Bowel Incontinence

Overview

Bowel incontinence (also called fecal incontinence) is the inability to control when you pass stool (poo). This can mean leaking a small amount when you pass gas, or not being able to reach the toilet in time. It is a common problem, but many people feel embarrassed and don't talk about it. Help is available.

Yes. Bowel incontinence is a common condition, and many people experience it at some point in their lives. However, because people often feel ashamed, it is not talked about openly. This makes it seem rarer than it actually is.

Bowel incontinence can affect anyone at any age, but it is more common in older adults, in people who have given birth vaginally, and in people with certain gut conditions such as inflammatory bowel disease. It is also more likely if you have a long-term illness that affects your nerves or muscles.

Symptoms

Common symptoms

• Leaking a small amount of stool (solid or liquid) without feeling it
• A sudden, strong urge to pass stool that you cannot control
• Passing gas with some stool leakage
• Finding stool in your underwear without remembering when it happened
• The feeling that your bowel has not emptied completely after a bowel movement

Symptoms in children

• Children can have bowel accidents (also called soiling) after the age when they are expected to be toilet trained.
• This often happens because of constipation, when a large, hard stool blocks the bowel and watery stool leaks around it.
• A child might hold in their stool because they are afraid of the pain of passing it, or because they don't want to stop playing to use the toilet.

Symptoms in older adults

• In older adults, bowel incontinence can be caused by weak pelvic floor muscles, long-term constipation, surgery, diabetes, or nerve damage.
• It can also be a side effect of some medicines, so it is worth reviewing all your medicines with a doctor.
• If the problem starts suddenly, it could be a sign of an infection or a more serious condition, so it needs to be checked.

Causes

Main causes

• Damage to the ring of muscle that holds the anus closed (the sphincter), which can happen during childbirth, surgery, or injury
• Weakness in the pelvic floor muscles (the muscles that support your bladder and bowel)
• Constipation – a hard, impacted stool can block the bowel and cause watery stool to leak around it
• Persistent diarrhoea, which gives you less time to reach the toilet
• Nerve damage, caused by conditions like diabetes, multiple sclerosis, or a spinal injury
• Inflammatory bowel conditions such as ulcerative colitis or Crohn's disease
• Reduced awareness – you no longer feel the urge to go until it is too late

Risk factors

• Being older, because muscles naturally weaken over time
• Having given birth vaginally, especially if you had a tear or an episiotomy
• Being overweight, since extra weight puts pressure on the pelvic floor
• Avoiding the toilet for a long time, which can weaken the pelvic muscles
• Long-term constipation or repeated straining
• Taking certain medicines that affect your digestion (always talk to your doctor)
• Smoking – a long-term cough can weaken your pelvic floor

When to see a doctor

See a doctor urgently if:

• If you suddenly lose bowel control and have any sign of a stroke (weakness on one side, drooping face, trouble speaking) or severe abdominal pain, call your local emergency number right away.
• If you have bleeding from your bottom and feel faint or dizzy, get urgent medical help.

Book a routine appointment if:

• If you have bowel leakage that happens regularly or often enough to bother you
• If you are avoiding work, social events, or exercise because you are scared of having an accident
• If you have a change in your normal bowel habits that lasts more than a few weeks
• If you have pain or a feeling of incomplete emptying after a bowel movement
• If your child is over the normal age for toilet training and is still soiling their underwear

Diagnosis

A doctor will ask about your symptoms, your medical history, and how the problem is affecting your daily life. They may need to gently examine your bottom to look for signs of damage or weakness. You might be asked to keep a diary of your bowel movements for a week or two.

Tests that may be done

• Anorectal manometry – a small tube is gently placed in the rectum to measure the strength of the sphincter muscles
• An ultrasound scan – can look at the sphincter muscles and the surrounding pelvic floor area
• Nerve function tests – check whether the nerves to the anal muscles are working properly
• A colonoscopy – a thin telescopic tube is used to look inside the lower part of the bowel, if your doctor thinks it is needed

What to expect at your appointment

Your doctor will usually start with simple steps: talking about your diet, fluid intake, and toilet habits. You may be asked to do pelvic floor exercises, and you might be referred to a specialist physiotherapist or a continence nurse. Most people do not need complex tests right away.

