Bowel Incontinence Patient Education
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Bowel Incontinence Overview
When stool or feces leaks from the rectum and there is loss of control in having bowel movements, a diagnosis of bowel incontinence is made.
The leakage ranges from full loss of bowel control to a small amount of seepage, either solid or liquid, when passing gas.
While more common in older people, it is not associated with aging. Twelve percent of adults suffer from fecal incontinence – almost 18 million people.
Causes of bowel incontinence include:
- Irregular bowel habits (constipation or diarrhea)
- Nerve injury
- Muscle weakness or damage
- Hemorrhoids
- Pelvic floor dysfunction
- Lack of flexibility for the rectum
Conditions leading to fecal incontinence include:
- Complicated childbirth with pelvic floor injuries to muscles
- Nervous system damage from injuries or disease
- Diarrhea
- Chronic medical ailments
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Doctors Who Treat Bowel Incontinence
As your fecal incontinence is diagnosed, treated and managed, you may encounter the following team of doctors and specialists listed in this patient education guide.
- Gastroenterologist — doctor who specializes in conditions and health of the digestive system. Any abnormalities will be diagnosed and treated accordingly.
- Proctologist — physician who specializes in the treatment and diagnosis of conditions affecting the colon, rectum and anus.
- Nutritionist — trained professional who formulates diet plans for both healthy and compromised individuals, as well as advising which vitamins and supplements promote good health. High fiber foods incorporated into a meal plan as well as those foods that promote regular bowel habits are key to treatment.
- Nurses and nurse practitioners — focus on prevention, wellness, and education of patients about health and healthcare choices. The nurse practitioner will discuss various therapy options with the patient and help determine the most appropriate choice for that individual.
- Colorectal surgeon — physician who specializes in the diagnosis and care of illness through incising (cutting the body) or repairing incisions. This physician will be the one to correct any bowel/rectal problems of structural abnormalities or dysfunctions.
How to Prepare for Your Bowel Incontinence Doctor Visit
Having made your appointment with a healthcare provider, there are certain actions you can take to maximize the benefit of your doctor visit, listed below in this bowel incontinence patient education guide.
Inform the doctor if you could be pregnant or breast-feeding.
On the day of consultation with the physician bring a list of:
- All past medical conditions and prior surgeries with dates
- All medications including vitamins, herbs, and supplements
- Any other symptoms
- Allergies
- All recent radiological images
- Results of all recent laboratory tests
- Food diary of foods that caused incontinence or diarrhea
- A record of bowel habits and incidences of leakage with type (most important)
For anorectal ultrasound – Eat a small dinner the night prior to the test, drinking only clear liquids and avoiding tea, coffee and soft drinks after dinner.
For CT scans or MRIs – Jewelry, hairpins, glasses, hearing aids, and dentures should be left home or removed. Do not eat for 6 hours prior to the exam.
For PET scans – Abstain from eating for 4-6 hours prior to scan and avoid any excessive physical activity. Bring a favorite music collection on CDs and a CD player or mp3 player.
Questions to Ask Your Doctor About Bowel Incontinence
From your initial diagnosis throughout your treatment and care, you will have questions. Listed below in thisbowel incontinence patient education guide are questions to discuss with your doctor so you can make informed decisions about your condition and your care.
Questions About My Diagnosis
- Are there other medical conditions causing fecal incontinence?
- Can this condition be from other drugs that I am taking?
- Is this a symptom of infection in my body?
- Is this problem permanent or treatable?
- Are there tests to confirm the diagnosis?
Questions About My Treatment
- What type of treatment do you advise trying first? Why?
- Do I need surgery, drugs or a combination?
- What are the risks of the treatment?
- What is the success rate of the treatment advised?
- Are there nutritional supplements to help me?
- Is there literature that I can read about this?
Questions About Lifestyle & Family
- What type of diet do you advise?
- What foods should I avoid?
- Can I still drink alcoholic beverages?
- Are there exercises that I should do to decrease leakage?
- Are there physical activities or exercises that make this worse?
- Do the physical activities on my job make my problem worse?
Common Tests or Labs to Diagnose Fecal Incontinence
Diagnosis of fecal incontinence is made tentatively with a thorough medical history from the patient and physical examination. Then, the following tests are used in evaluation.
|
Test |
Why Test? |
What Happens? |
Normal Result |
|
Anorectal ultra-sonography |
Assess the anal sphincter muscle structure and tone |
You are placed on your side on an examination table with knees flexed to the chest. A probe is then inserted into the rectum. High frequency sound waves (ultrasound waves) are emitted. The echo pattern is converted into a picture (sonogram) on a computer monitor. |
Normal images reveal the organ to be the appropriate shape and tissue corresponding to the proper anatomy with no strictures or tumors.
