Patient Perspective: Ellen's Story

 Patient Perspective - Ellen's Story of Living With Incontinence

After the birth of my 2nd child, I began experiencing urinary incontinence.  I started leaking a bit here and there, and it only got worse as I got older. I assumed it was just a part of aging and that there was nothing I could do. And while the episodes were embarrassing, I was able to control and hide them pretty well by wearing protection and always keeping a close eye on the toilet. 
 
However, when my youngest was 15 years old, I had my first real bowel accident, and life as I knew it officially changed.  I began having more and more episodes, and eventually didn’t even want to leave the house because I was so terrified of having an accident.  I stopped seeing friends. I ordered groceries and most things I needed online.  I refused to go on dates with my husband.  There is something that feels just a little bit worse about having a bowel accident vs. having a bladder accident – it’s messier, smellier, much more apparent, and just so humiliating that you never want others to know it is something you are going through.  
 
I lived like this for six years before finally realizing that I wasn’t controlling my ABL, it was controlling me.  I got up the nerve to speak with my doctor and was able to have a surgery that helped alleviate many of my issues. 
 
All of this could not have come soon enough – my first granddaughter was born a year ago and to think that I may have missed out on that moment or all the wonderful ones that have followed makes me cringe. My only regret is that I didn’t do something about it sooner.
 
Ellen T., Atlanta, GA

Ask The Expert: What Should Be The First Line Of Defense In The Treatment For Fecal Incontinence

 first line of defense in the treatment Of Fecal Incontinence

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question:  What should be the first line of defense in the treatment for Fecal Incontinence?

Answer:  My advice would always be to first talk with your doctor.  This may be an uncomfortable conversation to have, but it’s one worth having, since your doctor is best equipped to diagnose and treat the condition.  However, if you’re just not ready to take that step yet, there are a few things you can do.

How To Treat Fecal Incontinence

1. Keep a bowel diary. 

It may seem strange to track your bowel movements, but by tracking the time of your movements, what you were doing at the time, and what you eat during the day, you may be able to uncover some clues as to what is causing you to have frequent movements or accidents. Download a free bowel diary here.

2. Change up your diet. 

Certain foods can be irritating to your bowel and by keeping a healthy diet you may be able to lessen some of your symptoms.  Try eating foods rich in fiber, which can help create bulkier stools and make them easier to control. Drink plenty of water to avoid constipation (which, contrary to what you might think, can also cause ABL since loose stools can push their way past hardened ones causing leakage.)

3. Develop a routine. 

Take a look at your bowel diary and see if you notice a pattern to your bowel movements or accidents.  Try developing a voiding schedule to circumvent these episodes.

4. Exercise. 

Getting in a good workout is always a good idea, but it can be especially helpful in keeping constipation under control. Exercising helps to move food through the large intestine more quickly, which can prevent it from becoming hard and dry (and harder to pass.)  And keeping the pelvic floor in shape with regular exercise and kegel contractions can help control and reduce fecal incontinence.

If you don’t experience any improvement in your condition after making the above adjustments, it may be time to bite the bullet and speak with a doctor. Rest assured you won’t be the first one to share this type of problem with them and they will be able to point you in the direction of something that will work best for you.

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Contact us!

4 Common Myths Of Accidental Bowel Leakage

 4 Common Myths Of Accidental Bowel Leakage

Accidental Bowel Leakage (ABL) is something no one likes to talk about. Even more so than urinary incontinence, fecal incontinence carries a stigma that is hard to shake. And yet, tens of millions Americans struggle with it on a regular basis.

Today, we’re dispelling 4 common myths associated with accidental bowel leakage:

MYTH:  ABL only happens when you have watery or loose stools.

FACT:  While things like diarrhea can create a strong sense of urgency and may indeed lead to leakage, other factors may also be at play.  Being constipated can be a cause of ABL too - when large hard stools get stuck in the rectum, watery stools can leak out around them.  Regular bouts of constipation can also stretch and weaken the rectum, making it harder for you to hold stools long enough to make it to the restroom. To that end, any damage to the muscles or nerves around the anus can create an ABL issue.  Things like childbirth, diabetes, stroke, hemorrhoid surgery, multiple sclerosis, or spinal cord injury all have the potential to cause ABL.

MYTH:  ABL only happens to older people

FACT:  While age does play a factor with ABL, leaky stools can happen to anyone who has had muscle or nerve damage to the anus, and can occur in people as young as 40.  ABL is more common in our older population though, due to decreased muscle and tissue elasticity, which makes it harder to hold a stool.

