Bowel control
“Hospital without walls”
Introduction
Bowel function is mostly taken for granted, unless you start getting problems. These
problems can range from severe constipation to loss of bowel control. This leaflet is
for people who have loss of bowel control.
People are sometimes embarrassed to talk about this condition, but staff are used to
discussing it. Ask them any questions you want to.
Contact person
Claudia Clayman (Nurse Practitioner – Gastroenterology)
Phone: 020 7830 2923 (direct line with answerphone)
Normal bowel function
The bowel is part of the digestive system and its function is to digest food and get rid
of any waste products.
Food starts off as a thick liquid in the stomach and as it travels round the bowel, water
is absorbed, resulting in solid waste (stool or faeces). If the contents travel down the
bowel too quickly, less water is reabsorbed, which leads to diarrhoea. If the contents
travel too slowly, it results in very hard stool and can lead to constipation.
At the end of the bowel is a small reservoir called the rectum. Strong movements
along the bowel push its contents into the rectum, usually once or twice a day.
There are two rings of muscle in the back passage which control the exit of stool from
the rectum. Sensitive nerves in the rectum help you to distinguish between gas or
stool. You can then squeeze your muscles to stop anything coming out until you get to
the toilet.
Sometimes these muscles become weak or damaged and can lead to urgency in going
to the toilet or leakage of gas, liquid or solid stool. This is called faecal incontinence.
What causes faecal incontinence?
There are several possible causes:
 Weak muscles in the back passage
Occasionally these muscles can weaken with age, or due to a medical
condition such as scleroderma.
 Damaged muscles in the back passage
The most common cause is childbirth – around 1 in 3 vaginal births results
in some damage to the anal sphincters. Minor damage will not cause any
problems; however, some women get problems immediately after childbirth
and others get symptoms with menopause.
Damage can also occur accidentally during anal operations such as
haemorroidectomy (removal of piles) or lateral sphincterotomy (cut in the
anal muscles for fissure).
 Rectal prolapse
Often associated with leakage; the rectum falls down through the anus,
stretching and weakening the anal muscles.
 Loose stool or diarrhoea
This may be due to an acute infection such as food poisoning or chronic
inflammatory bowel disease (Crohn’s disease or ulcerative colitis). Patients
with irritable bowel syndrome may also suffer diarrhoea. Pressure waves in
the large bowel associated with diarrhoea can overwhelm even the strongest
anal muscles.
 Nerve injury or disease
Bowel control requires co-ordination of nerves and muscles. If nerves are
damaged (for example, due to spinal injury) or diseased (perhaps due to
multiple sclerosis or diabetes), this can result in the wrong messages being
sent to your brain. Loss of feeling may lead to the bowel emptying without
any warning sensation.
 Constipation
If the bowel becomes overloaded with stool, it may stimulate the bowel wall
to produce fluid and mucous which leaks out and this can be mistaken for
diarrhoea. Years of straining at the toilet may also weaken the anal muscles.
What tests will I have?
 The doctor or nurse will need to examine your back passage with a finger.
You may then be referred for special tests as an out-patient.
 Anorectal manometry
A small tube inserted into the back passage measures the strength of the
muscles. A balloon inflated in the rectum will provide information about
sensation in that area.
 Endoanal ultrasound
A small probe is inserted into the back passage and pictures of the muscles
can be taken.
These tests are not painful and provide useful information.
What treatment is available?
You can discuss possible treatments with your doctor or nurse. These will depend on
the cause of the faecal incontinence.
 You may be given advice about manipulating your diet to try and improve
your control. Everyone reacts differently to food and it may require some
trial and error on your part.
 You may be prescribed medication which will firm up the stool (e.g.
loperamide, codeine phosphate) and therefore give you greater control.
Again, dosage may need to be adjusted to get the right balance.
 Sphincter exercises may be helpful if you have urgency. The exercises are
designed to strengthen and improve the stamina of your muscles. They will
need to be repeated several times a day and will require some commitment
on your part. The nurse will explain these exercises and give you written
instructions.
 A course of biofeedback training may be suggested. The biofeedback
equipment gives you information about how you are using your muscles and
can teach you to improve your control. You will need to attend 5 or more
sessions over several months.
 Sometimes an operation is possible. If there is a clear defect in the external
sphincter, it may be possible to repair the damage. Around 80% of patients
regain control of their bowels with this operation.
Useful Contacts
Continence Foundation
020 7831 9831 (helpline)
Talk in confidence to a nurse specialist
Digestive Disorders Foundation
PO Box 251, Edgeware, Middlesex HA8 6HG
Information leaflets on digestive disorders.