bowel incontinence

by Diane K. Newman, RNC, MSN, CRNP, FAAN

As with bladder control, we take bowel control for granted. However, persons who lack bladder control may also lack bowel control. They have fecal incontinence (bowel incontinence), the loss of liquid or solid stool or gas involuntarily from the anus at inappropriate times.

Some evacuate their bowels into their clothing without any warning that they had to have a bowel movement. Having both urinary and bowel  incontinence (fecal incontinence) is so difficult to manage that sufferers live in a constant state of anxiety and may totally withdraw from society.

The reason both types of incontinence may occur at the same time is that the digestive tract and the lower urinary tract are closely connected, and anything that affects one of them can affect the other. Both systems share common nerves and are supported by the pelvic muscles and other structures that play a vital role in maintaining continence. Both the urinary tract and the digestive tract get their nerves from a common source, the pudendal nerve. Therefore, anything that cuts or damages this source of innervation will cause urinary and fecal incontinence.

Diseases or injuries that affect the spinal cord or the nerves or muscles can affect both systems. In adults, the most common cause of fecal incontinence is obstetric or surgical trauma, usually a direct injury to either the anal sphincter or the pudendal nerves. Rectal sensation warns of imminent defecation and helps you discriminate between formed and unformed stool and gas. Impaired rectal sensation may deprive a person of this useful information and result in incontinence.

Since the nerve branches of the urinary and digestive system come off the same trunk, it is possible to handle both kinds of incontinence with a single treatment. Therefore, a person receiving biofeedback treatment as a therapy for urinary incontinence may be taught to use biofeedback to contract their anal sphincter. Pelvic (Kegel) exercises, which involve tightening the pelvic floor muscles, are also very useful for learning to tighten the anal sphincter.

Among older people, the most common causes of fecal incontinence are neither loss of mobility nor dementia, but simply the natural effects of aging on the body. Muscles and tissues weaken, lose their elasticity, and become lax. Changes in muscle strength, muscle mass, and muscle and nerve reflexes affect the anorectal area just as they affect our arms and legs. Thus, some older people can't retain gas or stool, especially liquid stool, as well as or for as long as they once could. Also, the older person may not be able to reflexively close the anal sphincter quickly enough to avoid a fecal incontinent accident. Compared to continent people, incontinent elderly people have less rectal sensation and less sphincter strength.

Severe constipation can make you have bowel incontinence. The constipation can lead to a large amount of stool in the rectum, a condition called impaction. The impaction interferes with your normal ability to control your bowel movements. A liquid stool eventually trickles around the impaction and leaks out.

As with any other medical problem, understanding the cause of your bowel incontinence is important. Bowel and urinary incontinence are very similar in that they are hidden problems, cause social isolation and dysfunction, and can be treated through behavioral training.

If you have prolonged diarrhea, an impacted bowel problem that you can't resolve, or both urinary and fecal incontinence, see your doctor!

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References

Behm, R.M. (1985) A Special Recipe to Banish Constipation. Geriatric Nursing. 6(4):216-217.

Badiali, D., Corazziari, E., Habib, FI., Tomei, E., et. al. (1995) Effect of Wheat bran in treatment of chronic nonorganic constipation - A double-blinded controlled trial. Digestive Diseases and Sciences. 40(2): 349-356.

Benton, JM., O'Harra, PA., Chen, H., Harper, DW., Johnston, SF., (1997) Changing bowel hygiene practice successfully: A program to reduce laxative use in a chronic care hospital. Geriatric Nursing. 18(1)12-17.

Beverley, L, Travis, I. (1992) Constipation - Proposed Natural Laxative Mixtures. Journal of Gerontological Nursing. 18(10):5-12. 

Chassagne, P., Landrin, I., Neveu, C., Czernichow, P., et.al. (1999) Fecal Incontinence in the institutionalized elderly: incidence, risk factors, and prognosis. The American Journal of Medicine. Feb 106:185-190.

Chiang L., Ouslander J., Schnelle J., Reuben, D. (2000) Dually incontinent nursing home residents: Clinical characteristics and treatment differences. J Am Geriatr Soc. 48(6): 673-676. 

Doughty, D. (1996) Physiologic Approach to Bowel Training. JWOCN. 23(1): 46-56.

Howard, LV., West D, Ossip Klein DJ. Chronic constipation management for institutionalized older adults. Geriatric Nursing. 21(2): 78-82.

Jackson S., Weber A., Hull AT., Mitchinson A., Walters M. (1997) Fecal Incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 89(3): 423-427.

Jensen, L. (1997) Fecal Incontinence: Evaluation and Treatment. JWOCN. Sept 24(5):277-282.

Jensen, LL. (2000) Assessing and treating patients with complex fecal incontinence. OstomyWound Management. December 46(12): 56-60.

Johanson, JF., (1998) Geographic distribution of constipation in the United States. American Journal of Gastroenterology. 93(2): 188-191.

Ko, CY., Tong, J., Lehman, RE, et. al. (1997) Biofeedback is effective therapy for fecal incontinence and constipation. Arch Surg. 132:829-834.

Kumar, D., Bartolo, DCC., Devroede, G., Kamm, MA., Keighley, MRB., et. al. (1992) Symposium on constipation. International Journal of Colorectal Disease. 7:47-67.

Nelson R., Norton N., Cautley E., Furner S. Community-based prevalence of anal incontinence. JAMA. 1995; 274(7): 559-561.

Patamkar, SK, Ferrara, A., Levy, JR, Williamson, PR, Perozo, SE, (1997) Biofeedback in colorectal practice: a multicenter statewide, three-year experience. Diseases Colon Rectum. 1997;40:827-831.

Poulton, B., Thomas, S. (1999) The Nursing Coat of Constipation. Primary Health Care. November, 9(9):17-20.

Smith DA, Newman DK. (1989) The bran solution. Contemporary Long Term Care. 12:66.

Venn MR, Taft L, Carpentier B, Applebaugh G. (1992) The influence of timing and suppository use on efficiency and effectiveness of bowel training after stroke. Rehabilitation Nursing. May-June 17(3): 116-120.

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Posted February 2003
Updated May 2009

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