If you suffer from Accidental Bowel Leakage, you are not alone.
Accidental Bowel Leakage (ABL), medically termed bowel or faecal incontinence, is the uncontrolled leakage of stool from the rectum. Contrary to popular belief, ABL is not just a problem for the elderly; men and women of all ages are affected. Bowel and Bladder UK estimates that one in 10 adults will have problems with bowel control at some point in their lives.* A majority of ABL sufferers report a severe quality of life disruption, yet only a small number of those affected (approximately one in 10) have obtained a clinical diagnosis from a health care professional.**
Living With ABL
ABL can be hard to manage and many find it difficult to predict when and where the next episode will occur. ABL episodes can happen daily, weekly or less often depending on the person and the severity of his/her condition. Not all people experience ABL routinely and some may not even be aware when an episode of leakage occurs.
How The Body Works
Bowel control is maintained by a combination of strong pelvic floor muscles and functioning nerves. The sphincters need to remain contracted to keep stool in the rectum. The pelvic nerves give the sensation of urge and control emptying of the rectum. When any of these parts are damaged, weakened, or disrupted, ABL may occur.
Causes Of ABL
There are several common causes of ABL.
Childbirth is a leading cause of ABL. Women who have experienced a difficult vaginal delivery may have weakened or damaged muscles that can result in less bowel control.
Those suffering from diarrhoea and diarrhoea-related conditions, such as Irritable Bowel Syndrome (IBS) and Crohn’s Disease, have a high risk of developing ABL as loose/liquid stools are more likely to leak from the rectum.
In patients with neurological conditions, the nerves that control the anal sphincter may be damaged, increasing their risk of developing ABL.
Prior operations of the rectum or anus, such as removal of haemorrhoids, can result in ABL.
Radiation therapy for the treatment of certain cancers such as prostate, rectal, uterine, and cervical cancer can cause weakness in the pelvic muscles and/or nerves that control these muscles, leading to ABL.
Treatment and Management Options
High fiber diets increase the bulk of the stool and can help manage ABL. Exercises and biofeedback can strengthen weakened pelvic floor muscles. Antidiarrhoeal medication can help treat ABL by hardening the stool, reducing diarrhoea and the leakage of liquid stools.
Disposable pads used for urinary incontinence or feminine hygiene can be used to manage Accidental Bowel Leakage (ABL), but they may not be properly sized and fitted to contain anal leakage. There are larger incontinence pants or nappies that contain bowel leakage more effectively, but some people may find them excessively bulky.
Expandable foam anal plugs are designed to treat faecal incontinence by blocking the flow of solid and liquid stool from the rectum. Many patients find current foam anal plug devices difficult to tolerate.*** Expandable foam anal plugs need to be removed before having a bowel movement as they occupy a volume in the rectum that is too large to pass on their own.
Rectal irrigation systems may help to empty the rectum. An empty rectum may allow for more time between bowel leakage episodes.
There are pelvic floor and anal sphincter exercises with biofeedback that may help some patients. Tibial nerve stimulation has also been used to manage bowel incontinence. It is also possible to alter stool consistency through modification of diet and medication.
More invasive options include sphincter bulking agents, sacral nerve stimulation, radiofrequency energy sphincter reformation, implantable artificial bowel sphincters, and anal sphincter surgical procedures.
Please consult a health care professional to assess how appropriate any of these options may be to your situation.
**Nielsen Mature Women’s Health Survey commissioned by Renew Medical Inc.
*** Norton C, Kamm MA. Anal plug for faecal incontinence. Colorectal Dis. 2001; 3(5):323-327.