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Bowel incontinence - Treating bowel incontinence

NHS Choices Medical Reference

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If you have bowel incontinence, your treatment plan will depend on your underlying condition and the pattern of your symptoms.

Trying the least intrusive treatments first, such as dietary changes and exercise programmes, is often recommended.

Medication and surgery are usually only considered if other treatment options are unsuccessful.

Continence products

You may find it helpful to use continence products until your bowel incontinence is better controlled.

Anal plugs are one way to prevent involuntary soiling. An anal plug is made of foam and designed to be inserted into your bottom. However, these plugs can be uncomfortable and only a few people find them to be a long term solution.

If the plug comes into contact with any moisture from the bowel, it expands and prevents any leakage or soiling. Anal plugs can be worn for up to 12 hours, after which time they are removed using an attached string.

Disposable body pads are contoured pads that soak up liquid stools and protect your skin. They can also be used in cases of mild bowel incontinence.

Most continence products are available for free on the NHS.

Your local NHS continence service can offer help and advice about continence products, and you don't usually need a referral from your GP to make an appointment. These clinics are staffed by nurses who specialise in continence treatment. The Bladder & Bowel Foundation can help you find your local service.

Read more about incontinence support on the NHS.

Dietary changes

In cases of bowel incontinence associated with diarrhoea or constipation, it is often possible to control your symptoms by making changes to your diet.

It may be beneficial to keep a food diary to record the effect of your dietary changes on your symptoms.

Diarrhoea

The National Institute for Health and Care Excellence (NICE) has published dietary advice for managing diarrhoea in cases of irritable bowel syndrome (PDF, 39Kb). These guidelines can also be applied for people with diarrhoea associated with bowel incontinence.

The advice from NICE includes the following:

  • limit fibre intake from wholegrain breads, bran, cereals, nuts and seeds (except golden linseeds)
  • avoid skin, pips and pith from fruit and vegetables
  • limit fresh and dried fruit to three portions a day and fruit juice to one small glass a day (make up the recommended 'five a day' with vegetables)
  • limit how often you have fizzy drinks and drinks containing caffeine
  • avoid foods high in fat, such as chips, fast foods and burgers

Constipation

A high-fibre diet is usually recommended for most people who have constipation-associated bowel incontinence. Your GP can tell you if a high-fibre diet is suitable for you.

Fibre can soften stools, making them easier to pass. Foods that are high in fibre include:

  • fruit and vegetables
  • beans
  • wholegrain rice
  • wholewheat pasta
  • wholemeal bread
  • seeds, nuts and oats

Drink plenty of fluids because this can help to soften your stools and make them easier to pass.

Pelvic floor muscle training

Pelvic floor muscle training is a type of exercise programme used to treat cases of bowel incontinence caused by weakness in the pelvic floor muscles.

A therapist, usually a physiotherapist or specialist nurse, will teach you a range of exercises. The goal of pelvic floor muscle training is to strengthen any muscles that may have been stretched and weakened.

You will probably be required to carry out the exercises three times a day, for six to eight weeks. After this time, you should notice an improvement in your symptoms.

Exercises to try

Check with your health professional before trying these at home.

First, pretend you're trying to hold in a bowel movement. You should feel the muscles around your anus tighten.

Next, sit, stand, or lie in a comfortable position with your legs slightly apart.

  • Squeeze your pelvic floor muscles for as long as you can, then relax. Repeat five times.
  • Squeeze the muscles as hard as you can, then relax. Repeat five times.
  • Squeeze the muscles quickly, then relax. Repeat five times.

If you find these exercises too difficult, try fewer repetitions at first and build them up. If they get too easy, try doing more repetitions. You can do the exercises without anyone knowing about them, so they should be easy to fit into your daily routine.

Bowel retraining

Bowel retraining is a type of treatment for people who have reduced sensation in their rectum as a result of nerve damage, or for those who have recurring episodes of constipation.

There are three goals in bowel retraining:

  • to improve the consistency of your stools
  • to establish a regular time for you to empty your bowels
  • to find ways of stimulating your bowels to empty themselves

Improving stool consistency is usually achieved by modifying your diet (see above).

Establishing a regular time to empty your bowels involves assessing your daily routine and finding the most convenient time when you can go to the toilet without being rushed.

For some people, this may involve waking up early so that they can spend time going to the toilet after breakfast, while other people may prefer to set aside some time in the evening after dinner.

Ways to stimulate bowel movements can differ from person to person. Some people find that a hot drink and meal can help. Others may need to stimulate their anus using their finger.

Biofeedback

Biofeedback is a type of bowel retraining exercise that involves placing a small electric probe into your bottom.

The sensor relays detailed information about the movement and pressure of the muscles in your rectum to an attached computer.

You are then asked to perform a series of exercises designed to improve your bowel function. The sensor checks that you are performing the exercises in the right way.

Medication

Medication can be used to help treat soft or loose stools or constipation associated with bowel incontinence.

Loperamide is a medication widely used to treat diarrhoea. It works by slowing down the movement of stools through the digestive system, while allowing more water to be absorbed from the stools. Loperamide can be prescribed in low doses to be taken regularly over a long period of time.

Laxatives are used to treat constipation. They are a type of medication that helps you to pass stools. Bulk-forming laxatives are usually recommended. These help your stools to retain fluid. This means they are less likely to dry out, which can lead to faecal impaction.

