Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. It’s also sometimes known as faecal incontinence.
The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence.
Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind.
Some people experience incontinence on a daily basis, whereas for others it only happens from time to time.
It’s thought 1 in 10 people will be affected by it at some point in their life. It can affect people of any age, although it’s more common in elderly people. It’s also more common in women than men.
Why bowel incontinence happens
Bowel incontinence is a symptom of an underlying problem or medical condition.
Many cases are caused by diarrhea, constipation, or weakening of the muscle that controls the opening of the anus.
It can also be caused by long-term conditions such as diabetes, multiple sclerosis and dementia.
Seeking advice and treatment
Bowel incontinence can be upsetting and hard to cope with, but treatment is effective and a cure is often possible, so make sure you see your GP.
It’s important to remember that:
- bowel incontinence isn’t something to be ashamed of – it’s simply a medical problem that’s no different from diabetes or asthma
- it can be treated – there’s a wide range of successful treatments
- bowel incontinence isn’t a normal part of ageing
- it won’t usually go away on its own – most people need treatment for the condition
If you don’t want to see your GP, you can usually make an appointment at your local NHS continence service without a referral. These clinics are staffed by specialist nurses who can offer useful advice about incontinence.
How bowel incontinence is treated
In many cases, with the right treatment, a person can maintain normal bowel function throughout their life.
Treatment will often depend on the cause and how severe it is, but possible options include:
- lifestyle and dietary changes to relieve constipation or diarrhoea
- exercise programmes to strengthen the muscles that control the bowel
- medication to control diarrhea and constipation
- surgery, of which there are a number of different options
Incontinence products, such as anal plugs and disposable pads, can be used until your symptoms are better controlled.
Even if it isn’t possible to cure your bowel incontinence, symptoms should improve significantly.
Causes of bowel incontinence
Bowel incontinence is usually caused by a physical problem with the parts of the body that control the bowel.
The most common problems are:
- problems with the rectum – the rectum is unable to retain poo properly until it’s time to go to the toilet
- problems with the sphincter muscles – the muscles at the bottom of the rectum don’t work properly
- nerve damage – the nerve signals sent from the rectum don’t reach the brain
These problems are explained in more detail below.
It’s important to discuss any bowel problems with your GP as there’s a small chance they could be a sign of a more serious condition, such as bowel cancer.
Problems with the rectum
Constipation
Constipation is a leading cause of bowel incontinence.
In cases of severe constipation, a large, solid stool can become stuck in the rectum. This is known as faecal impaction. The stool then begins to stretch the muscles of the rectum, weakening them.
Watery stools can leak around the stool and out of the bottom, causing bowel incontinence. This is called overflow incontinence and happens most commonly in elderly people.
Repeated straining caused by constipation or faecal impaction can also lead to rectal prolapse, when part of your lower intestine falls out of place and protrudes from your bottom. Rectal prolapse may also lead to bowel incontinence.
Diarrhea
It’s difficult for the rectum to hold liquid stools (diarrhea), so people with diarrhea (particularly recurring diarrhea) can develop bowel incontinence.
Conditions that can cause recurring diarrhoea include:
- Crohn’s disease – inflammation of the digestive system
- irritable bowel syndrome – a condition that causes a range of digestive problems, such as diarrhea and bloating
- ulcerative colitis – inflammation of the large bowel
These conditions can also cause scarring of the rectum, which can lead to bowel incontinence.
Haemorrhoids
Hemorrhoids (piles) are enlarged blood vessels inside or around the bottom (the rectum and anus). Symptoms include discomfort, itching, bleeding or a lump hanging down outside of the anus.
In severe cases, hemorrhoids may lead to bowel incontinence.
Problems with the sphincter muscles
The sphincter muscles at the bottom of the rectum control the bowel. Bowel incontinence happens if these muscles become weakened or damaged.
Childbirth is a common cause of damage to the sphincter muscles and a leading cause of bowel incontinence. During a vaginal birth, the sphincter muscles can become stretched and damaged, particularly as a result of a forceps delivery. Other causes include a large baby, the baby being born with the back of their head facing the mother’s back (occipitoposterior position) and a long labour.
Sphincter muscles can also become damaged through injury, or damage from bowel or rectal surgery.
Nerve damage
Bowel incontinence can also be caused by a problem with the nerves connecting the brain and the rectum. A nerve problem can mean your body is unaware of stools in your rectum, and may make it difficult for you to control your sphincter muscles.
Damage to these nerves is related to a number of conditions, including:
- diabetes
- multiple sclerosis (a condition of the central nervous system)
- stroke
- spina bifida (birth defects that affect the development of the spine and nervous system)
An injury to these nerves, such as a spinal injury, can also lead to bowel incontinence.
Other health conditions
In some cases, bowel incontinence may result from a health condition such as dementia or a severe learning disability that causes the person to lose bowel control.
A physical disability can also make it difficult to get to the toilet in time.
Diagnosing bowel incontinence
Your GP will begin by asking you about the pattern of your symptoms and other related issues, such as your diet.
You may find this embarrassing, but it’s important to answer as honestly and fully as you can to make sure you receive the most suitable treatment. Let your doctor know about:
- any changes in your bowel habits lasting for more than a few weeks
- rectal bleeding
- stomach pains
- any changes to your diet
- any medication you’re taking
Your GP will usually carry out a physical examination. They’ll look at your anus and the surrounding area to check for damage and carry out a rectal examination, inserting a gloved finger into your bottom.
A rectal examination will show whether constipation is the cause, and check for any tumours in your rectum. Your GP may ask you to squeeze your rectum around their finger to assess how well the muscles in your anus are working.
Depending on the results, your GP may refer you for further tests.
Further tests
Endoscopy (sigmoidoscopy)
During an endoscopy, the inside of your rectum (and in some cases your lower bowel) is examined using a long, thin flexible tube with a light and video camera at the end (endoscope). Images can also be taken of the inside of your body.
The endoscope checks whether there’s any obstruction, damage or inflammation in your rectum.
An endoscopy isn’t painful, but it can feel uncomfortable, so you may be given a sedative to relax you.
Anal manometry
Anal manometry helps to assess how well the muscles and nerves in and around your rectum are working.
The test uses a device that looks like a small thermometer with a balloon attached to the end. It’s inserted into your rectum and the balloon is inflated. It may feel unusual, but it’s not uncomfortable or painful.
The device is attached to a machine, which measures pressure readings taken from the balloon.
You’ll be asked to squeeze, relax and push your rectum muscles at certain times. You may also be asked to push the balloon out of your rectum in the same way you push out a stool. The pressure-measuring machine gives an idea of how well your muscles are working.
If the balloon is inflated to a relatively large size but you don’t feel any sensation of fullness, it may mean there are problems with the nerves in your rectum.
Ultrasound
An ultrasound scan can be used to create a detailed picture of the inside of your anus. Ultrasound scans are particularly useful in detecting underlying damage to the sphincter muscles.
Defecography
Defecography is a test used to study how you pass stools. It can also be useful in detecting signs of obstruction or prolapse that haven’t been discovered during a rectal examination.
During this test, a liquid called barium is placed into your rectum. The barium helps make it easier to highlight problems using an X-ray. Once the barium is in place, you’ll be asked to pass stools in the usual way while scans are taken.
This test is occasionally carried out using a magnetic resonance imaging (MRI) scanner instead of an X-ray.