Bowel control problems/anal incontinence

About 10% of adults have problems with bowel control, but many people find it hard to talk about.
These problems can range from passing wind at the wrong time to not being able to prevent solid stool escaping the anus (back passage).
Some people only have short-term problems, such as after food poisoning.
Around 6% of adults use pads to manage their bowl control problems.
These can be bought at most pharmacies.
Bowel problems can affect daily life and cause embarrassment.
This leaflet gives basic information and encourages people to speak to their doctor, as simple treatments can often help.

Older people are affected more often than younger people.
Women are more likely than men, especially after having children.
Pregnancy can weaken the muscles and nerves in the pelvis.
Childbirth, especially if forceps are used, can sometimes damage the muscles that control the back passage.
More than half of people who have bowel control problems also have problems with leaking urine (pee).
People who have trouble moving around (reduced movement) can also be affected. Severe constipation can build up and cause “overflow” leakage from the back passage.
Some people develop problems after surgery on the anus (for example for piles or fistulas), or after an injury.
Severe diarrhoea from infections or bowel conditions can also cause accidents, but this often improves once the illness is treated.

Diet changes

Avoid spicy foods and foods that cause diarrhoea
Cut down on alcohol (especially beer) and caffeinated drinks
Some people find that eating less fibre makes stools smaller, firmer, and easier to control.
For people with reduced movement, if there is a build-up of stool (poo), a doctor may suggest:
- More fibre
- A laxative
- Suppositories (such as bisacodyl) to help the bowel empty more effectively.
If you often have loose or watery stools (poo), speak to your doctor to check for any causes, such as a bowel infection.
Once this is ruled out, your doctor may give medicines to help firm your stool, such as loperamide or codeine phosphate. A Pharmacist can help you find the right dose.
Some people only need to take these medicines when they are going out for the day.

You can train your bowels to empty better in the morning, which may reduce leakage later in the day.

If your pelvic floor muscles are weak, exercises can help make them stronger and improve bowel control.

A Physiotherapist may also use:

Your doctor can refer you to a Physiotherapist or Continence Specialist who will teach you these exercises.

If the simple measures described above have not helped, your doctor may refer you to a Bowel Specialist.

The Specialist will:

They may also do tests to:

Neuromodulation uses gentle electrical pulses to stimulate the tibial nerve in your lower leg
It is done as an outpatient procedure (you do not stay overnight in hospital).

If tests show a gap in the anal sphincter muscle, your Specialist may discuss whether surgery to repair it could help you.

For severe bowel control problems, a Specialist may suggest sacral nerve stimulation.
This involves placing a small wire under the skin of your lower back.
The wire sends gentle electrical signals to the sacral nerves to help improve control of the anal muscles.
It is only done in specialist centres.

Some people have both urinary leakage and bowel control problems
These are usually treated by different Specialists
If you have both, speak to your Doctor about whether you need referrals to both types of Specialist.