MYTH: Diet doesn’t affect ABL

FACT:  Diet can play a huge role in how and if you experience ABL. Everyone’s triggers are different - spicy food, fried and fatty foods, and food and drink with caffeine can cause problems for many. Additionally, eating larger meals can sometimes have a negative effect.  Try using a bowel diary to keep track of your food intake and your bowel problems. This may help you to see a trend in your eating habits that are leading to ABL.

MYTH:  There is nothing I can do to treat ABL

FACT:  ABL can and should be treated.  Watching what you eat, getting proper exercise (including pelvic floor exercises!), making certain behavior modifications, taking medication to address the issue are just a few of the things that can be done to combat ABL.  Surgery to correct the problem may also be an option for you.  The most important thing to remember is that you have options, and you owe it to yourself to seek them out by talking with your doctor.

Learn more about Accidental Bowel Leakage and available treatment options in our Conditions section.

The Best Products For Treating Accidental Bowel Leakage

 The Best Products For Treating Accidental Bowel Leakage

If you suffer from fecal incontinence, you know that you will do anything to prevent leaks from happening.  Fortunately, there are many products on the market that can do just that.  We’ve rounded up some of the most popular products for accidental bowel leakage to share with you here.   

The Best Products For Accidental Bowel Leakage

Supplements.

Fiber supplements may be a good first step to try if you are experiencing loose stools, as they bulk up the consistency of your stool and make it less liquid.  Good sources of fiber are found in lots of foods such as split peas, many types of beans, and berries. Fiber supplements can also help, and can be found in many health food stores.  Look for products that contain psyllium or methylcellulose.

Anti-diarrhea Medication.

Products like Immodium or Pepto-Bismol can really help people who deal with the occasional loose stools.  However, it’s important to not use products like these for more than a couple of days

Anti-Constipation Medication.

While most cases of constipation can be fixed by incorporating a healthier diet and maintaining proper fluid intake (8 cups of water a day is the norm), sometimes you may need a little help to get things moving.  Most of the medications available, such as Amitiza® and Miralax® work by drawing extra water to the stool to make it softer and easier to pass. As with anti-diarrhea medication, these products usually should not be used for extended periods of time.

ABL Specific Absorbent Products.

Absorbents for urinary incontinence get a lot of attention, but did you know that there are specific products just for fecal incontinence? Butterfly body liners are designed for light leakage and are unique in that they fit discreetly in between the buttocks.  Other super absorbent products from common names like Tena, Poise and Reassure also work well for bowel leakage.

Skin protection.

If you suffer from any type of incontinence, it is important to take care of your skin.  Barrier creams and ointments to protect and treat the skin from rashes or infection can be found online and in local drugstores.

Collection Symptoms.

For those with heavier leakage, there are multiple options ranging from bags adhered directly to the skin to catheters and tubes attached to a collection bag.

Vaginal Inserts.

Eclipse™, which is fitted first by a physician, is an inflatable balloon device that is inserted into the vagina. When inflated, the balloon puts pressure through the vaginal wall onto the rectal area, thereby reducing the number of FI episodes.

Rectal Inserts.

The Renew® Insert is a new product designed to comfortably fit with your body to form a seal with the rectum, which blocks the anal passage and prevents leaks from occurring.  

Another device on the market, the Fenix® Implant, is a small, flexible band of connected metal beads with magnetic cores that is placed around the anal canal to treat accidental bowel leakage (ABL). The beads will separate temporarily to allow the controlled passage of stool. The magnetic force between the beads then brings the implant back to the closed position to prevent unexpected opening of the anal canal that may lead to ABL.

Have you tried any other products not listed above? Tell us about them in the comments!

How To Perform Bowel Retraining To Treat Accidental Bowel Leakage Or Constipation

 How To Perform Bowel Retraining To Treat Accidental Bowel Leakage Or Constipation

Those who struggle with bowel control issues know full well the impact it can have. From fecal incontinence (also known as accidental bowel leakage), to constipation, not being regular can be be a huge nuisance, and can cause embarrassment, shame and frustration.

One way to manage bowel control is with bowel retraining, which literally means to “teach” your bowel how to function properly again.  By stimulating the bowel at regular intervals, you can train it to empty regularly, and with a normal consistency.

Some tips before you begin:

  1. Keep a Bowel Diary.  Knowing how often and when you empty your bowel now will help you later on as you begin the retraining process.  Keep a bowel diary for at least 4 days to get a good idea of both your voiding schedule, and what you’re eating and drinking.  
  2. Manage Your Diet.  Speaking of eating and drinking, what you consume can have a huge effect on your bowels.  To maintain a good bowel consistency, be sure to consume high fiber foods, like vegetables, beans and whole grain foods.  If you suffer from loose stools, using a bulking agent, such as psyllium, which can be found at health food stores, can help.  And don’t forget to drink plenty of water, which is vital when trying to maintain a healthy bowel.
  3. Be Consistent. Select a time of day that works for you to perform this exercise and stick with it.  This will ensure that you are training your bowel not only to function properly, but at the same time each day as well.