|
|
Anal manometry |
Evaluates rectal contractility and sensitivity |
You are placed on your side upon the examination table with knees flexed to the chest. A small, flexible tube with a balloon at one end is inserted into the rectum. The tube is connected to a machine where pressure is measured. The small balloon is inflated in the rectum to evaluate the normal reflex pattern. During the test, you may be asked to squeeze or tighten the sphincter as well as push so that values are acquired during these maneuvers. |
The maximum basal pressure (MBP) = 68 +/- 21 for men and 63 +/- 19 mmHg) for women. Maximum squeeze pressure (MSP) = 183 +/- 73 for men and 102 +/- 36 mmHg, p less than 0.001) for women. MBP and MSP decrease significantly with age. |
| MRI (magnetic resonance imaging) |
Looks for abnormalities throughout the digestive system/can provide images of the anal sphincter muscles |
You are asked to lie on your back on a table with head, torso and arms strapped down to prevent movement. The table then slides into the tunnel-like space that contains a magnet. You may hear banging or tapping noises from the magnet movement but are often offered piped in music to soothe you and mask the noise. Images are taken in body cross sections. The test usually takes 30-60 minutes and is painless. |
No enlargement, strictures, tumors, or masses are seen. Anal sphincter shows proper tone. |
|
Proctography (also known as defecography) |
Demonstrates the amount of stool the rectum holds and rectal capacity. Also shows the efficiency of stool elimination by the rectum |
You are asked to lie on an exam table with your knees flexed. A caulk gun device is inserted rectally with infusion of barium paste creating distension. You are then transferred to a portable plastic commode adjacent to a fluoroscope that records defecation. An x-ray camera visualizes the buttocks, lower pelvis and rectal vault. |
Visualizes a rectal outlet obstruction, if present, as well as an anterior or posterior rectocele and prolapse.
|
|
Proctosigmoidoscopy |
Searches and diagnoses any tumors, inflammation, or scar tissue in the rectum and lower section of the large intestine |
You are asked to lie on an exam table on your left side with your knees flexed toward your chest. The doctor slowly inserts a gloved finger into the anus to assess any inflammation or blockage. A lubricated tube with a lens and light is then inserted into the anus and upward into the rectum and lower colon while blowing air through the scope to dilate the colon along the way, thereby improving visualization. Any watery stool, liquid, blood or mucus is aspirated through the scope. The process takes less than ten minutes. |
No masses, strictures, or obstructions are seen. |
|
Anal electro-myography |
Measures the integrity of the nerve stimulation to both rectal muscle and pelvic floor |
After lying on your left side, knees flexed to the chest, a small plug electrode is inserted into the anal canal. You’re then asked to relax, squeeze, and push while the anal sphincter muscle electrical activity is recorded and displayed on a computer screen. |
The EMG confirms the proper muscle contractions during squeezing and muscle relaxation during pushing |
|
CT Scan (computed tomography) |
Used to detect enlargement or abnormalities of organs, blood vessels, lymph nodes, and soft tissue of the body Also used to guide biopsies to affected areas and to guide needles for minimally invasive tumor treatments Helps in radiation treatment administration Helps to stage cancers and determine success of chemotherapeutic treatments |
You will be asked to lie on a narrow examination table. An intravenous needle and line may be inserted. You may be asked to swallow contrast material, which may be slightly unpleasant. Restraints may or may not be used to maintain a still position. The table then slides into the center of a tunnel-like machine. The X-ray tube rotates around you and you may hear banging as imaging takes place. A speaker and microphone may be fixed into the chamber allowing you to talk to and hear the technician as well as hearing piped in music. When satisfactory images are obtained, the table will slide out of the chamber and you may arise from the table. |
Normal sized organs, blood vessels and lymph nodes with no enlargements, distortions, abnormal shapes or narrowing. |
Written by Barbara Hales, MD
Common Medications and Treatments for Bowel Incontinence
|
Treatment |
How/Why it Works |
|
Laxatives
|
When incontinence is caused by constipation and overflow, the laxatives will assist in waste elimination by softening the stool. |
|
Anti-diarrhea drugs |
These drugs cause bulking of stool and less frequent passage of waste products. |
|
Anti-spasmodic drugs |
These drugs decrease spontaneous bowel motions. |
Surgical Therapy
Surgical correction is used to improve quality of life when all other methods have failed to bring relief.
|
Treatment |
How/Why it Works |
|
Sphincteroplasty |
Rejoins the separated ends of a torn sphincter muscle |
|
Artificial sphincter |
Involves the insertion of an inflatable cuff around the anus and a small pump implanted subcutaneously with inflation controlled by the patient to mimic the function of a normal sphincter |
|
Correction of structure |
Repair of hemorrhoids, rectal prolapse, or rectocele |
|
Colostomy |
In rare and severe cases: digestion is rerouted to a bag attached to the intestinal opening through the abdominal wall which collects stool |
Supportive/Natural Therapies
|
Treatment |
How/Why it Works |
|
Diet modification |
Eating high-fiber foods like wheat and grains adds bulk to the stool. If incontinence is secondary to constipation, increase intake of fluids and also eat high-fiber foods. |
|
Exercise and holistic therapies |
Bowel training – try to evacuate the bowels on a schedule after eating and make it routine Biofeedback – strengthen anal sphincter muscles and pelvic floor muscles by contracting the anus when a feeling of waste release is imminent |
|
Sacral nerve stimulation |
A device can be implanted which gives small electrical impulses to the sacral nerves, which go from the spinal cord to the pelvic muscles. The pulses can enhance the strength of the pelvic and bowel muscles. This treatment is not offered until other options have been tried. |
