of the bladder and rectum.

Bowel training (also called bowel retraining)

In this approach, you set a regular time to go to the bathroom and follow a routine, such as sitting on the toilet for 10 to 15 minutes after meals.

After you begin to feel the urge to have a bowel movement, you may be taught how to hold off until you get to the toilet. Once there, you are asked to relax for several minutes (or up to an hour) before trying to have a bowel movement.

You are first taught how to relax the muscles in your lower abdomen, back, and buttocks (pelvic floor). Then you learn how to pass stool without leaking, squeezing only at the end of a bowel movement.

 

Bulking Agents

Bulking agents are used with other types of therapy, such as exercise and biofeedback. These fiber supplements usually come in capsules that you take by mouth.

When bulking agents are used, they generally are taken once a day for at least 6 weeks. But it may take several months to notice an improvement in bowel control.

Surgical Treatment

Surgery may be needed if the other treatments do not help or cannot be done because of other health problems or age limits.

An operation is more successful in younger patients and those with milder symptoms.

Surgery usually is not successful for those with severe fecal incontinence.

The prognosis (Outlook) How well a person does after treatment depends on the cause of fecal incontinence and how long it has been present.

Kegel exercises are fairly simple to do, show improvement that is both immediate and long-term, have few side effects, and are inexpensive.

Biofeedback and other types of therapy may require several visits to a specialist or therapist.

They are not as easy to do as Kegel exercises and usually take longer for improvement to be seen. Surgery needs more time before you can tell if it will help.

Lifestyle And Home Remedies

You may be able to gain better control of your bowel movements by following some basic lifestyle and home remedies steps.

• Eat a high-fiber diet: A high-fiber diet can help you stay regular because fiber helps the stool pass through your intestines more quickly. Foods rich in fiber include whole grains, fruits, vegetables, and beans. Whole wheat bread contains more fiber than other types of bread. Some crackers and cereals are also high in fiber. Adding more fiber to your diet may cause mild bloating and gas at first, but these symptoms usually diminish over time.
• Healthy lifestyle habits: Healthy lifestyle habits such as regular exercise can help control your bowel movements. Exercise also helps you stay strong, no matter what your age. By being physically active, you can improve your bowel control and endurance. Keeping a healthy weight is also important for good bowel control. Obesity increases the risk of getting many diseases that affect bowel function. Overweight people have a greater chance of constipation than do people who weigh less.

 

 

References:

https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/bowel-incontinence

https://www.healthline.com/health/bowel-incontinence#causes

https://www.radiologyinfo.org/en/info/fecal-incontinence

https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/diagnosis-treatment/drc-20351403

http://www.proctologyinstitute.com/proctologists-los-angeles-beverly-hills-newport-beach-huntington-beach-la/