Is bowel incontinence making your life miserable?
Bowel incontinence is a debilitating problem that can impact upon your lifestyle, ability to work and self esteem.
This 4 step Pelvic Floor Physiotherapist guide helps you regain control with diet, exercises and bowel management techniques.
Read on now to learn how to:
1. Improve your stool consistency
2. Empty your bowels completely
3. Strengthen your anal sphincter and pelvic floor control
4. Avoid lifestyle factors that worsen bowel incontinence
Step 1: How to Improve your Stool Consistency and Avoid Bowel Leakage
Bowel incontinence usually causes most problems if your stool is watery or liquid rather than solid form.
The first and vital step towards treating bowel incontinence is usually to correct the stool consistency.
The ideal stool for overcoming bowel incontinence is a soft, well formed bulky stool. This is usually Type 3-4 on this Bristol Stool Chart (shown right).
Improving your stool consistency helps you:
- Sense or know of when your rectum is full and when you need to empty your bowel
- Leave less residue for leakage and empty more completely
- Empty your bowels more easily and avoid straining
How to Improve your Stool Consistency for Bowel Control
There are 4 methods of improving the consistency of your stool to help overcome bowel incontinence:
A. Choosing the best foods that firm your stool
B. Avoiding bowel irritants that contribute to bowel incontinence
C. Including bulking agents in the diet
D. Using anti diarrhoeal medications to firm your stool
If you have chronic bowel problems that cause loose stools or diarrhoea e.g. IBS, Crohn’s disease or Ulcerative Colitis speak with a dietician about the best diet to help you improve your stool consistency before making changes to your diet.
A. Choosing the best foods to firm your stool
Foods that firm the stool include:
- Boiled white rice
- White bread
- White pasta
- Mashed potato
- Milk arrowroot biscuits
- White marshmallows
Foods to Avoid that Soften the Stool
Try to avoid or limit these foods that soften the stool if your stools are loose and you have bowel incontinence problems:
- Vegetables (especially vegetable peels, red capsicum, spinach, broccoli, brussel sprouts, beans)
- Wholegrain breads and cereals
- Nuts and seeds
- Fresh fruit (especially skins of fruits, stone fruits, prunes and grapes)
- Juices (orange, prune or grape)
It is vital to monitor your intake of insoluble fibres with bowel incontinence problems.
Insoluble fibres increase the speed that waste matter travels through your bowel and can worsen bowel incontinence problems e.g. skins of fruit and vegetables. Insoluble fibres are not digested in the bowel and they cause loose stools, wind and bloating.
B. Avoiding bowel irritants that worsen bowel incontinence
These foods and drinks can irritate the bowel potentially worsening bowel incontinence problems:
- Caffeine – coffee, chocolate, cola drinks, tea
- Spices – chilli, curry
- Alcohol – especially beer and red wine
- Artificial sweeteners – Sorbitol, Mannitol
- Food intolerances to specific foods –e.g. gluten, fructose, lactose
C. Including bulking agents in the diet
Bulking agents are bulk fibre supplements and are readily available in most supermarkets, pharmacies and health food stores e.g. Psyllium (shown here).
Bulking agents absorb water from wastes in the bowel making the stool firmer and reducing bowel leakage. Increasing the bulk of the stool also promotes more effective bowel emptying.
Bulking agents can sometimes cause wind and bloating and need to be introduced gradually along with adequate fluid intake. While bulking agents consist of vegetable fibre, always be mindful of potential allergy to fibre supplements.
Bulking agents include:
- *Pysllium (Metamucil)
- Guar Gum (Benefibre)
- Sterculia (Normafibe)
- Psyllium and maize starch (Nucolax)
*Many women find they achieve good results in bulking their stool using Psyllium husks however this fibre can produce gas and cause bloating.
D. Using anti diarrhoeal medications to firm the stool
Some women find that they need to use medication to assist them on occasions to manage their bowel incontinence. Anti diarrhoeal medications reduce water in the stool and slow down the movement of wastes through the bowel.
Anti diarrhoeal medications include:
- Immodium (Lopermide)
- Lomotil (Diphenoxylate)
Always check with your medical caregiver before taking any new medication.
Step 2: How to Empty your Bowels Completely without Straining
Repeatedly trying to empty the bowels completely can cause straining, bladder incontinence, hemorrhoids and even rectal prolapse problems.
Establishing a Regular Bowel Routine
It is very important to try to establish a regular morning (or evening) bowel emptying routine. A good bowel routine will help to reduce repeated visits to the toilet, straining and improve bowel emptying.