How to perform bowel retraining:

  1. Insert a lubricated finger into the anus and make a circular motion until the sphincter relaxes. This may take a few minutes.
  2. After you have done the stimulation, sit in a normal posture for a bowel movement. If you are able to walk, sit on the toilet or bedside commode. If you are confined to the bed, use a bedpan. Get into as close to a sitting position as possible, or use a left side lying position if you are unable to sit.
  3. Try to get as much privacy as possible. Some people find that reading while sitting on the toilet helps them relax enough to have a bowel movement.
  4. If digital stimulation does not produce a bowel movement within 20 minutes, repeat the procedure.
  5. Try to contract the muscles of the abdomen and bear down while releasing the stool. Some people find it helpful to bend forward while bearing down. This increases the abdominal pressure and helps empty the bowel.
  6. Perform digital stimulation every day until you establish a pattern of regular bowel movements.
  7. You can also stimulate bowel movements by using a suppository (glycerin or bisacodyl) or a small enema. Some people drink warm prune juice or fruit nectar to stimulate bowel movements.

The most important thing to remember when practicing bowel retraining is to be consistent, and to not get frustrated if you don’t see results right away.  This process usually takes a few weeks to develop a normal routine.  If you find that you are still having problems after several weeks of bowel retraining, or if you have additional questions, be sure to consult your physician.

Fecal Incontinence In The Bedroom

 Fecal Incontinence In The Bedroom

Is fecal incontinence (FI) affecting your romantic relationships?

If you are single, do you avoid meeting new people, dating, or sex? If you're married, are you worried that your partner no longer finds you attractive? Dealing with incontinence during intimate moments can be a frustrating experience for both partners. Most of us have problems talking about sex at all, and talking about problems in the bedroom is just about impossible. It might be an uncomfortable conversation to have with your partner, but talking about Fecal Incontinence (FI) is the best way to gain the support and understanding needed to get back to enjoying your sex life again.

The causes of FI can include inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), constipation, diarrhea and, for women, weakened muscles in the anus or rectum after childbirth. In most cases, incontinence is not a permanent condition, and will improve when the cause is treated. If incontinence is a long-term issue, then dealing with the problem directly and how it affects romance becomes even more important.

Talking about fecal incontinence with your healthcare provider.

The first step to improving your sex life will be to work with your doctor, or nurse practitioner, to explore the ways that you can treat the cause of the incontinence. Make sure your healthcare provider is aware that incontinence is affecting your romantic relationships and that you are interested in finding ways to treat the problem. This can be a difficult conversation so use the words you are most comfortable with and remember that your healthcare provider has heard about all of these problems before. The treatment of FI will depend largely on the cause. Your doctor or nurse practitioner may have some new suggestions for you once you have made him or her aware of your concerns.

Think about ways your sex life can be improved. If you're avoiding intimacy, obviously you'll want to get back to it! How can you and your partner work together to make your romantic moments more fulfilling for both of you? When is incontinence the most troublesome and how can you improve it so you can enjoy your sex life? If you find that incontinence is a problem during intercourse, perhaps exploring different positions or other forms of intimacy would be helpful. If avoiding intimacy is causing you emotional stress and worsening your symptoms, perhaps beginning to talk about it with your partner will help lower your stress level.

Discussing FI with your partner.

Now for the more difficult conversation: discussing how FI affects your sex life with your current or future partner. If your partner is not already aware of the condition that's causing the incontinence, you'll want to discuss it first. You can talk about all the ways your life is affected, including everything from your job to your feelings about your medical problems. Your partner may not be aware of the stress and difficulties you are having and that you are worried about how it's affecting your relationship.

Once you both have the whole picture in mind, you can move on to discussing how FI affects your intimate moments. Bring up the ideas you have on how you can be more comfortable being romantic. Your partner will likely also have some suggestions and ideas. Work together to come up with some solutions, whether they are short-term or long-term.

When you need more help.

The above approaches will be helpful in a perfect world. But we're often not in situations or in relationships that are perfect. If your healthcare provider has not proven to be helpful you have the option of searching for a provider who is more willing to listen to your concerns. If your partner does not want to talk about your intimacy concerns, you don't have that same options. In that case you will want to seek outside help. The best option is to seek counseling as a couple but if your partner is unable or unwilling, you should seek help alone.