Bowel incontinence


Bowel leakage, also called bowel incontinence, can be a very embarrassing topic to discuss. Many women experience bowel leakage at some time in their life. There are usually ways to reduce incontinence, so seek help as soon as possible. Remember, it is never too late and you are never too old to seek improvements.

What is normal, what are the causes, how is it diagnosed and what can you do to prevent and manage bowel incontinence?

What is bowel incontinence?

Toilet paper

Bowel incontinence is the accidental or involuntary leakage of faeces (also called stools or poo) or wind. This is commonly caused by constipation, but also may be associated with diarrhoea, and can happen to anyone at any age.

What is the normal frequency for bowel movements?

Normal frequency of emptying the bowel when you are healthy can be anything from three times a day to three times a week. You should have a warning that you need to empty your bowel, but be able to get to the toilet in time without having to hurry.

What causes bowel incontinence?

Incontinence can result from having weakened muscles in the pelvic floor and around the anus. This could be as a result of having chronic constipation or haemorrhoids, or can occur after having children or pelvic surgery, and from some medical illnesses.

Diagnosis

Even though it is quite common, many women are embarrassed to talk to their doctor about bowel incontinence, or are unsure what incontinence is.

If you are worried about leakage, try to tell your doctor what's happening, no matter how trivial you think it is.

Bowel weakness can be diagnosed by:

Diagnostic approach What to expect
Medical history

Your doctor may ask you questions about:

  • how often you leak faeces
  • whether you have to rush to get to the toilet
  • when the leakage of faeces occurs, and how often
  • whether there is any pain or bleeding
  • how often you have a bowel movement
  • whether you feel satisfied that you have emptied your bowel completely
  • what your bowel action looks like
  • whether you have constipation and how long this has been happening
  • your daily fluid intake
  • any surgery that might have contributed to the symptoms
  • medications you are taking
Physical examination

The physical examination will assess:

  • the function of your pelvic floor muscles
  • whether there is any bulging of the bowel into the vagina (vaginal prolapse), or rectal prolapse
Anal manometry A test of your anal reflexes and sensations where a small balloon-like device is placed in the anus and then inflated.
Anal and rectal ultrasound An ultrasound is used to provide an image of the rectum, the sphincter muscles and surrounding tissue.

Prevention & management

You can prevent and manage bowel incontinence with a number of simple dietary and lifestyle actions.

Water Drink 6-8 cups or glasses of fluid per day. This does not have to be only water, and includes all of your drinks. Not drinking enough fluid makes stools hard, dry and difficult to pass, which increases the strain on the pelvic floor muscles, and can cause leakage around the hard stool.
Caffeine and alcohol Cut down on caffeinated and carbonated drinks and alcohol, as they can contribute to bowel urgency and incontinence.
Food

To avoid constipation and strain on the pelvic floor muscles, each day:

  • eat
    • 2 serves of fruit
    • 5 serves of vegetables
    • 5 serves of cereals/breads
  • replace refined grains such as white flour with wholegrains such as wholemeal flour
  • include legumes such as kidney beans and lentils
  • eat wholegrain cereals or oats for breakfast
  • try including seeds in your diet, such as pumpkin, flax, sunflower and hemp.
Physical activity Be physically active as this stimulates bowel movement: aim for 30 minutes of moderate physical activity most days of the week, preferably in the morning to get your bowels moving.
Pelvic floor exercises Do pelvic floor exercises regularly to strengthen your muscles.
Lifting

Avoid heavy lifting to reduce strain on your pelvic floor.

Coughing Quit smoking as chronic coughing associated with smoking can weaken your pelvic floor – for help call the Quitline on 13 7848 or visit quit.org.au  
Visit your doctor if you have ongoing respiratory problems that cause you to cough.

Toilet habits

  • Go only when you have the urge to go
  • Sit down properly with your feet firmly supported to fully relax your pelvic floor and sphincter muscles. Leaning forward with your feet up on a small stool can help.
  • Don't strain. Relax and take your time; it can take a few minutes for the bowel action to come.
Medication Medication may be prescribed to treat bowel incontinence.
Surgery Surgery may be used to treat some types of bowel incontinence.
Continence products Continence pads come in different sizes and are designed to absorb bladder or bowel leakage. Continence liners are as small as regular panty liners. Ask your doctor, continence nurse, pelvic floor physiotherapist or pharmacist for advice.

Last updated 01 September 2018 — Last reviewed 04 August 2018

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2018.

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