Bowel incontinence is a common problem, but it is one that very few people are prepared to talk about. In fact, there is so much embarrassment and stigma around the issue that nearly half of people with the condition wait at least five years before seeking help.
As gastrointestinal doctors, we are concerned that people are suffering in silence for so long when there are treatments that could help. If you are one of these people, please take comfort from the fact that you are not alone. We believe around one in 10 people are affected at some point in their life, most commonly older people, although bowel incontinence can affect people of any age.
Bowel incontinence isn’t a life sentence and talking to a gastrointestinal specialist could not only help you to understand more about the condition but it could also identify treatments that might help.
What is bowel incontinence?
Bowel incontinence – also called faecal incontinence – means being unable to control your bowel movements, resulting in sudden and unexpected soiling. Naturally, this is a very distressing experience. You may experience a sudden urge to go to the toilet but be unable to get there in time. This is known as urge incontinence. Or you might not experience any kind of sensation before soiling yourself, which is known as passive incontinence or passive soiling. For some people, slight soiling occurs when passing wind.
For some people, bowel incontinence occurs rarely whereas for others it can be a daily occurrence.
Why it happens
Bowel incontinence is normally a symptom of an underlying problem or medical condition. It might be caused by diarrhoea or constipation or because the muscles in the anus have become weakened.
Alternatively, certain long-term health conditions can cause problems with bowel continence, such as dementia, multiple sclerosis and diabetes. A common cause of bowel incontinence is irritable bowel syndrome or IBS.
A 2014 study of 500 people with IBS found that 57% of them cited bowel incontinence as one of their symptoms. Most – 91% – of them reported that it happened once a week or more.
The researchers concluded that bowel incontinence is a major symptom of IBS but one that most patients are unlikely to disclose voluntarily unless specifically asked.
Another condition that causes bowel incontinence is inflammatory bowel disease. One study published in the Journal of Crohn’s and Colitis, September 2013, concluded that at least a quarter of people with IBD but possibly as many as three quarters experience the problem.
Damage to the anal sphincter, which can occur during childbirth, can also be a problem, as can neurological damage which may impair rectal sensation. In childhood, soiling problems (encopresis) can be linked to chronic constipation.
Impact of bowel incontinence
Bowel incontinence can affect a person’s confidence, self-esteem and quality of life. Fear of “soiling” may prevent people from socialising or enjoying the activities they used to enjoy. The stigma associated with the problem causes many people to try and conceal it from family and loved ones and even from their doctor.
Treatment of bowel incontinence
Telling your doctor about the problem can be a weight off your mind and the start of the journey to get your life back. Your doctor will want to refer you for tests to rule out any kind of serious health condition, such as bowel cancer, and to pinpoint the cause of the incontinence.
Treatment for the problem is likely to involve a combination of dietary and lifestyle changes (such as recognising your triggers and learning how to manage them), medication to bulk up the stool and slow its transit through the gut, and exercises.
If this fails to address the problem, you may need surgery to repair the muscles around your anus. As a last resort in severe cases, a colostomy may be needed. For children, physical strategies to retrain the bowel may be accompanied by psychotherapy.
Help is available:
- The NHS runs continence clinics, which offer support and information as well as access to continence products.
- The IBS network and Disability Rights UK offer Radar NKS Keys which enable you to access around 9,000 disabled toilets across the country.
If you or a member of your family is experiencing bowel incontinence we can provide discreet and sympathetic diagnostic testing, advice and treatment at one of our private London clinics.