Information about
Maintaining Bowel Control
www.corecharity.org.uk
What are the symptoms?
What are the causes?
What is faecal incontinence?
When should I consult a doctor?
What will the doctor do?
How should I treat
faecal incontinence?
Can acute faecal incontinence be prevented?
Faecal incontinence explained
Most of us take it for granted that we can does not function properly. Bowel contents
control our bowels. We barely have to think escape. Faecal (or anal) incontinence, also
about controlling the release of wind (gas), known as soiling, is the loss of stool, liquid
or of liquid or solid (stools or faeces) from or gas from the bowel at an undesirable
the bowel. We do not have ‘accidents’ nor time. It can occur at any age and may affect
are we ‘caught short’, unless perhaps we up to one in 20 people. It is certainly more
suffer a short-lived bout of diarrhoea. common than was thought some years ago.
Simple tests can often show where the
Sometimes, however, control is lost problem is, and treatment is frequently
because the bowel or the muscular ring successful.
(sphincter) around the back passage (anus)
How do we normally
control the bowel?
Normally the bowel and rings of muscle
around the back passage (anal sphincter)
work together to ensure that bowel contents
are not passed until we are ready. The bowel
contents move along the bowel gradually.
The sphincter has two main muscles which
keep the anus closed: the inner (internal anal
oesophagus
sphincter) ring, which keeps the anus closed
at rest, and the outer (external anal
liver sphincter) ring, which provides extra
stomach protection when the urge to open the bowel
is felt and when we exert ourselves or cough
or sneeze. These muscles, the nerves
gall pancreas
bladder supplying them and the sensation felt within
the bowel and sphincter all contribute to
the sphincter remaining tightly closed.
colon This balance enables us to stay in control
small
intestine (or ‘continent’).
rectum
anus
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Medical advice
What causes incontinence? • People suffering from disorders
Faecal incontinence occurs most commonly such as multiple sclerosis, and strokes –
because the anal sphincter is not functioning resulting in damage to the nerves
properly. Damage to the sphincter muscles supplying the sphincter
or to the nerves controlling these muscles,
excessively strong bowel contractions, or What tests may be needed?
alterations to bowel sensation can all lead Tests of sphincter function are relatively
to this disturbance of function. simple, do not require preparation, are
quick to perform and are usually pain-free.
Who suffers from faecal The strength of the muscles, sensation and
incontinence? nerve function, for example, can all be
Males and females of any age may be tested using simple pressure-measuring
incontinent, for example: devices. An ultrasound scan can provide a
• Children and teenagers – if they are born clear picture of both the sphincter muscle
with an abnormal sphincter or if they have rings, showing if one or both is damaged.
persistent constipation This test is not uncomfortable, takes only
• Mothers, following childbirth – due five minutes, and involves no radiation.
usually to a tear (hidden or obvious) in
the sphincter muscles These tests are usually performed in units
• People of any age who experience an with a special interest in continence.
injury or infection of the sphincter: Your family doctor can advise.
they may be affected immediately or later
in life What is the treatment?
• People suffering from inflammatory Simple Self Help Measures
bowel disease (colitis) or irritable bowel • Changes to diet and bowel habit
syndrome (alternating diarrhoea and can be helpful for many people. It is
constipation together with abdominal worth experimenting with your diet to
pain) – because the bowel is very see if certain foods worsen the situation.
overactive and squeezes strongly In particular, an excessive high fibre
• Older people – because of constipation diet (too much bran, cereal, fruit etc), too
and overflow from the bowel, or due to much caffeine or alcohol and a
failing ability to get to the toilet, or due to lot of artificial sweeteners can worsen
sphincter damage persisting from a faecal incontinence.
younger age
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Medical advice
Drugs may be helpful when: What else might help?
• The bowel is squeezing too strongly In the very unusual situation that nothing
(urgency to get to the toilet quickly) can be done to decrease incontinence,
• The stool is very loose appliances and advice are available which
• The sphincter muscles are weak. can make life much more comfortable.
Advice should be sought from a local
Drugs can decrease movement in the continence advisor; your family doctor
bowel, make the stool more formed, can help.
and make the sphincter muscle tighter.
These drugs are well-established, relatively Where should I go for help?
free of side-effects, and safe to use. Your family doctor will be able to put you
Occasionally faecal incontinence is due to in contact with a specialist who has expert
not emptying the bowel completely, and knowledge about faecal incontinence.
then use of suppositories or laxatives might These problems are common so you need
be helpful. not feel embarrassed about discussing them.
Most of the treatments are simple and
Exercise and Biofeedback effective, so do not hesitate to seek advice.
Special exercises to strengthen the anal
sphincter muscles help many people. If you would like to talk to a nurse in
Techniques such as biofeedback are now confidence you can call the Continence
available to re-train the bowel to be more Foundation Helpline on 0845 345 0165
sensitive to the presence of stool, so that the or contact www.bowelcontrol.org.uk.
sphincter contracts when necessary.
The need for research
Surgery The causes and treatments for faecal
When the sphincter has been injured, incontinence are still not fully understood
leading to a gap in the sphincter muscles, an and more work is needed to improve
operation performed through the skin treatments and practical help for sufferers.
around the anus can improve the problem
for many patients. When there is nerve
damage to sphincter muscles a different
operation to tighten the sphincter will
sometimes help.
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