Accidental bowel leakage affects a significant part of the population — 1 in 10 people at some time in their lives — and is much more common in women than in men. It’s a difficult topic that many are embarrassed to discuss, but it can affect women of all stages of life, from new mothers to the elderly.
The good news is that, the more the medical community has come to understand what causes involuntary bowel leakage, the more we’ve been able to develop effective treatments. Rest assured, accidental bowel leakage does not have to diminish your quality of life.
Most people have bowel movements once per day, but normal BM frequency can vary from three times per day to as little as twice a week. Usually, our bowel and anal sphincter (rings of muscle around the back passage of the bowel) work together to make sure bowel contents aren’t passed until we’re ready. The sphincter has two main muscles: the inner ring, which keeps the anus closed as we go about our day, and the external ring, which provides extra protection when we feel the urge to go or when we exert ourselves — such as when we cough, sneeze, and exercise.
Bowel control relies on both of these muscles, the bowel and anal sphincter, working together. So if any of the muscles in this important system are damaged, involuntary bowel leakage can occur. (Similar issues can occur with urinary incontinence) (link to first primer),
There are three types of accidental bowel leakage:
- Urge leakage occurs when one doesn’t make it to the bathroom in time, and can be a result of diarrhea.
- Passive leakage is involuntary passage of stool or gas without awareness.
- Fecal soiling occurs when just enough stool is leaked to stain the underwear, but without significant loss of stool.
Causes of accidental bowel leakage include:
- Childbirth, which can result in hidden tears in the sphincter.
- Sphincter injury. People of any age who experience injury or damage to the sphincter muscles can experience bowel leakage, either immediately post-injury or later in life.
- Colitis or IBS. People with conditions that result in overactive bowel activity often experience fecal leakage.
- Colon surgery.
- Radiotherapy, especially to the pelvic area.
- Rectal prolapse, or any prolapse of organs in their pelvis.
- Multiple sclerosis, or any type of nervous system/spinal cord disease.
Because accidental bowel leakage ranges from light to severe and can come from a number of causes, many treatment options are available, from simple lifestyle changes to surgery.
Diet/Bowel Habit Changes
An excessively high-fiber diet, in addition to caffeine, alcohol, and artificial sweeteners can make involuntary bowel leakage worse. Consider keeping a diary of diet, fluid intake, and bowel frequency to track patterns and possible triggers.
Leakage can be managed by making sure you have bowel movements at regular times during the day, particularly in the morning. In addition, remember to position yourself correctly on the toilet and avoid straining — for a visual guide, refer to the IUGA’s guide to accidental bowel leakage.
For women, the pelvic floor (a sheet of muscles that extends from the tailbone to the pubic bone in the front) is the primary supporter of the bladder, bowel, and uterus, and the pelvic floor muscles are responsible for controlling when you pass urine and stool. If those muscles are weakened or damage, a physical therapist is the best resource for developing a tailored exercise program to regain strength in the pelvic floor. Biofeedback and electrical stimulation are also sometimes used in conjunction to physical therapy to regain continence.
Medication is recommended for those with chronic urge incontinence, when the bowel squeezes too strongly. It’s also recommended to treat stool that appears loose, or weakened sphincter muscles. If you’re suffering from either of these issues, talk to your doctor about which medication is right for you.
Doctors may recommend surgery to women who are experiencing accidental leakage due to nerve damage or childbirth complications. Types of surgery include repair of the sphincter muscles and sacral neuromodulation in which a small nerve stimulator is placed in the lower back. Other experimental surgical treatments are being tested but have not yet been proven to be helpful.
Only a urogynecologist can make the right recommendation for corrective bowel surgery. If you or a loved one struggle with any of three types of accidental bowel leakage, call The Woman’s Center For Advanced Pelvic Surgery to make an appointment with one of our board-certified urogynecologists or physical therapists. We’re happy to answer your questions and find the treatment option that’s right for you.
Dr. Ryan Stratford is board-certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) as well as Obstetrics and Gynecology (Ob/Gyn) with a wealth of clinical and research experience. Learn More about Dr. Stratford