Accidental Bowel Leakage

Accidental bowel leakage (ABL) is the loss of normal control of your bowels. It also is called fecal incontinence or anal incontinence. This condition leads to leakage of solid stool, liquid stool, mucus, or gas.

Accidental bowel leakage can have a significant effect on your quality of life. But there is hope for improvement with the right treatment.

Normal bowel function requires healthy muscles and nerves in the rectum and pelvis. The large intestine (also called the colon) must be able to form and store the stool until you can get to the bathroom. The sphincter muscles of the anus must be strong enough to stay closed until you need to pass stool or gas.

Talking about ABL may feel embarrassing, but telling your obstetrician–gynecologist (ob-gyn) is the first step in getting treatment. Many types of treatment are available depending on the cause of the problem.

Symptoms of a bowel control problem may include:

• Leaking stool, mucus, or gas

• Strong or urgent need to have bowel movements

• Diarrhea

• Constipation

• Streaks or stains of stool on your underwear

ABL can be caused by digestive disorders, including:

• Irritable bowel syndrome (IBS)

• Inflammatory bowel disease (IBD)

• Other chronic diseases

In some women, bowel control problems often are the result of vaginal childbirth. As the fetus passes through the vagina, the muscles and tissues of the rectum may be stretched or torn. The anal sphincter also can be injured during vaginal delivery.

Some women have short-term bowel control problems right after childbirth that improve within a few days or weeks. Other women do not develop a problem until later in life. Also, as a person ages, the anal sphincter may weaken. A minor problem in a younger woman can become worse with age.

Some other common factors that may put you at high risk of ABL include:

• Chronic constipation

• Diarrhea

• Increased number of bowel movements (more than 21 stools a week)

• Often feeling an urgent need to have a bowel movement

• Not being able to control urine

• Obesity

• Smoking

• Older age

• Decreased physical activity

• Anal intercourse

• Other health conditions, such as depression, diabetes mellitus, and IBD

• Past radiation therapy to the anal region

Finding the cause of ABL is an important step in finding the right treatment. Talking honestly with your ob-gyn offers the best chance of finding the right treatment for you.

Your ob-gyn may examine your vagina, anus, and rectum. This is done to look for signs of problems, such as loss of nerve reflexes or muscle tone. In some cases, tests may be needed.

At your office visit, your ob-gyn should ask about your medical history and symptoms. You may be asked to keep a record each time you pass stool. Write down whether you had regular bowel movement or leakage of stool or gas. Also, write down any other symptoms and what you were doing at the time. This symptom record will help your ob-gyn diagnose why you are having problems.

You also should tell your ob-gyn about any prescription or over-the-counter products or herbal remedies you may be taking. Some medications and supplements can cause constipation or diarrhea and may contribute to your symptoms.

You and your ob-gyn should review the results of your physical exam and any tests that might have been ordered. You also should talk about your symptom record. Describe your symptoms clearly to help your ob-gyn find the best treatment for you.

The following are some of the tests that may be done to see how well the muscles in your anus and rectum are working:

• Anorectal manometry—This test uses a small sensing device to test the strength of the anal sphincter. The device is placed in the anus and records changes in pressure as you relax and tighten the muscles.

• Defecography—This X-ray test is used to study the rectum and anal canal during a bowel movement.

• Nerve tests—These tests check if the nerves to the rectum and anus are working well.

• Imaging tests, such as an ultrasound exam

• Tests to look inside your anus, rectum, and colon, including colonoscopy

• Tests of blood, stool, and urine

The type of treatment depends on the cause of the problem and how severe it is. Your ob-gyn may care for you, or you may be referred to a doctor who specializes in treating ABL, such as a gastroenterologist.

Many women with ABL can improve symptoms with self-care. Changes in diet, taking medication, or doing special exercises can make a difference for many women.

Also, your doctor can give you advice about caring for the skin around the anus, which can become irritated. This irritation can lead to pain or itching. You can manage anal discomfort by

• avoiding foods that irritate the perianal skin

• using zinc oxide ointment around the anus

• wearing disposable underwear or using pads in your own underwear

Talk with your ob-gyn about approaches that are best for you. Report any skin breakdown, rashes, irritation, or itching.

If you leak gas or have diarrhea, keeping a food diary can help you identify foods that cause these problems. If you find a pattern, you can avoid these foods. Your food diary should note what you eat, how much, and when. You also will keep track of your symptoms, what type of bowel movements you have, and when they occur.

Dairy products and foods that contain gluten, a protein found naturally in wheat, rye, and barley, can cause gas and diarrhea in some people. Some artificial sweeteners also can cause diarrhea. Some people have trouble absorbing fatty foods. Other people have trouble with spicy foods, alcohol, and caffeine. Keeping a food diary can help you figure out which foods affect you.

