Bowel incontinence – time we talk about it

Bowel incontinence isn’t something that comes up in conversation often. People may avoid telling their doctor or caregiver about their problems with bowel incontinence. They would rather talk about things like itching or other continence-related issues that are more comfortable to talk about.

If you are in a caregiving position, knowing that this is how people approach these conversations can be a good thing. In this article, we will outline what bowel incontinence is, along with some of the most common causes and ways to treat it.

Bowel incontinence, also known as fecal incontinence, is the unintentional loss of stool. For a bowel to function properly and avoid bowel leakage, the nerves and muscles in the rectum and anus work together in a complex system, and when that system fails, bowel incontinence happens.

Bowel incontinence can also happen due to constipation or diarrhea. This is why knowledge about stool consistency is highly useful for you as a caregiver when treating and managing someone living with this problem.

You can learn more about double incontinence.

Common symptoms of bowel incontinence include:

• A sudden urge to pass stool without control¹
• Leakage of stool during daily activities,¹ sometimes without feeling the urge to go to the bathroom
• Difficulty controlling gas and bowel movements¹

While this condition could be distressing, there are many strategies and treatments available to help manage symptoms and improve quality of life.

Bowel incontinence can be caused by many factors, like diarrhea, constipation, or nerve- or muscle damage. Individuals with diseases that affect the central nervous system (for example multiple sclerosis (MS), Parkinson’s disease, spina bifida, stroke, etc.) often have constipation or bowel incontinence. This occurs because there is an interruption to the nerve pathways. If the nerves that control the anal sphincter muscles or those that sense stool are damaged, it can cause constipation or fecal incontinence.

Common causes of bowel incontinence include:

• Muscle or nerve damage: Damage to the anal sphincter or pelvic floor muscles, often caused by childbirth, surgery, or nerve disorders, can affect bowel control.¹
• Chronic diarrhea or constipation: Both conditions can strain and weaken the muscles that control bowel movements, making leaks more likely. ¹
• Hemorrhoids: Swollen veins around the anus can stop it from closing properly, leading to accidental stool leakage.¹
• Neurological conditions: Conditions such as diabetes or multiple sclerosis can interfere with nerve signals between the brain and the bowels. ¹
• Anal prolapse: This occurs when part of the bowel protrudes from the rectum, leading to fecal incontinence. It’s more common in older adults. Learn more about prolapse and incontinence.
• Aging: As we get older, the muscles that help control bowel movements naturally weaken, increasing the chance of incontinence

Many different medications can cause bowel incontinence by affecting bowel function, sphincter tone or cognitive awareness. Bowel incontinence can also happen if you have inflammatory diseases like Crohn’s disease or ulcerative colitis. Both Crohn’s and ulcerative colitis cause diarrhea, which in turn can cause leakages. Loose stool and urgency from the bowel can cause even the strongest pelvic floor to leak if the bathroom is not close enough.

Also, just falling ill can affect bowel continence. An elderly person with a medical disease might be immobile, cognitively impaired and/or experience a loss of appetite and difficulties with drinking enough fluids. All these factors could increase the risk of incontinence.

The bowel incontinence treatment would depend on the underlying cause of the problem, but the purpose is always to regulate the bowel movements and make necessary changes to get proper consistency of the feces.

Avoid constipation

Exercise, drink a lot of water and add more high-fiber foods to the diet.

Treat the diarrhea

Treating the cause of diarrhea, caused by an intestinal infection, may take away the fecal incontinence too. For example, make sure to review the medications to see how they affect the bowel. Too many laxatives can be what’s causing diarrhea.

Strengthening the pelvic floor

Training the muscles of the pelvic floor through Kegel exercises might also be helpful and find a correct toilet posture to help bowel emptying. Surgery may be an alternative if no other treatment works.

Bladder and bowel training

Scheduled toileting, learning to delay urges, and establishing routines can improve control over time.1 If you’re also working on bladder control, Bladder Training can be a helpful resource.

Don’t forget the skin care

Prolonged contact with fecal enzymes and microorganisms is a key risk factor for incontinence associated dermatitis (inflammation and/or erosion of the skin caused by exposure to urine or feces). Feces contain harsh enzymes and corrosive compounds that can quickly degrade the skin. Therefore, if an accident has occurred, prompt removal of feces is important. Clean the skin gently with proper products for perineal care and put on a protective barrier cream if necessary. Check out TENA skin care products.

Dietary Adjustments

Diet plays a big role in bowel health. And some adjustments may be needed to manage incontinence.

• Identify trigger foods: Certain foods (like spicy foods, caffeine, or dairy) can trigger bowel urgency or diarrhea in some people. 1 It’s helpful to keep a food diary to spot patterns and avoid those triggers.
• Increase fiber intake: Adding more fiber to the diet can help bulk up stool and regulate bowel movements but check in with a healthcare provider before making drastic adjustments. ¹
• Stay hydrated: Drinking plenty of water keeps digestion smooth and can help prevent constipation.

For more guidance, check out What to Eat and Drink for Bladder and Kidney Health.

Managing Anxiety & Stress

Bowel incontinence can be worsened by stress and anxiety, but learning to manage mental well-being can help:

• Try relaxation techniques like mindfulness, meditation, and deep breathing exercises to calm the body and mind.
• If a patient is feeling overwhelmed, counselling or joining a support group can be incredibly helpful for emotional support and learning coping strategies.

Learn more in this helpful guide: Anxiety Related Incontinence and What to Do When it Happens

Incontinence Products

• Having the right products on hand can make all the difference
• Protective underwear or pads offer security and confidence when out and about.
• Don’t forget about skin care! Regular cleaning and using barrier creams can help prevent irritation or rashes. ¹
• You can browse Incontinence Briefs to find what works best for patient needs.

Try and support the person you take care of to make sure the problem gets addressed. Doctors handle these issues every day, and it’s important that you get the right diagnosis. Once you know what is causing the problem it is easier to find proper treatment.

Also, bear in mind that people are different. A person with frequent leaks may need a different product than someone with incontinence that is more spread out. Make sure you find a product that really does the job. Finding a toileting routine that works is highly important, and make sure you remove the fecal leakage promptly. Perform proper skin care and use a barrier cream for extra protection.