How to establish a regular bowel routine:
- Have a warm drink and eat breakfast
- Move around for 15-20 mins e.g. walking around your house
- Try to be aware of the correct feeling or sensation of needing to empty your bowels
- Avoid ‘just in case’ visits to the toilet
- Using urge control strategies to defer unnecessary visits to the toilet by: sitting, using relaxed diaphragmatic breathing techniques and trying not to panic which makes bowel urgency worse
How to empty your bowels completely:
Complete emptying reduces the need for successive visits to the toilet, straining and bowel leakage associated with residue in the bowels.
- Positioning your body in the correct bowel emptying posture
- Using the correct ‘Brace and Bulge’ technique for bowel emptying (watch our online video now)
- Removing bowel residue with half a glycerine suppository after emptying the bowels to remove remaining residue and overcome soiling after emptying
- Making your last wipe a wet wipe using an alcohol free flushable wipe rather than repeated wiping with toilet paper and cleaning carefully around hemorrhoids
*Professional treatment in bowel emptying and improving rectal sensation using biofeedback can help to overcome bowel incontinence problems associated with poor sensation of rectal filling.
Step 3: How to Strengthen your Anal Sphincter and Improve Pelvic Floor Control
Your anal sphincter relaxes when you empty your bowels and it contracts to prevent bowel leakage. The anal sphincter consists of pelvic floor muscle fibres and pelvic floor muscles can be exercised and trained.
Pelvic floor exercises can improve the strength, endurance and control of the pelvic floor muscles. Pelvic floor exercises involve repeatedly contracting and relaxing the pelvic floor muscles in and around the pelvic openings (urethra or urine tube, vagina and anus). Pelvic floor muscle exercises involve the pelvic floor muscles repeatedly lifting and squeezing, relaxing and resting briefly before being repeated again.
Pelvic floor muscle exercises help to reduce bowel incontinence by:
- Overcoming bowel leakage
- Controlling bowel urgency
- Improving bowel emptying
Professional guidelines for pelvic floor strengthening are available by referring to Inside Out – the essential women’s guide to pelvic support by Pelvic Floor Physiotherapist Michelle Kenway along with Dr Judith Goh (Urogynaecologist).
Alternatively please refer to these online pelvic floor exercise guidelines
Pelvic floor muscles should be contracted to:
- Close the anal sphincter and prevent bowel leakage during urgency and when walking to the toilet
- Overcome or reduce the urge to empty the bowel (with relaxed breathing)
- Overcome bowel incontinence problems using ‘The Knack’ technique during lifting, coughing and sneezing
Step 4: Avoiding Lifestyle Factors that Worsen Bowel Incontinence
Addressing the following factors will help you to alleviate the pressure on your pelvic floor and reduce bowel incontinence.
Lifestyle factors that worsen bowel incontinence can be remedied by:
- Losing weight if you are overweight
- Avoiding heavy lifting and using pelvic floor safe lifting techniques
- Bracing your pelvic floor muscle before and during all lifting
- Avoiding those inappropriate general exercises most likely to strain your pelvic floor (e.g. high impact exercises and intense core abdominal exercises)
- Avoiding sustained squatting positions
- Seeking medical treatment to manage chronic coughing or sneezing
- Using strategies to reduce anxiety and stress (e.g. relaxation, meditation)
What is Bowel Incontinence (faecal incontinence)?
Bowel incontinence is the lack of control over gas (wind) or faeces.
Bowel incontinence can range in severity from smearing or staining on underwear to the complete loss of stool.
Problems caused by bowel incontinence include:
- Needing to empty bowels up to 15 times a day
- Often rushing to empty and not making it in time
- Embarrassment with odour and/or staining
- Anal pain, redness and skin breakdown
- Fear of going out
- Social isolation
- Difficulty in scheduling and keeping appointments
What Causes Bowel Incontinence?
There are many potential causes of bowel incontinence including:
- Trauma with childbirth especially 3rd or 4th degree tears
- Recent childbirth
- Bowel diseases e.g. IBS, Crohn’s disease
- Straining with constipation
- Faecal impaction
- Pelvic organ prolapse
- Rectal prolapse
- Lower back pain
- Coccyx injury
- Inappropriate fitness activities
- Anorectal surgery
- Rectal/pelvic radiotherapy
- Spinal cord injury
Key Points for Overcoming Bowel Incontinence
There is no one treatment solution for bowel incontinence – multiple strategies are often required to improve bowel control. The essential steps for better bowel control are:
- Improving your stool consistency especially with dietary modifications
- Improving bowel emptying with good emptying techniques and bowel habits
- Training your pelvic floor muscles to provide better control
- Eliminating those controllable lifestyle factors that make bowel incontinence problems worse.
ABOUT THE AUTHOR, Michelle Kenway
Michelle Kenway is a Pelvic Floor Physiotherapist and author of Prolapse Exercises Inside Out. Prolapse Exercises is a complete exercise guide for women with prolapse and after prolapse surgery seeking to exercise safely and protect their pelvic floor.