Learn About Bowel Leakage

Bowel leakage, also referred to as fecal incontinence, is marked by the inability to control bowel movements.  It occurs in both men and women but is more common in women.1

Causes of bowel leakage vary from person to person, and in many cases there are multiple causes and risk factors ranging from digestive issues to muscle or nerve damage, aging and childbirth.1

Causes:

  • Constipation: chronic constipation causes the the muscles of the rectum and intestines stretch and eventually weaken, allowing stool to leak out. It may also cause nerve damage that leads to incontinence and leakage.
  • Nerve or muscle damage: Any injury to the muscles at the end of the rectum (anal sphincter) or the nerves that control the anal sphincter.
  • Medical conditions: chronic conditions that can damage the nerves, like diabetes or multiple sclerosis

Risk Factors:

  • Post-partum: bowel leakage can be a complication of childbirth.1 At 3-6 months after vaginal or cesarean delivery, as many as 13-25% of women report incontinence.2

Age: bowel leakage is more common in adults over 65.

Women may experience occasional leakage due to diarrhea or constipation, but some women experience what is considered “chronic leakage.” This can come in two forms - urge incontinence, when someone is unable to stop the urge to go to the bathroom, and passive incontinence, when someone is not aware they need to pass stool. Both forms of chronic leakage often lead to “accidents.”1 

Bowel leakage will often be accompanied by other digestive issues, like:1

  • Gas
  • Bloating
  • Constipation
  • Diarrhea

There are several tests your doctor can perform to determine the cause of your bowel leakage and identify an appropriate treatment.  Some tests include:3

  • Digital rectal exam: Your doctor inserts a gloved and lubricated finger into your rectum to evaluate the strength of your sphincter muscles and to check for any abnormalities.
  • Bowel function tests: Your doctor may perform one or more of the following tests to see how well the muscles and nerves in your anus, pelvic floor, and rectum are working:
    • Anal manometry
    • Defecography
    • Electromyography

Colonoscopy: Allows your doctor to look inside your anus, rectum and colon to identify inflammation that may be causing bowel leakage.

Bowel Leakage Treatment Options

Women often suffer from bowel leakage silently due to stigma and limited information around the condition and treatment options.  The good news? Advances in medicine have contributed to different treatment options to help women manage their symptoms so they can get back to being in control of their lives. 

Lifestyle has a tremendous impact on pelvic health, and making certain changes can help you effectively manage bowel leakage. Things like eating fiber-rich foods can aid in relieving constipation and add bulk to your stools to prevent diarrhea.  Doctors also recommend that people suffering from bowel leakage be mindful of their fluid intake – staying hydrated is highly important, especially for individuals experiencing diarrhea.

There are also steps women can take to feel comfortable and tend to skin issues caused by leakage. To relieve anal discomfort, you should always wash the area with water after every bowel movement. Avoid soap when washing, and ensure the area is dried thoroughly before re-dressing.  For irritated skin, try non-medicated talcum powder or cornstarch. Wearing cotton underwear and loose clothing can also give the skin room to breathe. 

Exercises

Doctors will often recommend therapies or exercises designed to improve anal sphincter control and help patients become more aware of their urge to go to the bathroom.

Kegel exercises strengthen the pelvic floor muscles that support the bladder and bowels. To perform Kegel exercises, contract the muscles that you would normally use to stop the flow of urine, hold the contraction for three seconds, then relax for three seconds. Repeat this pattern 10 times. As your muscles strengthen, hold the contraction longer, gradually working your way up to three sets of 10 contractions every day.

You can also train your bowels by scheduling bowel movements for a specific time of day, each day.  This will help you feel more in control and gain greater awareness over your bowel movements, making it easier to recognize the urge.

Depending upon what is causing bowel leakage, you can turn to over-the-counter medicine for temporary relief.  For those suffering from diarrhea, Anti-diarrheal drugs such as Imodium or Pepto-Bismol are recommended.  If constipation is causing the leakage, your doctor may recommend laxatives, stool softeners or fiber supplements such as methylcellulose (Citrucel) and psyllium (Metamucil).

If the OTC options aren’t helping, your doctor may recommend prescription medications that are designed to treat conditions like irritable bowel syndrome and Crohn’s Disease.

When other treatments have failed to improve symptoms of bowel leakage, your doctor may consider surgery.  As some surgeries that treat symptoms of bowel leakage come with negative side effects or impact quality of life, surgery should only be considered as a last resort intervention.

Sacral nerve stimulation (SNS): If other treatments have failed, some doctors will recommend implanting a device that sends small electrical impulses continuously to the nerves to strengthen muscles in the bowel.

Sphincteroplasty: For women whose bowel leakage started post-partum or after an injury, Sphincteroplasty is a procedure that reconnects the separated ends of an anal sphincter tear.

Corrective surgery: bowel leakage can often be caused by rectal prolapse, a rectocele or hemorrhoids, so surgical correction of these problems may reduce or eliminate leakage.

Sphincter Replacement: an option for people with a damaged anal sphincter, this procedure involves placing a device around the anal canal to control the passage of stool. 

Colostomy: This is rarely used to treat bowel leakage, but may be considered as a last resort.  This is a major surgery in which the colon is brought through an opening in the abdominal wall, and stools are collected in a bag on the outside of the abdomen. Given the nature of the procedure, it can have a significant impact on the quality of life post-procedure. 

REFERENCES

  1. Mayo Clinic. Fecal Incontinence. Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397. Accessed January 2019.
  2. Fecal Incontinence. Epidemiology: Frequency. https://emedicine.medscape.com/article/268674-overview. Accessed January 2019.
  3. National Institutes of Health. Bowel Control Problems. Symptoms and Causes. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/symptoms-causes. Accessed January 2019.
  4. Mayo Clinic. Fecal Incontinence. Diagnosis and Treatment. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/diagnosis-treatment/drc-20351403. Accessed January 2019.
  5. National Institutes of Health. Bowel Control Problems. Treatment. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/treatment. Accessed January 2019.
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