The National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) defines bowel control problems as "the inability to hold a bowel movement until reaching a bathroom." Also known by the medical term fecal incontinence (FI), Accidental Bowel Leakage (ABL) is often associated with:
- Having trouble holding a bowel movement
- Having solid or liquid stool leak when least expected
- Finding streaks of stool in the underwear
- Seeking out the restroom when out in public
- Avoiding specific types of foods
Millions of Americans contend with ABL every day. Most of ABL is characterized by light to moderate leakage. While age is a contributing factor, ABL has been reported to affect both men and women as early as 40. As a growing concern among the Baby Boomer generation, more studies and research are being conducted to see what can be done to better manage and reduce or treat ABL.
Accidental Bowel Leakage may occur from a number of underlying conditions that affect bowel control.
Diarrhea. The increased volume of loose stools can create a sense of urgency to get to the toilet.
Constipation. When large, hard stools get stuck in the rectum, watery stools can leak out around the hard stool. What’s more, constipation causes the muscles of the rectum to stretch, weakening them. When these muscles are compromised, they might not be able to hold stool long enough for the person to get to a bathroom as a result.
Damage to Muscles or Nerves. Any damage to the anus can create incontinence issues as stool can leak out. Weak pelvic floor muscles also make holding stool in the rectum more difficult. Nerve damage can interfere with signals to the brain. When this occurs, the brain is not properly alerted that a stool is in the rectum and ready to be voided. Nerve damage can be caused by a myriad of circumstances including:
- Hemorrhoid surgery
- A history of straining to pass stool
- Multiple sclerosis
- Spinal cord injury
Rectal Change. Radiation treatment for rectal cancer or other pelvic cancers can cause scarring of the rectum, reducing its ability to keep stool from leaking. Inflammatory bowel diseases can cause swelling and irritation that make the rectal wall stiff, again compromising its ability to properly function.
Aging. As you age, muscles and tissues lose elasticity. As this ability to stretch becomes more limited, leakage can occur.
Childbirth. Childbirth puts tremendous stress on your body. If there is damage to the pelvic floor muscles during delivery, bowel control problems can appear immediately. In other cases, incontinence may not emerge until many years later. Childbirth-related bowel control problems may be caused by:
- Injuries to nerves during labor and delivery
- Tearing of muscle during delivery
- Damage to muscles as a result of using forceps during delivery
- Episiotomy (when a d octor makes a cut in the vaginal area to ease delivery)
Gallbladder Removal. One of the accepted reasons for loose stools following gallbladder surgery is that an increased amount of bile in the intestines acts as a laxative. The looser stools are harder to control since the anus is designed to control solid waste.
Medication Side Effects. Certain medications can cause diarrhea, which contributes to leakage.
Pelvic Floor Dysfunction. Pelvic floor strength is critical to digestive (bowel) health for both women and men. Here’s how a poorly functioning pelvic floor can create a situation for ABL:
- Impairs the ability to sense stool in the rectum
- Decreases the ability to contract muscles used during a bowel movement
- Rectal prolapse causes the rectum to drop down through the anus—this can lead to stretching of the anus muscles, stretching of the pelvic floor nerves, and mucus discharge from the prolapse segment
- Rectocele causes the rectum to protrude through the vagina
- Causes the pelvic floo r to become weak and sag
It goes without saying that if you or someone you know is experiencing any of these conditions, it’s important to share that information, along with the frequency of ABL episodes, with your healthcare provider.
So what puts someone at risk of ABL?
- Neurological disorders (multiple sclerosis, Parkinson’s disease, etc.)
- Physical injury to the rectal area (childbirth, radiation, or surgical damage for prostate cancer treatment)
- Various diseases (diabetes, obesity, celiac disease)
- Inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
- Functional gastrointestinal disorders (irritable bowel syndrome)
- Reduced phy sical mobility
For the tens of millions with ABL, there are a number of things that can be done to improve systems. But first, successful bowel control treatment relies on correctly diagnosing the underlying problem. If you are experiencing light to moderate ABL, you may be able to control your condition with lifestyle modifications, management techniques, and behavioral modifications.
Sometimes even small behavioral modifications, such as dietary modifications or the changing of certain medications, can be helpful in regaining bowel control. The first step is to normalize stool consistency with increased fiber intake and to strengthen the sphincter muscles with pelvic floor exercises.
For 90% of those with ABL, leakage is light to moderate. Many people are able to manage their condition with lifestyle and behavior changes. Those who require additional help managing their condition may want to try:
- Butterfly®. A body liner specifically designed for women and men with light to moderate ABL, Butterfly fits comfortably and invisibly on the buttocks, providing secure protection.
- Absorbents and Protective Wear. A variety of disposable or reusable absorbent products that may be used for management exist.
- Collection System. 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.
- Healthy Bowel Habits. Increased fluid intake, regular exercise, and regular bowel habits can reduce or eliminate ABL. Fiber and sufficient fluid intake helps create a softer stool that is well formed.
- Bowel Retraining
- Diet Modification. Add high-fiber foods to your diet, including whole wheat grains, fresh vegetables, and beans. Products containing psyllium, such as Metamucil, add bulk to the stools. And as you’ve heard a million times, try to drink 2-3 liters of fluid a day.
- Pelvic Muscle Exercises (Kegels)
- Sacral Nerve Stimulation
- SECCA®. A physician delivers precisely controlled radiofrequency energy to the anal canal to thicken the tissue and thereby improve the function of the sphincter muscle.
- Fenix®. A small, flexible band of titanium beads with magnetic cores is used to create a barrier to involuntary bowel leakage. The magnetic bond is temporarily broken to allow the voluntary passage of stool and restored immediately thereafter.
For diarrhea, there are many over-the-counter medications including Imodium® as well as prescription medication such as Lomotil®, Nulev®, and Lotronex®.
If you have more severe ABL, treatment may include anything from active management to surgery to improve your quality of life. However, these measures do not always guarantee a return to complete bowel control. Talk with your doctor if you are not seeing results.