Bowel Incontinence: Causes and Symptoms
A common problem, especially in older people, is bowel incontinence or leaking of fecal matter. Individuals suffering from this condition may fear embarrassment and even avoid activities. Unless specifically asked about it, many people are reluctant to talk about this issue, even with their doctor.
How Common is Bowel Incontinence?
Estimates are that 6-10% of older men have bowel incontinence, where as in women under 40, about 6% have bowel incontinence and the problem increases to 15% of women over 40. Women are affected by bowel leakage more often than men because pregnancy and childbirth strains muscles and nerves of the pelvic floor or anorectal area. The problem is much more common in nursing home residents, with 45% of both sexes likely to have bowel incontinence.
The anatomy of the rectum and anus area is complicated. Normal bowel functioning requires a complex feedback and interaction between the muscles and nerves in the area. The rectum holds the stool while two circular muscles between the rectum and the anus control the release of the bowel movement. The internal sphincter is controlled involuntarily by the nervous system, while the external anal sphincter is actively controlled by the individual. Normally, when the rectum is full, the internal sphincter relaxes so that the cells in the anus alert the individual to the need to defecate.
Causes of Bowel Incontinence
Damage to the muscles and nerves of the anus can cause individuals to be unable to completely control their external sphincter muscles, resulting in loss of bowel control. Common causes of nerve damage are:
- Vaginal childbirth (known as obstetric anal sphincter injury)
- Anal or rectal surgery
- Neurologic diseases like multiple sclerosis, stroke, spina bifida or spinal cord injury
- Peripheral nerve damage from diabetes
- Bowel diseases like irritable bowel syndrome, Crohn's disease, and ulcerative colitis
Bowel Incontinence vs. Stool Seepage
Minor staining and leakage from bowels are equally embarrassing, but different than bowel incontinence. Stool seepage can be caused by:
- Rectal fistula
- Rectal prolapse
- Chronic diarrhea
- Parasite infections
- Laxative abuse
- Chronic constipation where liquid stool leaks around the hard fecal mass
Symptoms and Diagnosis of Bowel Incontinence
Along with the passage of stool which is liquid or solid and the inability to control flatus, people with bowel incontinence often also have problems with anal itching, buttock skin infections, or skin ulcers due to exposure to digestive enzymes.
A physical exam including a rectal examination of the sphincter tone is usually done. Sometimes an ultrasound will also be ordered to evaluate anal sphincter muscle damage. In women, a pelvic exam may also be performed. Additionally, health care professionals need to take a history of the patients including:
- How often bowl incontinence occurs and in what situations.
- The consistency of the bowel movements, and whether solid, liquid or gas.
- Obstetric history or surgery in the anal area.
- Diet and medications, including laxatives.
Treatment of Bowel Incontinence
Treatments are individualized and based on the cause of the problem. The goal of treatment is to decrease the frequency of bowel movements and increase the firmness of the stool. Treatment plans can include:
- Dietary changes and medications that bulk the stool.
- Pelvic floor exercises and electrical stimulation to strengthen pelvic and anal muscles.
- Biofeedback training for anal sphincter muscles to help the patient recognize rectal fullness.
- Injections of silicone, collagen or carbon beads to enhance internal and external sphincter muscle functioning.
- Surgery to repair muscles of the pelvic floor and sphincter muscles.
When none of the above options is successful, a colostomy may be performed, diverting the bowel through the abdomen to empty into a removable bag.
Preventing Bowel Incontinence
Unfortunately, a frequent cause of bowel incontinence for women is anal surgery during childbirth and it can be years before the symptoms of incontinence appear. However, maintaining sphincter tone by preventing constipation and increasing fiber is an important preventative measure for both men and women, along with keeping hydrated and avoiding straining during passing a bowel movement.
Prognosis for Bowel Incontinence
Like most muscle groups, the sphincter muscles get weaker with age, and this causes bowel incontinence to be more frequent among the elderly. Often diet, medication, and pelvic floor exercises are successful in controlling symptoms. While many patients benefit from surgery in the short term, that benefit tends to decrease as the person ages and bowel incontinence often reoccurs.
Treating Patients With Bowel Incontinence
Accidental bowel leakage is difficult to resolve and can significantly interfere with normal life. Moreover, since it is usually not a serious medical issue, people may be reluctant to consult a health care professional. Therefore, health care practitioners need to be alert to medical histories that may suggest a problem with bowel incontinence so that they can help the patient talk about it and make the appropriate referral for treatment.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.