bowel incontinence

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

Like bladder control, we take bowel control for granted. However, persons who lack bladder control may also lack bowel control. They have fecal 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 (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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Last updated February 2003