Enemas or rectal irrigation

Rectal irrigation or enemas are used in cases where bowel incontinence is caused by faecal impaction and other treatments have failed to remove the impacted stool from the rectum.

These procedures involve a small tube that is placed into your anus. A special solution is then used to wash out your rectum.

Surgery

Surgery is usually only recommended for the treatment of bowel incontinence after all other treatment options have been tried.

The main surgical treatments used on the NHS are sphincteroplasty and sacral nerve stimulation. Other treatments - such as tibial nerve stimulation, endoscopic heat therapy and artificial sphincter surgery - can also be used, but their availability on the NHS is limited.

An operation called a colostomy is more widely available on the NHS, but it is only used if other treatments are unsuccessful.

These treatments are outlined in more detail below.

Sphincteroplasty

A sphincteroplasty is an operation to repair damaged sphincter muscles. The surgeon removes some of the muscle tissue and the muscle edges are overlapped and sewn back together. This provides extra support to the muscles, which makes them stronger.

Sacral nerve stimulation

Sacral nerve stimulation is a treatment used for people with weakened sphincter muscles.

Electrodes are inserted under the skin in the lower back and connected to a pulse generator. The generator releases pulses of electricity that stimulate the sacral nerves.

The stimulation causes the sphincter and pelvic floor muscles to work more effectively, helping to decrease episodes of incontinence.

At first, the pulse generator is located outside your body. If the treatment is effective, the pulse generator will be implanted deep under the skin in your back.

The most commonly reported complications of the procedure are infection at the site of surgery and technical problems with the pulse generator, which require additional surgery to correct.

See the NICE guidelines on Sacral nerve stimulation for faecal incontinence.

Tibial nerve stimulation

Tibial nerve stimulation is a fairly new treatment for bowel incontinence.

A fine needle is inserted into the tibial nerve just above the ankle and an electrode is placed on the foot. A mild electric current is passed through the needle to stimulate the tibial nerve. It is not known exactly how this treatment works, but it's thought to work in a similar way to sacral nerve stimulation.

NICE concludes that the procedure appears to be safe, although there are still uncertainties about how well it works.

See the NICE guidelines on Treating faecal incontinence by stimulating the tibial nerve.

Injectable bulking agents

Bulking agents, such as collagen or silicone, can be injected into the muscles of the sphincter and rectum to strengthen them.

The use of bulking agents in this way is a fairly new technique, so there is little information about the long-term effectiveness and safety of this type of treatment.

You should discuss the possible advantages and disadvantages of this type of treatment in full with your treatment team before deciding whether to proceed.

See the NICE guidelines on Treating faecal incontinence with injectable bulking agents.

Endoscopic heat therapy

Endoscopic radiofrequency (heat) therapy is a fairly new treatment for bowel incontinence.

Heat energy is applied to the sphincter muscles through a thin probe, to encourage scarring of the tissue. This helps tighten the muscles and helps to control bowel movements.

The National Institute for Health and Care Excellence (NICE) recently produced guidelines on this procedure. NICE concluded that the procedure appears to be safe, although there are still uncertainties about how well it works.

As well as the uncertainties surrounding this procedure, it is also very expensive. Therefore, it is usually only used on the NHS during clinical trials.

See the NICE guidelines on Treating faecal incontinence using endoscopic radiofrequency therapy.

Stimulated graciloplasty

A stimulated graciloplasty is an operation to replace your sphincter muscles. The surgeon takes a small piece of muscle from your thigh and uses it to create a new sphincter muscle.

Electrodes are inserted into the new sphincter, which are attached to a pulse generator placed inside your abdomen.

The pulse generator runs an electrical current through the implanted muscles, which gradually changes the way the muscles work to make them act like natural sphincter muscles.

As with sacral nerve stimulation, the most common complications of stimulated graciloplasty are infection at the site of surgery and technical problems with the pulse generator.

Nowadays, this procedure is less commonly used than many of the other surgical options for bowel incontinence.

See the NICE guidelines on Stimulated graciloplasty for faecal incontinence.

Artificial sphincter

An artificial sphincter may be implanted if you have bowel incontinence caused by a problem with your sphincter muscles.

This operation involves placing a circular cuff under the skin around the anus. The cuff is filled with fluid and sits tightly around the anus, keeping it closed.

A tube is placed under the skin from the cuff to a control pump. In men, the pump is placed near the testicles, in women it's placed near the vagina. A special balloon is placed into the abdomen (tummy), and this is connected to the control pump by tubing that runs under the skin. 

The pump is activated by pressing a button located under the skin. This drains the fluid from the cuff into the balloon, so your anus opens and you can pass stools. When you are finished, the fluid slowly refills the cuff and the anus closes.

The use of an artificial sphincter is a relatively new procedure, so there isn't much good-quality information about the long-term effectiveness and safety of this type of treatment yet.

Possible problems from this operation include infection, injury during surgery and the cuff becoming dislodged. In some cases, further surgery is required to correct problems.

See the NICE guidelines on Treating faecal incontinence with an artificial sphincter inserted through a cut in the abdomen.

Colostomy

colostomy is usually only recommended if other surgical treatments are unsuccessful.

A colostomy is a surgical procedure in which your colon (lower bowel) is cut and brought through the wall of your stomach to create an artificial opening. Your stools can then be collected in a bag, known as a colostomy bag, which is attached to the opening.

Medical Review: March 13, 2013
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