Bowel incontinence
Bowel incontinence means losing control over emptying the bowel: the contents arrive before you can reach a toilet, or leak out without you noticing at all.
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Medicines commonly prescribed for Bowel incontinence
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 0.67 g lactulose/mlActive substance: lactuloseManufacturer: Lainco S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 10 g lactulose/ 15 mlActive substance: lactuloseManufacturer: Cooper Consumer Health B.V.Prescription requiredDosage form: CAPSULE, 2 mg loperamide hydrochlorideActive substance: loperamideManufacturer: Jntl Consumer Health (Spain) S.L.Prescription not required
Bowel incontinence means losing control over emptying the bowel: the contents arrive before you can reach a toilet, or leak out without you noticing at all. It is not a disease in its own right but a sign that something has gone wrong with the muscles, with the nerves, or with the consistency of the stool. The subject is awkward, which is why people come forward late — often years after the first episodes. Yet what helps most of them is fairly simple: sorting out the diet, treating whatever sits behind the symptom, and training the muscles. Few ever need surgery.
The different ways it shows up
One name covers several distinct situations, and each is treated differently. Your doctor needs to know which one is yours.
- The urge is there, the time is not. The sensation arrives suddenly and leaves you seconds to get to a toilet. Usually behind it is weakness of the outer muscle ring, the one under your control, or stool that is simply too loose.
- Leaking with no warning. You feel nothing, yet marks appear on your underwear. This happens when the inner sphincter, which works without our involvement, is weak, and when the rectum has lost sensitivity.
- Soiling after a bowel movement. The bowel does not empty completely and the remainder comes away later. It often accompanies haemorrhoids and a prolapsed rectum.
- Loss of control over wind. Usually the very first sign, and the one people least often treat as a reason to see anyone.
What lies behind it
There is hardly ever a single cause. More often two or three circumstances add up, none of which would have been noticed on its own.
- loose stool from any source — an infection, irritable bowel syndrome, lactose intolerance, the side effect of a medicine;
- damage to the muscles of the back passage: difficult childbirth with tearing or forceps, surgery for haemorrhoids, a fistula or a fissure;
- age-related weakening of the pelvic floor, more noticeable in women after the menopause;
- nerve disease — long-standing diabetes, multiple sclerosis, the after-effects of a stroke, spinal injury and spinal surgery;
- a rectum that has lost its stretch, after radiotherapy to the pelvis or because of ulcerative colitis and Crohn's disease;
- conditions in which a person stops recognising the urge at all, such as dementia or a severe stroke;
- a prolapsed rectum and large haemorrhoids that stop the muscle ring closing tightly.
Why constipation is so often the cause
This is the least obvious misunderstanding of all, particularly in older people and in children. Hard stool becomes stuck in the rectum and keeps it stretched. The muscles stop holding, and liquid contents flow around that plug from above and escape. From the outside it looks like diarrhoea; in fact it is constipation.
Then comes the mistake: the person takes something to bind the bowel, the plug hardens further and the leaking gets worse. The circle can only be broken the other way round — softening and clearing what has built up, then establishing regular emptying. That is why leaking of this kind is not a thing to treat on your own: first someone has to establish whether the rectum is empty.
In children the picture is much the same. The child holds on because it once hurt, the stool hardens, and liquid stool leaks around it. Parents see soiled underwear and put it down to laziness or misbehaviour. Telling the child off is useless here, and harmful.
When not to wait
Call the emergency services if bowel control has been lost suddenly and at the same time you have numbness around the back passage and the inner thighs, weakness in the legs, difficulty passing urine or severe low back pain. That is how compression of the nerve roots at the base of the spine presents. Hours matter: an operation within the first day usually preserves function, a delayed one no longer does.
Book an appointment within days, rather than waiting for it to settle by itself, if you notice:
- blood in the stool, or black tarry stool;
- weight loss you were not aiming for;
- a change in your bowel habit that has not returned to normal for more than three weeks;
- abdominal pain with a fever;
- urgency that wakes you at night.
Doctors discuss this every day, and your case will not surprise them.
How it is investigated
It all starts with a conversation: when it began, how often, whether there is any warning, what the stool is like, what you eat and what you take, whether there have been births or operations. A diary kept for a week or two helps a great deal, because it shows connections memory cannot reconstruct. Then comes examination of the area and an internal examination of the rectum, in which the doctor judges how strongly the muscles close and checks for retained stool. It is brief and usually painless.
Everything else follows only if something needs clarifying. An ultrasound scan through the back passage shows tears in the muscle ring, manometry measures pressure and sensation, and a colonoscopy is arranged when there are warning signs. Blood tests check glucose, thyroid hormones and inflammation.
What actually helps
The first step is to correct the cause: settle the bowel in irritable bowel syndrome, damp down a flare of colitis, review the medicines. Go through your own cupboard too — magnesium, metformin, some antibiotics and weight-loss drugs all loosen the stool, and sometimes a conversation about switching is all that is needed.
Food is reviewed one item at a time, otherwise you cannot tell what worked. Soluble fibre — psyllium, oats, the flesh of an apple — takes up water and gives the stool form. Coarse bran, by contrast, sometimes increases urgency. The usual troublemakers are caffeine, alcohol, spicy and fatty food, and the sweeteners ending in "-ol" found in sugar-free products.
Pelvic floor exercises do work, but only with correct technique and persistence: months, as a rule. A specialist can add biofeedback, a sensor that shows which muscles you are actually tightening, and learning moves along much faster.
The medicines used are those that slow the passage of contents through the bowel when the stool is loose and, conversely, softeners and osmotic agents when the cause turns out to be retention. The dose is set by a doctor, because both groups tip easily into the opposite extreme. Routine helps as well: trying to empty the bowel at the same time every day, ideally half an hour after breakfast.
If that is not enough, there is rectal irrigation with water on a schedule, and plugs that seal the back passage. For persistent incontinence, procedures are discussed: repairing a torn muscle ring, stimulating the pelvic nerves with a small device under the skin and, in severe cases, forming a stoma. A surgeon goes through the benefits and the risks of each option separately.
Managing everyday life
The skin around the back passage breaks down quickly and heals slowly. Wash with warm water and no soap, pat dry rather than rub, and use a barrier cream, which stops the skin becoming waterlogged. Wipes with alcohol and fragrance are better put away.
- carry spare underwear, a damp cloth and a bag — it gives you back the freedom to go out;
- choose clothes that come off quickly, without belts or awkward fastenings;
- when you arrive somewhere new, note where the toilet is straight away;
- do not drink less in the hope that it will happen less often: dehydration hardens the stool and leads to constipation, and constipation to leaking;
- give up smoking, as nicotine speeds the passage of contents through the bowel.
Online consultation
In an online appointment the doctor will ask what the episodes are like, go through your food and bowel diary, judge whether anything calls for a face-to-face examination or urgent care, help you adjust your diet and your emptying routine, review the medicines you take, and explain which tests are worth arranging and which specialist to see.
This material is for information only and does not replace medical advice.
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