If you have constipation, your ob-gyn may suggest you eat more fruits and vegetables, drink plenty of water, and add fiber. Fiber is found in plant foods. It is the part of the plant that your body cannot digest. Fiber can help prevent constipation by adding bulk to the stool, making it easier to pass.

Adult women should eat about 25 grams of fiber daily. Foods that are high in fiber include

• the outer shell of whole grains like oats, corn, and wheat

• beans

• berries

• green, leafy vegetables

You also can add fiber by using fiber supplements.

In some cases, yes. You and your ob-gyn may choose a medication that fits your situation and that can best control your bowel leakage. Some over-the-counter medications can help relieve symptoms. Stronger medications that treat diarrhea, control gas leakage, or prevent constipation may be prescribed.

Yes. Kegel exercises strengthen the muscles that surround the openings of the anus, urethra, and vagina. Doing these exercises regularly may improve incontinence. Your ob-gyn or a physical therapist can help you be sure you are doing these exercises correctly.

Kegel exercises help tone the muscles of the pelvic floor. These muscles support your urethra, bladder, uterus, and rectum. Strengthening these muscles may help improve bladder control. After delivery, exercises may help tighten vaginal muscles that are stretched from childbirth. Here is how Kegel exercises are done:

• Squeeze the muscles that you use to stop the flow of urine. This pulls the vagina and rectum up and back.

• Hold for 3 seconds, then relax for 3 seconds.

• Do 10 contractions three times a day.

• Increase your hold by 1 second each week. Work your way up to 10-second holds.

Make sure you are not squeezing your stomach, thigh, or buttock muscles. You also should breathe normally. Do not hold your breath as you do these exercises.

You can do Kegel exercises anywhere—while working, driving in your car, or watching television. But you should not do these exercises when you are urinating.

Bowel training involves training yourself to have regular bowel movements at the same time each day. Several techniques can be used. Your ob-gyn can tell you which technique is best for you based on your symptoms.

When used to manage ABL, biofeedback is a training technique that helps you improve the function of the anal sphincter muscles. In biofeedback, sensors are placed inside or outside the anus. These sensors provide visual feedback on a monitor so you can see if you are contracting and relaxing muscles correctly.

Like exercising any other type of muscle, you can strengthen the anal sphincter muscles over time. By helping you identify your anal muscles, biofeedback can improve your ability to sense stool or gas in the rectum.

• One device pumps air into a balloon inside your vagina. The inflated balloon puts pressure on the rectum. This keeps stools from passing. To control when you pass stool, you can add or remove air from the balloon.

• Another device is an anal plug. You can remove the plug when you need to pass stool.

Electrical stimulation therapy can be used when the nerves that control the bowels are not working correctly. With this treatment, a device is implanted under the skin, usually right above the buttocks. A thin wire is placed near the sacral nerves (near the tailbone), which control the colon, rectum, and anal sphincter. The device sends a mild electrical signal along the wire to these nerves to restore the normal function of the bowels.

A special kind of injection can be used to treat bowel control problems. With this treatment, an agent that adds bulk is injected in the tissue surrounding the anus. This narrows the anal opening to help the anal sphincter work better.

In some cases, surgery may help correct loss of bowel control. Most people will try other treatments before surgery is recommended.

If the sphincter muscle of the anus is torn, it sometimes can be repaired with surgery. Sutures (stitches) are used to bring together the torn ends of the sphincter so they can heal. Your ob-gyn can help you decide if surgery is an option for you.

Anus: The opening of the digestive tract through which bowel movements leave the body.

Biofeedback: A technique used by physical therapists to help a person control body functions, such as heartbeat or blood pressure.

Bladder: A hollow, muscular organ in which urine is stored.

Bowels: The small and large intestines.

Colon: The large intestine.

Colonoscopy: An exam of the large intestine using a small, lighted instrument.

Depression: Feelings of sadness for periods of at least 2 weeks.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Fecal Incontinence: Involuntary loss of control of the bowels.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Inflammatory Bowel Disease (IBD): The name for a group of diseases that cause inflammation of the intestines. Examples include Crohn’s disease and ulcerative colitis.

Irritable Bowel Syndrome (IBS): A digestive disorder that can cause gas, diarrhea, constipation, and belly pain.

Kegel Exercises: Pelvic muscle exercises. Doing these exercises helps with bladder and bowel control as well as sexual function.

Large Intestine: The portion of the intestine that starts at the end of the small intestine and ends at the anus.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Pelvis: The lower portion of the trunk of the body.

Radiation Therapy: Treatment with radiation.

Rectum: The last part of the digestive tract.

Sphincter Muscles: Muscles that can close a bodily opening, such as the sphincter muscle of the anus.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body.

Urethra: A tube-like structure. Urine flows through this tube when it leaves the body.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.