Bowel incontinence, sometimes referred to as faecal incontinence, is the inability to control bowel movements resulting in involuntary soiling. It is a common problem which is most frequently seen in older adults, and is more likely to affect women than men. Symptoms of bowel incontinence can be upsetting and quite embarrassing, with many choosing to ignore and hide their problem rather than discussing it with a healthcare professional.
The experience of bowel incontinence varies from person to person, with some feeling a sudden urge to go to the toilet (urge bowel incontinence) and others feeling no urge whatsoever (passive incontinence) prior to soiling themselves.
Cause and diagnosis
The causes of bowel incontinence are varied, with diarrhoea, constipation, or weakening of the anal sphincter (the muscle that controls the opening of the anus) being some of the most common contributing factors. Inflammatory bowel diseases, and other chronic conditions such as multiple-sclerosis, dementia, diabetes and spinal cord injuries can also cause bowel incontinence.
In order to get a full diagnosis, your GP will ask you a number of questions about your symptoms and other contributing factors which may be causing your bowel incontinence. Although it may seem embarrassing to share information like this, it is important to do so to ensure your bowel incontinence is not being caused by any unknown serious conditions. After first discussing your symptoms with your doctor, you will be required to have a physical examination to examine the strength of the anal sphincter muscle. Other examinations may include, among others, a stool test, an endoscopy (the examination of your rectum and lower bowel using a long thin tube with a camera attached to the end) and an anorectal manometry (the insertion of a pressure monitor into the anus and rectum to examine the strength of the sphincter muscles).
If you would prefer to speak with a specialist nurse rather than your GP, you could attend a local NHS continence clinic. At these clinics you can make an appointment to see a specialist without a referral, who can offer advice and support specific to your condition.
Treatment and medication
Bowel incontinence isn’t something that will go away on its own so it is important to seek help if you suspect you may be affected by this problem. Most cases of bowel incontinence can be cured and treatment is usually highly effective.
Treatment varies depending on the cause and severity of each case. In the initial stages of treatment, doctors will usually recommend a number of lifestyle changes first. A change in diet can be quite effective. People who are experiencing bowel incontinence should limit the amount of foods they consume that are rich in fibre, avoid fizzy drinks and caffeinated drinks, and limit the amount of fatty foods they eat. Patients should also be advised to carry out exercises to strengthen anal muscles. For those whose bowel incontinence is caused by underlying issues with constipation, bowel training can also be a good way to improve bowel habits. By giving yourself a bowel routine (i.e. improved diet rich in fibre to soften stools, allocating a time to go to the bathroom, and finding ways to stimulate a bowel movement) you should notice more regularity when passing a stool (a piece of faeces).
In cases where lifestyle changes are not sufficient, there are medications and products to consider which can improve bowel activity and help you live better with bowel incontinence. Bowel incontinence pads and pull ups can be a solution for those who experience bowel leakage and can provide security for mild to moderate cases of incontinence.
Loperamide, most commonly found in medications such as Imodium, can be prescribed for people experiencing problems with stools that are too loose. Loperamide slows down the movement of stools through the digestive system, allowing more water to be absorbed from the stools. Laxatives can be prescribed for people struggling with incontinence caused by constipation. In cases of faecal impaction (a stool that has hardened to such an extent that it is impossible to pass) an enema or rectal irrigation can be beneficial. This procedure involves a tube being inserted into the anus which then flushes a special solution through the rectum to loosen any faeces.
There are also many surgical solutions for those with chronic bowel incontinence that cannot be cured by other means.
Sphincteroplasty is an operation to repair damaged sphincter muscles by overlapping muscle tissues and sewing them together. Sacral nerve stimulation is an operation where electrical pulses are used to stimulate the sacral nerves which control the sphincter and pelvic floor muscles, helping them to work more effectively. These are some of the most common operations carried out by the NHS for those with bowel incontinence.
In cases where surgical solutions will not work, a patient will undergo a colostomy, where their colon is cut and brought out through the wall of their stomach. This opening (otherwise known as a stoma) will then be attached to colostomy bag (bags which collect waste) which will collect the stools. Life after a colostomy can be hard to adjust to, however most will become accustomed to it over time.
For support on how to live with bowel incontinence, and support post colostomy, please visit charities Bladder and Bowel UK, IBS network, Crohn’s and Colitis UK, and Age UK. We also have a forum where our community can offer advice and support to each other here.
Sources of evidence used available on request
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Information written by the talkhealth team
Last revised: 10 February 2017
Next review: 10 February 2020