Bowel Incontinence

Bowel incontinence is not being able to hold a bowel movement. Someone is incontinent when solid or liquid stool accidentally leaks out (in other words, they have an accident).

Usually it takes one or more of the following things for a person to become incontinent.

• Watery or frequent stools: if stool gets too watery or are too frequent, it can be harder to hold in.

• Severe constipation: if stool gets very hard, watery stool can build up behind it and leak out.

• Damaged or weak sphincter muscles: sometimes the muscles that help hold stool in the rectum are injured or weak. This can mean they can't hold stool in as well as they used to. Causes include surgery on the anus or rectum, childbirth, nerve disorders, and getting older.

• Abnormal sensation: sometimes people don't feel the urge to pass stool early enough, and stool can leak out.

• Rectal stiffness: sometimes the rectum doesn't stretch enough to store stool, so stool leaks out.

• Anatomical issues: certain problems with the rectum can make it harder for the body to hold stool in.

Avoiding these foods can sometimes help with bowel incontinence:

• alcohol
• caffeine (coffee, tea, chocolate)
• greasy and fatty foods
• dairy (if you're lactose intolerant)
• certain sugars (fructose) and certain artificial sweeteners (sorbitol, mannitol, and xylitol)

Increasing fiber might also help with bowel incontinence. It will add bulk to stool so it's more solid and less likely to leak. Here are some ways to add more fiber:

• Switch from white to brown or whole-grain breads, pastas, and rice
• Stick to soluble sources of fiber: oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, and carrots.
• Aim for 20 to 30 grams of fiber per day

Kegel exercises

These are exercises to strengthen the sphincter muscles that control bowel movements.

1. Contract (squeeze) the muscles of the anus, buttocks, and pelvis. Hold the muscles as tight as you can and slowly count of five. Imagine you are trying to stop the flow of stool or trying not to pass gas.
2. Relax for 5 counts.
3. Repeat steps 1 and 2 up to 30 times each day.

Track your diet

• Certain foods (in addition to those listed above) can trigger bouts of incontinence. But, it is often different foods that trigger symptoms for each person.

• The best way to identify which foods are triggers for you is to keep a journal of foods you eat and how often you are having incontinence.

• Review your journal at the end of each week to see if you can identify which foods are triggers.

• Share your journal with your doctor or dietician. Together, you can discuss the patterns you see. It might help you figure out which foods to avoid.

Loperamide

• Loperamide slows down the small intestine and colon to give them more time to absorb fluid and nutrients from food
• Taking loperamide helps people have fewer bowel movements
• Talk to your doctor if you are using loperamide for more than a week

Common names:

• Immodium A-D™
• Maalox Anti-Diarrheal™
• Kaopectate 1-D™

Bismuth subsalicylate

If incontinence is related to diarrhea, bismuth might help by:

• Reducing fluids released into the intestines
• Killing certain types of bacteria

Common names:

• Pepto-Bismol™
• Kaopectate™

Bulking Agents

If you find it difficult to get the recommended 20-30 grams of fiber from your diet, you can try a bulking agent.

• Bulking agents absorb liquid and help make stool firmer. If stool is firmer, it can sometimes be easier to hold in.
• It is safe to use bulking agents regularly.
• Take with plenty of water.

Common names:

• Psyllium
• Citrucel™
• Metamucil™

Caution:

• Increase fiber intake slowly by adding small amounts each day. Increasing fiber intake too quickly can result in bloating or constipation.
• Drink plenty of water when increasing fiber

Caution:

Loperamide should not be used if a person has bloody, black, or tar-like stools.

Caution:

• Bismuth subsalicylate should not be given to children or teenagers with fever or flu symptoms.
• Bismuth subsalicylate can sometimes cause the tongue to become black or darkened, but this is a harmless side effect.

To learn more about bowel incontinence, please visit these websites:

• The American College of Gastroenterology
• The International Foundation for Functional Gastrointestinal Disorders
• National Institute of Diabetes and Digestive and Kidney Diseases