Accidental Bowel Leakage - Adults

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Prolapse-related ABL

Postby CazH on Tue Sep 03, 2019 9:12 pm


I think this is a brilliant clinic to run because ABL is something very rarely talked about and has a heap of stigma and social shame attached to it. There's also a lot of stereotyping around it, such as it affecting older individuals, whereas actually a lot of younger people can struggle, too. I now have a stoma (ileostomy) so, gratefully, I do not have this kind of ABL to contend with. However, I did have chronic constipation for a number of years, and ABL can sadly happen with all the laxatives. There's also the issue of prolapses; with rectal prolapse, perhaps especially full external grade 5, plus the likes of intussusception and rectoceles, ABL can occur. This often seems to tie in with anismus in some people. Personally, I would strongly advise caution against the likes of mesh for 'repairing' prolapse issues, but I was just wondering what your thoughts were on dealing with ABL when you have prolapse issues and/or anismus? What kind of conservative measures would be there as alternatives to risky mesh surgery?

I'm asking as I'm curious as to your thoughts, and also in case this could help anyone else dealing with similar but who are, perhaps, not too comfortable discussing it on here.

Thanks :)
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Re: Prolapse-related ABL

Postby Polly Weston on Thu Sep 05, 2019 10:55 am

Hi Kaz

Many thanks for your feedback regarding this forum. I’m sure your comments will also be appreciated by other users of the forum. Bowel issues are such a private matter and in my clinical practice I have patients who struggle to discuss their symptoms due to the embarrassment of the topic.
Regarding avoiding mesh, there are options for surgical repair if prolapse and surgeons will try the least invasive intervention where ever possible. Non surgical treatment would be to avoid constipation, maintain hydration with good fluid intake and dietary advise, as well as pelvic floor muscle exercise.
The NHS bladder and bowel services are available in each regional area. They will offer assessment of the rectal muscle, with examination to ascertain rectal muscle tone and then give individual specific support with pelvic floor muscle exercises.

Best wishes
Polly Weston
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Re: Prolapse-related ABL

Postby Sharon Holroyd on Mon Sep 09, 2019 1:35 pm

Hi Caz, thank you for sharing your experience. You are right, this is a topic that is not discussed in enough detail with many suffering in silence. There are several surgical options available for prolapse depending on severity, it is worth discussing this with individual medics. Conservative measures include managing the correct type of fibre supplementation to achieve a consistent bowel action. Laxatives are often misused / prescribed, a discussion with your local specialist nurse should direct an individual to the right type of medication for their needs, and also offer an expectation of the result from each laxative. Too often we see a see saw effect of laxatives to treat constipation followed by loperamide to stop the loose stool that follows. Some laxatives are designed to result in loose stools and often patients are not told to expect this. Anismus is treated in some cases with biofeedback or Botox injections.
Sharon Holroyd
Lead CNS Calderdale Bladder and Bowel Service
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