Treatment of bowel incontinence should begin with identifying the cause of the incontinence. There are several ways to help achieve normal bowel function and strengthen the rectal muscles.
In people with bowel incontinence due to diarrhea, medications may be used to control the diarrhea. This may correct the bowel incontinence. Loperamide (imodium) has antidiarrheal properties and improves the condition of the rectal muscle.
Other antidiarrheal medications include cholinergic medications (belladonna or atropine), which decrease intestinal secretions and movement of the bowel. Opium derivatives (paregoric or codeine) increase intestinal tone and decreases movement of the bowel, and diphenoxylate (lomotil) decreases movement of the bowel and slows the movement of stool through the bowel.
Other medications used to control bowel incontinence include medications that reduce the water content in the stools (activated charcoal or Kaopectate), protect the intestinal lining from irritation (amphogel or Pepto-Bismol), or absorb fluid and add bulk to the stools (Metamucil).
With your health care provider, review all the medications you take. Certain medications can cause or increase the frequency of bowel incontinence, especially in older people. These medications include:
- Sedatives and hypnotics
- Muscle relaxants
People who have bowel incontinence despite medical treatment may need surgery to correct the problem. Several different options exist. The choice of which type of surgery will be based on the cause of the bowel incontinence and the person's general health.
Rectal Sphincter Repair
Sphincter repair is performed on people who have a rectal sphincter (muscle ring) that isn't working well as a result of injury or aging. The procedure consists of re-attaching the rectal muscles to tighten the sphincter and increase the capacity of the anus.
Gracilis Muscle Transplant
In people with loss of nerve function within the rectal sphincter, gracilis muscle transplants have been performed to restore bowel control. The gracilis muscle is taken from the inner thigh and is used to encircle the sphincter, thus providing sphincter muscle tone.
Artificial Bowel Sphincter
Some patients may be treated with an artificial bowel sphincter. The artificial sphincter consists of three parts: a cuff that fits around the anus, a pressure regulating balloon, and a pump that inflates the cuff.
The artificial sphincter is surgically implanted around the rectal sphincter. The cuff remains inflated to maintain continence. The person has a bowel movement by deflating the cuff. The cuff will automatically re-inflate in 10 minutes.
Sometimes a fecal diversion is performed for people who cannot benefit from other therapies. The large intestine is directed to an opening in the abdominal wall. Stool passes through this opening to a special bag, called an appliance. The person will always need to wear an appliance to collect the stool.
Bowel incontinence often happens as a result of a deceased ability of the rectal sphincter to handle large amounts of liquid stool. Often, simply changing the diet may reduce the occurrence of bowel incontinence.
Alcohol and caffeine should be taken off the diet, because they may cause diarrhea and the resulting incontinence is some people. Additionally, certain people are unable to digest lactose, a sugar found in most dairy products, and thus develop severe diarrhea after eating such foods. Some food additives such as nutmeg and sorbitol have also been shown to cause diarrhea in susceptible people.
Adding bulk to the diet may thicken the stool and decrease its amount. Certain foods thicken the stools, including rice, bananas, yogurt, and cheese. An increase in fiber (30 grams daily) from whole-wheat grains and bran adds bulk to the diet. Additionally, psyllium-containing products such as Metamucil can be used to add bulk to the stools.
Formula tube feedings often cause diarrhea and bowel incontinence. For diarrhea or bowel incontinence that is occurring because of tube feedings, consult your health care provider or dietician. The rate of the feedings may need to be changed, or bulk agents may need to be added to the formula.
Constipation or fecal impaction may also contribute to fecal incontinence. Loss of rectal muscle tone may result in leakage of watery, liquid stool around the fecal impaction. Usually once a fecal impaction has developed, laxatives and enemas are of little help. In this case a health care provider will insert one or two fingers into the rectum and break the mass into fragments so that it can be expelled.
Measures should be taken to prevent further development of fecal impaction. Fiber should be added to the diet to help form normal stool. In addition, drinking enough fluids and getting enough exercise may enhance normal stool consistency.
When a person has frequent bowel incontinence, special external fecal collection devices may be used to contain the stool and protect the skin from breakdown. These devices consist of a drainable pouch attached to an adhesive wafer. This wafer has a hole cut through the center which fits over the anal opening.
Most people who have bowel incontinence due to a lack of sphincter control, or decreased awareness of the urge to defecate, may benefit from a bowel retraining program and exercise therapies aimed at restoring normal muscle tone.
Special care must be taken to maintain bowel control in people who have a decreased ability to recognize the urge to defecate, or who have impaired mobility that prevents them from independently and safely using the toilet. Assist the person to use the toilet after meals, and promptly respond to the person's request to use the toilet.
If toileting needs are often unanswered, a pattern of negative reinforcement may develop. In this case the urge to defecate is no longer associated with appropriate actions. See also toileting safety.
Consult the doctor if
- There is any incontinence of stool in a child that has been previously toilet trained
- There is any incontinence of stool in an adult
- There is any skin irritation or ulceration as a result of bowel incontinence