Bowel dysfunction is a term that includes many different conditions, however at Summit Health we focus on those primarily with either constipation or fecal incontinence.
What is constipation?
- Straining during a bowel movement more than 25% of the time
- Hard stools more than 25% of the time
- Incomplete evacuation more than 25% of the time
- Two or fewer bowel movements in a week
What causes constipation?
Constipation is usually caused by a disorder of bowel function rather than a structural problem. Common causes of constipation include:
- Inadequate water intake
- Inadequate fiber in the diet
- A disruption of regular diet or routine; traveling
- Inadequate activity or exercise or immobility
- Eating large amounts of dairy products
- Stress
- Resisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoids
- Overuse of laxatives (stool softeners) which, over time, weaken the bowel muscles
- Hypothyroidism
- Neurological conditions such as Parkinson's disease or multiple sclerosis
- Antacid medicines containing calcium or aluminum
- Medicines, especially strong pain medicines, such as narcotics, antidepressants, or iron pills)
- Depression
- Eating disorders
- Irritable bowel syndrome
- Pregnancy
- Colon cancer
What should I do if I’m constipated?
- Drink two to four extra glasses of water a day, unless fluid restricted.
- Try warm liquids, especially in the morning.
- Add fruits and vegetables to your diet.
- Eat prunes and/or bran cereal.
- If needed, use a very mild stool softener or laxative, such as Peri-Colace or Milk of Magnesia.
- Do not use laxatives for more than two weeks without calling your doctor, as laxative overuse can aggravate your symptoms.
What is fecal incontinence?
Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.
Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with aging or with giving birth.
What causes fecal incontinence?
The causes of fecal incontinence include:
- Muscle damage. Injury to the rings of muscle at the end of the rectum (anal sphincter) may make it difficult to hold stool back properly. This kind of damage can occur during childbirth, especially if you have an episiotomy or forceps are used during delivery.
- Nerve damage. Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to fecal incontinence. The nerve damage can be caused by childbirth, constant straining during bowel movements, spinal cord injury, or stroke. Some diseases, such as diabetes and multiple sclerosis, also can affect these nerves and cause damage that leads to fecal incontinence.
- Constipation. Chronic constipation may lead to a mass of dry, hard stool in the rectum (impacted stool) that is too large to pass. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool from farther up the digestive tract to move around the impacted stool and leak out. Chronic constipation may also cause nerve damage that leads to fecal incontinence.
- Diarrhea. Solid stool is easier to retain in the rectum than is loose stool, so the loose stools of diarrhea can cause or worsen fecal incontinence.
- Loss of storage capacity in the rectum. Normally, the rectum stretches to accommodate stool. If your rectum is scarred or your rectal walls have stiffened from surgery, radiation treatment or inflammatory bowel disease, the rectum can't stretch as much as it needs to, and excess stool can leak out.
- Surgery. Surgery to treat enlarged veins in the rectum or anus (hemorrhoids), as well as more complex operations involving the rectum and anus, can cause muscle and nerve damage that leads to fecal incontinence.
- Prolapse. Fecal incontinence can result if the rectum drops down into the anus (rectal prolapse) or, in women, if the rectum protrudes through the vagina (rectocele).
What are the treatments for fecal incontinence?
You may be able to gain better control of your bowel movements by:
- Keeping track of what you eat. Make a list of what you eat for a week. You may discover a connection between certain foods and your bouts of incontinence. Once you've identified problem foods, stop eating them and see if your incontinence improves. Foods that can cause diarrhea or gas and worsen fecal incontinence include spicy foods, fatty and greasy foods, cured or smoked meat, carbonated beverages, and dairy products (if you're lactose intolerant). Caffeine-containing beverages and alcohol also can act as laxatives, as can products, such as sugar-free gum and diet soda, which contain artificial sweeteners.
- Getting adequate fiber. Fiber helps make stool soft and easier to control. Fiber is predominately present in fruits, vegetables, and whole-grain breads and cereals. Aim for 20 to 30 grams of fiber a day, but don't add it to your diet all at once. Too much fiber suddenly can cause uncomfortable bloating and gas.
- Drink more water. To keep stools soft and formed, drink at least eight glasses of liquid, preferably water, a day.
Kegel exercises strengthen the pelvic floor muscles, which support the bladder and bowel and, in women, the uterus, and may help reduce incontinence. To perform Kegel exercises, contract the muscles that you would normally use to stop the flow of urine. Hold the contraction for three seconds, then relax for three seconds. Repeat this pattern 10 times. As your muscles strengthen, hold the contraction longer, gradually working your way up to three sets of 10 contractions every day.
The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can strengthen muscles in the bowel. This treatment is usually done only after other treatments are tried.
This procedure repairs a damaged or weakened anal sphincter. An injured area of muscle is identified, and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion, strengthening the muscle, and tightening the sphincter.
