Bowel incontinence - what is it, what are the symptoms and who's most at risk?

Bowel incontinence generally means that you’re not able to control your bowel movement, causing you to leak stools. This can range from an occasional leaking of stool while passing gas to a complete loss of bowel control. Bowel incontinence isn’t the same for everyone, though! Some people might feel the sudden need to go to the toilet but can’t make it there in time whereas others don’t experience any sensation before soiling themselves. To some people, these accidents happen on a daily basis, for others it’s only from time to time.

Online Doctor Banner Image

The reasons behind bowel incontinence are generally not life-threatening but the condition can severely interfere with your quality of life. You might not want to leave the house anymore and avoid any social activities and contact out of fear of embarrassing yourself.


Symptoms of Bowel Incontinence

The most common symptoms of bowel incontinence are:

  • Sometimes leaking stool (e.g. when you’re passing wind)
  • Sudden urges to poo that you can’t control
  • Constipation, diarrhoea, passing wind, and bloating
  • Soiling yourself without realising that you needed the toilet
  • Frequent bowel accidents


Who’s most at risk?

As with everything, there are certain groups of people that are at a higher risk of suffering from bowel incontinence. The most common risk factors are:

Age: Although bowel incontinence can happen at any age, it is far more common in adults over the age of 65.

Being female: Bowel incontinence can be a complication of childbirth. Additionally, recent research has found that women who take a menopausal hormone replacement are more likely to develop some form of bowel incontinence.

Nerve damage: If you have a condition that damages the nerves, like long-standing diabetes or MS, you are at higher risk of developing bowel incontinence.

Alzheimer’s and dementia: Faecal incontinence is often present in people with late-stage Alzheimer’s and dementia. This is because being continent is a learned behaviour that can be forgotten.

Physical disability: Having a physical disability may make it difficult for you to reach the toilet in time, especially when you’re suffering from diarrhoea.


What causes bowel incontinence?

Bowel incontinence can be caused by a multitude of reasons and is often caused by a combination of problems. Severe or long-lasting constipation or diarrhoea, Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), and severe haemorrhoids can all contribute to your condition. Other possible causes are:

Muscle damage: An injury to the anal sphincter may make it difficult for you to control your bowel movements. This type of injury is common during childbirth, especially when the woman is having an episiotomy – a small incision in the perineum – or when forceps are used during delivery.

Nerve damage: Nerve damage can happen during childbirth, because of constant straining when trying to poo, because of a spinal cord injury or a stroke, as well due to certain diseases like diabetes or spina bifida.

Surgery: Simpler surgical procedures to treat haemorrhoids as well as more complex operations involving rectum and anus can lead to bowel incontinence.

Less storage capacity in the rectum: If the rectum is scarred or the rectal walls have stiffened because of surgery, radiation treatment or IBD, the rectum can’t stretch as much as it needs to and excess stool might leak out.

Rectal prolapse and rectocele: This is a bulge in the front wall of the rectum that presses into the back wall of your vagina.

Faecal impaction: If you’re suffering from chronic constipation, then this can lead to a faecal impaction. This means that hard stools are stuck in the rectum, which can stretch and weaken the sphincter. This makes it impossible for the sphincter muscle to stop the leakage of stool.


When to seek help

If you are experiencing any difficulty controlling your bowels, we would always advise that you speak to your GP about it. Even though it might feel uncomfortable, always remember that it is nothing to be ashamed of. Bowel incontinence is a very common condition and GPs are used to seeing and treating people with this problem. It really isn’t something you should or have to put with! Most cases of bowel incontinence can be treated, but it’s unlikely going to get better on its own.

Don’t worry if you don’t feel comfortable seeing your local GP about this problem! You can make an appointment at an NHS continence or colorectal service instead. This way, you can be almost certain that you will be treated by someone who you don’t know. And we know just how much pressure this can take away!


How is bowel incontinence diagnosed?

