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Bowel incontinence – time we talk about it

Carer helping woman out of bed
Many people avoid telling their doctor or caregiver about their problems with bowel incontinence. Instead, they might express complaints about things like itching or other continence related issues that are more comfortable to talk about. If you are in a caregiving position, that can be a good thing to bear in mind. In this article, we will outline what bowel incontinence is, along with some of the most common causes and treatment.   

What is bowel incontinence?

Bowel incontinence, also known as faecal incontinence, is the unintentional loss of stool . For a bowel to function properly and avoid bowel leakage, the nerves and muscles in the rectum and anus work together in a complex system, and when that system fails, bowel incontinence happens. 
 
Bowel incontinence can also happen due to constipation or diarrhea. This is why knowledge about stool consistency is highly useful for you as a caregiver when treating and managing someone living with this problem.

Common causes of bowel incontinence

Bowel incontinence can be caused by a number of reasons, like diarrhea, constipation or a nerve or muscle damage. Individuals with diseases that affect the central nervous system (for example multiple sclerosis (MS), Parkinson’s disease, spina bifida, stroke, etc.) often have constipation or bowel incontinence. This occurs because there is an interruption to the nerve pathways. If the nerves that control the anal sphincter muscles or those that sense stool are damaged it can cause constipation or faecal incontinence. 
 
Many different medications can cause bowel incontinence by affecting bowel function, sphincter tone or cognitive awareness. Bowel incontinence can also happen if you have inflammatory diseases like Crohn’s disease or ulcerative colitis. Both Crohn’s and Ulcerative Colitis cause diarrhea, which in turn can cause leakages. Loose stool and urgency from the bowel can cause even the strongest pelvic floor to leak if the toilet is not close enough.
 
Also, just falling ill can affect bowel continence. An elderly person with a medical disease might be immobile, cognitively impaired and/or experience a loss of appetite and difficulties with drinking enough fluids. All these factors could increase the risk of incontinence.

Constipation

 
Chronic constipation can cause a hard mass of stool to form in the rectum, which then becomes too hard to pass. This can cause the muscles of the anus and rectum to stretch and weaken, the weakened muscles can prevent the anal sphincters from closing tight, resulting in faecal leakage. 

Diarrhea

 
Faecal leakage during diarrhea is usually not a sign of a chronic state of incontinence, but it is harder to keep loose stool in the rectum than regular stool. 

Hemorrhoids

 
Hemorrhoids can keep the anus from closing completely, which can allow stool to leak out.

Bowel incontinence treatment

The bowel incontinence treatment would depend on the underlying cause of the problem, but the purpose is always to regulate the bowel movements, and make necessary changes to get proper consistency of the faeces. 

Avoid constipation


Exercise, drink a lot of water and add more high-fiber foods to the diet.

Treat the diarrhea


Treating the cause of diarrhea, which can be caused by an intestinal infection, may actually take away the faecal incontinence too. For example, make sure to review the medications to see how they affect the bowel. Too many laxatives can be what’s causing diarrhea.

Strengthening the pelvic floor


Training the muscles of the pelvic floor through Kegel exercises might also be helpful, as well as finding a correct toilet posture to facilitate bowel emptying. Surgery may be an alternative if no other treatment works.

Don’t forget the skin care


Prolonged contact with faecal enzymes and microorganisms is a key risk factor for incontinence associated dermatitis (inflammation and/or erosion of the skin caused by exposure by urine or faeces). Faeces contain harsh enzymes and corrosive compounds that can quickly degrade the skin. Therefore, if an accident has occurred, prompt removal of faeces is important. Clean the skin gently with proper products for perineal care and put on a protective barrier cream if necessary.
 

What can you as a caregiver do for your patient or family member with bowel incontinence?

Try and support the person you take care of to make sure the problem gets addressed. Doctors handle these issues every day, and it’s important that you get the right diagnosis. Once you know what is causing the problem it is easier to find proper treatment.
 
Also, bear in mind is that people are different. A person with frequent leaks may need a different product than someone with incontinence that is more spread out. Make sure you find a product that really does the job. Finding a toilet routine that works is highly important, and make sure you remove the faecal leakage promptly. Perform proper skin care and use a barrier cream for extra protection.
 
If you're caring for someone who suffers from incontinence, it may help to understand more about the condition and what you can do to support your loved one. Explore our articles on incontinence related issues to learn more.