Treatment of Fecal or Bowel Incontinence and Constipation

Treatment of Fecal Incontinence

Diet do's and don'ts

If you suffer from constipation...

  • Drink at least 8 glasses of water a day
  • Eat high-fibre foods such as fruits, vegetables, whole grains and cereals
  • Eat smaller meals, more frequently
  • Be as active as possible

If you suffer from diarrhea...

  • Avoid spicy or greasy foods, cured or smoked meat, dairy products, caffeine, alcohol and artificial sweeteners
  • Eat plenty of fibre

Luckily, treatments are available that can help you regain bowel control or at least minimize/manage your symptoms. The right treatment will depend on the cause of your incontinence. Your doctor may suggest you make changes to your diet or take medication or try special exercises and behavioural training. Surgery may be an option if other treatments fail.

Dietary Changes

Dietary changes centre around improving the consistency of your stool to prevent episodes of incontinence. If you suffer from constipation, you’ll want to drink plenty of liquids and foods that are rich in fibre. Getting lots of fibre in your diet will also help bulk up the stools if diarrhea is contributing to your incontinence. See our list of Diet do’s and don’ts (right) for more helpful tips.

Medications

Medications work by improving the consistency of stool or slowing down the movement of food through your intestine. This will allow water to be fully absorbed in the colon (to prevent diarrhea) and give you enough time to get to the bathroom when you feel the urge to defecate. Some of the most commonly recommended medications are available at your local pharmacy without a prescription.

Fibre supplements: There are all sorts of products available to give you an extra dose of fibre. Some come in chewable form, while the powdered versions can be mixed with water or sprinkled on your food. Try different things until you find one you like.

Antidiarrheal drugs: Loperamide (Imodium®) slows down he movement of food and waste through your intestine and helps treat diarrhea. It can be safely combined with other medications.

Laxatives and stool softeners: If you suffer from constipation, temporary use of a mild laxative to make you go to the bathroom may provide relief, but using them continuously can make fecal incontinence worse. As the name implies, stool softeners will soften your stool to prevent impaction and make it easier to pass. Some products contain both a laxative and a stool softener in the same pill.

Bowel Training

Bowel training is geared towards restoring lost muscle strength in your bowel wall or anal spincter and teaching you healthy behaviours that can put you back in control. Following an established bathroom routine is one way to make your bowel movements more predictable and reduce the risk of accidents. You can also practice contracting your anal sphincter to strengthen those muscles and prevent leakage. As with urinary incontinence, biofeedback may be helpful in making sure you’re doing these exercises correctly.

Surgery

Surgery can be an option for some causes of fecal incontinence, most often to repair a prolapse or a damaged anal sphincter.

Sphincter repair/replacement: In a procedure called a sphincteroplasty, the damaged area of the sphincter is detached and the edges are sown back together. If necessary, a piece of muscle can be taken from the thigh and wrapped around the sphincter to reinforce it. If the damage is more extensive, an artificial anal sphincter (essentially an inflatable ring) can be implanted, which you can deflate with a pump inserted under the skin of the scrotum (in men) or major labia (in women) when you need to go to the bathroom.

Surgery for rectal prolapse/rectocele: The fallen rectum is lifted back to the correct position and stitched in place. At the same time, the surgeon can repair any damaged muscles that caused the prolapse in the first place.

Hemorrhoidectomy: Internal hemorrhoids can prevent the anal sphincter from closing properly. They can be removed with a scalpel (a surgical knife), a laser or electricity (cautery pencil).

Colostomy: This is a more drastic procedure reserved for people with severe incontinence and for whom other treatments have failed. The rectum is closed off and stool is diverted to an opening in the abdominal wall, to which a special bag is attached to collect the stool.

Sacral Nerve Stimulation

Sacral nerve stimulation The sacral nerve controls the sensation and strength of the anal muscles as well as the bladder. The same procedure described to treat urinary incontinence can be used for fecal incontinence as well.

Bulking Agents

Bulking agents similar to those used to treat urinary incontinence have recently been developed for fecal incontinence. They’ve only been tried in a limited number of people, though, and larger and more rigorous studies are needed. However, they may soon become an option in people with severe incontinence that hasn’t responded to other treatments.

Patient Story – Louise Mott

“When I discuss incontinence with anyone and begin to tell my story about incontinence almost everyone assumes I have urinary incontinence. In fact I am 43 and I have suffered with fecal incontinence for 14 years now since the birth of my first child. I would really like to bring fecal incontinence out of the realms of 'taboo' and a subject anyone can talk about without feeling shame.

In 1997 I was a nurse and midwife when I had my first child. It was a difficult labour that ended in a forceps delivery. I had no idea how much that delivery would change my life. I sustained an extensive tear and was in a great deal of pain. Soon after my delivery I became aware that I was unable to control my wind and I seemed to be soiled all the time. I decided it was because of the tear and assumed it would get better.

At my post natal 6 week check I advised my doctor that I was 'having accidents' but she advised me it was early days and because my tear was so extensive I probably had a haematoma. I was embarrassed and decided to keep quiet.

The next five months were awful. I became reclusive and very depressed. I didn't even tell my husband, mum or friends, I was horrified. On the very few occasions I had gone out it had ended with my bowels emptying into my clothing and I was left feeling ashamed, alone and even more desperate. On one particular occasion my husband came home unexpectedly just after I had an accident. I was in tears and he was very concerned but I lied about why I was upset because I felt dirty. He sat with me and asked more questions His kindness and understanding helped me to share my secret with him – I was fecally incontinent.

The next day we visited our doctor and I was referred to the UK's leading Colorectal Hospital. I was diagnosed with a 60% effective anal sphincter. When my baby was 18months old I had an anal sphincter repair but sadly on the third day post operatively my wound burst open with a terrible infection. I had to wait 7 months for the hole in my perineum to heal up – it was awful.

My incontinence was worse than ever and because of a blood clotting disease it was deemed unsafe to perform a colostomy. Initially I felt depressed and dirty', I never felt attractive and intimacy was a thing of the past. When you think nothing can be done you feel so alone.

One day during a biofeedback session I was approached by a research nurse and asked if I would share my story with some nurses. I was very nervous and scared but they really appreciated it and it felt great. The research nurse then arranged a self help group and I was actively involved. We wrote a paper about the group which found that self help groups were the most effective tool in helping sufferers.

I have had incontinence now for 14 years and I have managed to turn my life around. I recovered from depression and started giving personal perspectives of living with incontinence to health care professionals at several UK universities.

In August 2008 we moved to Canada – something I never thought I would be able to do. This year I travelled to New Orleans and Chicago to give healthcare professionals my personal/professional perspective and I offer them diagnostic tools to help identify women at risk.

The very best part of giving lectures is that women have been identified in the community and helped.

My aim is to take away the taboo surrounding fecal incontinence and offer men and women sufferers the support they need and deserve. I can be contacted through The Canadian Continence Foundation: help@canadiancontinence.ca and want sufferers to know they are NOT alone.”

— Louise Mott

Additional Information

For more information about fecal incontinence, visit these websites:

Contact Us
PO Box 417
Peterborough ON K9J 6Z3
Phone: (705) 750-4600
Email: help at canadiancontinence dot ca
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