For the diagnosis, your nurse or doctor will perform a thorough evaluation of your medical history and your physical wellbeing. You will likely be asked about the frequency of your incontinence and when it happens as well as your diet, any medications you are on, and any additional health issues. During the physical examination, your healthcare professional might check the strength of your anal sphincter muscle by inserting a gloved finger into your rectum.

If these tests are inconclusive or your doctor feels like they need some more information, they might perform further tests such as:

Endsonography: During an endsonography, an ultrasound probe is inserted into the anus. This produces images that can help your doctor to identify problems in the anal and rectal walls.

Colonoscopy: At a colonoscopy, your doctor examines your colon using a camera and light attached to a flexible tube called the colonoscope. For this procedure, you will usually get a sedative and pain medication as it can be quite uncomfortable.

Endoscopy: A tube with a camera on top is inserted in the anus. With this test, the doctor can identify any problem in the anal canal or colon.

Anorectal manometry: Here, a doctor will insert a tube with a balloon on the tip into your anus. Once inserted, the balloon is inflated, and your doctor will slowly remove it. This allows to measure the tightness of the muscles around the anus and how well the rectum functions.

Nerve test: Your nurse or doctor might also measure the responsiveness of the nerves that are controlling your anal sphincter muscles. This test can detect nerve damage that can cause bowel incontinence.


How Bowel Incontinence is Treated

Bowel incontinence is usually well treatable and can be cured completely in some cases. There are various treatment options which vary according to the cause of the incontinence. However, in most cases your doctor will use more than one treatment option to control the symptoms of your incontinence.

Non-Surgical Treatments

To start with, non-surgical treatments are usually preferred. If your nurse or doctor thinks you would benefit from a bowel management program, some, or all of the below mentioned treatment options might be combined into an individual plan.

Continence products: Your doctor or nurse will likely start by recommending continence products like foam plugs or pads to reduce the impact your bowel incontinence has on your life. However, these products don’t deal with the underlying issue, so they are generally used a short-term measure.

Dietary changes: What we eat has a great impact on our bowel health. So to relieve your faecal incontinence, your doctor might suggest that you eat less high-fibre foods, avoid caffeine and alcohol, drink several glasses of water per day, and that you avoid anything that contains sorbitol.

Medication: Certain medicines, like immodium, can help with bowel incontinence as they reduce the number of your bowel movements. It is really important that you speak to a healthcare professional before you take any medication, though, as you need to make sure that whatever you are taking is suitable for your individual needs.

Exercises: If examinations show that your pelvic floor muscles are a bit weak, your doctor or nurse will work on an exercise plan with you. This program usually involves Kegel exercises to build some of the strength in your pelvic muscles and sphincters back up. As these muscles get stronger, your bowel incontinence may improve.

Bowel training: It’s not just your muscles that need training though, sometimes your bowel does too. You can achieve this by having a scheduled bowel movement each day. This doesn’t just prevent accidents in between bowel movements but it also gives you some of your confidence back.

Surgical Treatments

If non-surgical treatments are unsuccessful, surgical treatments can be used to reduce the impact of your bowel incontinence on your life. However, these types of treatment are often used as a last resort.

Sphincteroplasty: If the cause for your bowel incontinence are damaged anal sphincters, a surgeon might be able to repair those muscles by stitching them together more tightly.

Sacral nerve stimulation: In this case, a surgeon implants an electronic device that stimulates the pelvic nerves and helps your muscles to work better. This type of surgery is most effective when your incontinence is caused by nerve damage.

Injectable bulking agents: Here, a healthcare professional will inject bulking agents into the anal sphincters and pelvic floor muscles to make them stronger and increase their ability to hold back faeces.

Sphincter cuff device: If your anal sphincters are too weak and damaged to be repaired, you might have a sphincter cuff device implanted. This is an air-filled cuff that surrounds your anal sphincter muscles. How does it work? Well, if you are ready to go for a poo, you can simply deflate the cuff and then inflate it again afterwards to prevent any accidents until your next bowel movement.

Colostomy: If your doctor can’t see a different way to relieve your bowel incontinence, they might suggest a colostomy. This means that part of your colon gets redirected through an opening in the skin of the belly – called a stoma.