Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. It is also sometimes referred to as faecal incontinence. It’s thought that one in 10 people will be affected by it at some point in their life.
The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach it in time, this is known as urge bowel incontinence. This can be passing of a small amount of stools, or total loss of back passage control. Other people experience no sensation before soiling themselves, this is known as passive bowel incontinence, or passive soiling.
In some cases there might be sight soiling when passing wind.
Some people find it very difficult to control the passing of wind, as well as stools. For some people, there’s no specific soiling as such, but ‘staining’ of the underwear, due to the inability to wipe the anus clean after passing a motion.
Bowel incontinence can affect some people on a daily basis, whereas for others it only happens from time to time. It can be transient i.e. present after childbirth, intermittent i.e. linked to diet or certain food types, or regular i.e. linked to weakened sphincter muscle and nerve damage.
Causes of bowel incontinence:
- Diarrhoea – diet, food intolerance, IBS, inflammatory bowel disorders
- Constipation – large stools becoming impacted in the rectum causing excessive stretching/weakening and pressure overload to the sphincter beneath…. linked to diet, fluid intake, lifestyle, side effects of certain medications, ignoring urge to pass stools
- Sphincter muscle weakness at the bottom of the rectum or pelvic floor weakness
- Nerve damage eg MS, stroke, spinal injury, diabetes, childbirth
- Rectal Prolapse – childbirth, repeated straining to pass stools
- Haemorrhoids – caused by excess weight, chronic constipation, pregnancy and childbirth
- A physical disability can also make it difficult to get to the toilet in time
Physiotherapy for Bowel Incontinence:
- Rectal examination (with consent) to check position of perineum, anus, rectum, pelvic floor muscle activity and sphincter strength and activation.
- Vaginal examination (with consent, as indicated) to check pelvic floor muscle activity, tone, strength, endurance
- Teaching correct pelvic floor muscle exercise program
- Diet advice- what to eat, what to avoid, types of fibre etc
- Advice & techniques to improve diarrhoea and/or constipation
- Lifestyle advice
- Bladder and bowel re-training techniques
- Advice on continence products
- Biofeedback and muscle stimulation as indicated
- Liaise with GP re: medication, bulking agents, rectal irrigation, surgery