Bowel incontinence

Bowel incontinence is when you poo by accident. You may also hear it called faecal incontinence.

Some people have it every day. For others it only happens from time to time. Bowel incontinence can be upsetting and hard to cope with, but if it's happening to you, you're not alone.

It's common, but it shouldn't be thought of as normal, and you should get the help you need. There are things you can do to improve your symptoms, like:

• changing your diet
• strengthening your pelvic floor

Read more on lifestyle advice for managing constipation, or further information about managing diarrhoea.

There are 2 types of bowel incontinence:

• urge incontinence, when you feel a sudden and very intense need to poo and can't stop it before you reach a toilet
• passive incontinence or passive soiling, when you don't feel the need to poo before it happens, or when a little bit of poo comes out as you pass wind

You can have both types of bowel incontinence at the same time.

Bowel incontinence is more common in women than in men. Some things make it more likely to develop, including:

• pregnancy and vaginal birth
• being overweight
• a family history of incontinence
• diseases of the bowel, like colitis
• getting older (but incontinence isn't an inevitable part of ageing)

Bowel incontinence can be a symptom of:

• diarrhoea
• constipation
• long-term conditions like diabetes, multiple sclerosis and dementia
• a physical problem with the parts of the body that control going for a poo (the rectum and sphincter muscles) or nerve damage

Please talk to your doctor about any bowel problem. There's a small chance it could be a sign of a more serious condition, like bowel cancer.

• you think you have bowel incontinence
• you have any changes in your poo that aren't getting better, like softer poo, diarrhoea or constipation that isn't usual for you

Speak to your doctor if you have bowel incontinence symptoms that bother you or get in the way of your day-to-day life.

Your doctor will try to understand what could be causing the problem. They'll ask:

• when and how often your symptoms happen
• about your diet
• how much caffeine, fizzy drinks and alcohol you drink

You may find this embarrassing, but it's important to answer as honestly and fully as you can. That way you'll get the most suitable treatment. Depending on your symptoms, your doctor may refer you to a specialist.

Let the doctor know about:

• any changes in your bowel habits (when you poo) lasting for more than a few weeks
• bleeding from your back passage (rectum)
• stomach pains
• any changes to your diet
• any medicine you're taking

Your appointment may involve a physical examination. This is an intimate examination, so the doctor may have another person (a chaperone) present. Women can ask for a female doctor if they prefer. If there isn't a female doctor available, you can ask if another female health professional can carry out the examination.

The doctor will look at your anus (where the poo comes out) and may put a gloved finger into it. You may be asked to squeeze around their finger so they can see how well the muscles in your anus are working.

In some cases, your doctor may find that you have haemorrhoids or a prolapse (where part of your lower bowel is pushing through your anus). It's not life threatening and can be treated.

If you're eligible and haven't had a recent bowel screening test, your doctor may suggest this first. You may also be referred to a specialist, who'll explain whether you need any further tests, like:

• colonoscopy (sigmoidoscopy), where a long, thin flexible tube with a light and video camera at the end (endoscope) is used to check your rectum (and sometimes lower bowel) for any obstructions (blockages), damage or inflammation
• anal manometry, where a device with a small balloon on the end is put into your rectum and the balloon is inflated. It shows how well the muscles and nerves in and around your rectum are working
• ultrasound scan
• defecography, where an X-ray or MRI scan is used to see how well your rectum and pelvic floor muscles work while you poo. A liquid called barium or a gel is placed into your rectum, which makes it easier to see any problems when you poo

With the right treatment, many people with bowel incontinence can keep normal bowel function throughout their life. Most people find their symptoms get much better by:

• changing their diet
• taking a fibre supplement to help have regular, firm poos
• strengthening their pelvic floor muscles

Which treatment you need will often depend on what is causing your incontinence and how severe your symptoms are. Other possible options include:

• exercise programmes to strengthen the muscles that control the bowel
• medicines to help you have regular, firm poos

Only a small percentage of people need surgery.

You can read more on lifestyle advice for managing constipation, or find further information about managing diarrhoea.

There are many non-surgical treatments for bowel incontinence. Here are the main ones.

Dietary supplements such as ispaghula husk (usually sold under the brand name Fybogel) or psyllium husk are taken daily to help you have regular, firm poos. They usually come as plain or fruit-flavoured granules, which you mix with water to make a high-fibre drink.

Medicine like Loperamide can be used to manage diarrhoea or runny poo. It makes your poo less watery and cuts down the number of times you need to go to the toilet. It can be prescribed in low doses for regular use over a long period of time.

Laxatives are used to treat constipation and help you to poo. There are different types:

• stimulant laxatives, which speed up the movement of your bowels
• stool softener laxatives, which increase the fluid content of poo to make it easier to pass

You can buy laxatives over the counter at a pharmacy without a prescription, and the pharmacist can help you choose the right one for you. You can also get them from supermarkets.

Enemas or rectal irrigation are used when your poo won't come out easily (this is sometimes called faecal impaction). To remove the poo, you may be given a minienema (a squeeze of foam), a suppository (a small solid medicine that goes in your bottom), or water irrigation. A healthcare professional would advise you on what to do.

Most people with bowel incontinence won't need surgery. It's only needed in rare cases, and there are different types of operation, depending on your symptoms. If surgery is on the table, you would be referred to a colorectal surgeon, who will explain your options and answer any questions you have.

A colostomy is usually only recommended if other medical and surgical treatments haven't worked.

There are ways of managing the symptoms of bowel incontinence yourself.

Incontinence products, like pads, aren't a treatment for incontinence. But you may find them useful day to day while you wait for an assessment, or for a treatment to start working.

These products may help you feel more confident in everyday activities, like socialising or exercising.

You don't usually need a referral from your doctor to make an appointment. You can also buy these products from pharmacies or online.

These plugs are made of foam or silicone and go into your anus (bottom) in a similar way to a tampon. They create a barrier and stop any leaks.

Wear trousers or skirts that are easy to undo and have elasticated waistbands rather than buttons.

Disability Rights UK offers access to 9,000 disabled toilets around the UK with a Radar NKS key. The key costs £5.00 and is only sold to people who need to use toilet facilities because of a disability or health condition.

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