Treatment

There are many ways to treat bowel incontinence, and the best option depends on the cause. Treatment often starts with simple lifestyle changes and exercises, and can move on to medicines, devices, or surgery. Most people see a significant improvement with the right support.

Self-care at home

• Set a regular time for your bowel movement – for example, sit on the toilet about 30 minutes after a meal.
• Use pads or disposable pants when you leave the house to feel safer and more confident.
• Plan ahead – know where public toilets are before you travel, and carry a small 'emergency kit' with wipes and a change of underwear.
• Wash your bottom gently with mild soap and water, and use a barrier cream to protect your skin from irritation.
• Stop holding in your stools – go to the toilet when you feel the urge, not when you are at home later.

Medical treatments

Your doctor might suggest approaches such as pelvic floor muscle training (Kegel exercises) with a physiotherapist, biofeedback (a method that helps you retrain your muscles using a small sensor), or medicines that help control the speed of your bowel movements. In some situations, a special plug can be worn inside the anus to prevent leakage. Another option is nerve stimulation, where a small device sends mild signals to the nerves that control the sphincter. Your doctor or specialist nurse will discuss the options that might suit you – there is no one-size-fits-all treatment.

When is surgery considered?

Surgery is usually only considered if other treatments have not worked. Options include repairing the sphincter muscle, making the anus tighter, or sometimes creating a colostomy bag (where waste is collected in a pouch on the outside of the body). Your doctor will explain the benefits, risks, and what recovery would look like. Surgery is not the right answer for everyone, but for some it can change their life for the better.

Living with this condition

Living with bowel incontinence can feel exhausting and lonely, but there are practical ways to manage it. Carry a small bag with wipes, a change of underwear, and pads in case of accidents. Try to eat and drink at regular times to make your bowel routine more predictable. When you go out, notice where the toilets are before you need them, and don't be afraid to ask about accessible toilets.

Lifestyle tips

• Do pelvic floor exercises regularly – your physiotherapist or nurse can teach you how to do them correctly.
• Stay physically active with gentle activities like walking, swimming, or cycling.
• Try to reach and keep a healthy weight to reduce pressure on your pelvic floor.
• Avoid long periods of sitting on the toilet and don't strain when you go.
• If you smoke, ask for help to quit – a chronic cough can weaken your pelvic floor.

Diet and exercise

Eat plenty of fibre from fruits, vegetables, and whole grains, but increase your fibre slowly so your stomach has time to adjust. Drink enough water – roughly 6 to 8 glasses a day, unless your doctor tells you otherwise. Some foods and drinks can make symptoms worse, such as spicy food, rich or fatty food, sugary drinks, caffeine, and alcohol. Keep a food diary to find out what affects you. For exercise, gentle activities are usually best – avoid very bouncy or high-impact workouts if they make your symptoms worse.

Mental health and emotional wellbeing

Bowel incontinence can make you feel anxious, depressed, ashamed, and isolated. These feelings are very real and very common. It is important to remember that this is not your fault and that there is help. Talk to your doctor about how you feel, not just about your physical symptoms. If you ever have thoughts of harming yourself, please reach out for crisis support right away – you deserve help and care.

Prevention

It is not always possible to prevent bowel incontinence, but you can lower your risk by keeping your pelvic floor muscles strong, avoiding constipation, staying active, and maintaining a healthy weight. If you have had a baby, ask about pelvic floor rehabilitation after giving birth. Avoid holding in your bowel movements for long periods.

Complications

If left untreated

• Skin irritation, soreness, or infections around the anus from constant dampness
• Urinary tract infections if hygiene becomes harder to manage
• Avoiding food and drink because you worry about accidents, which can lead to dehydration or unhealthy weight loss
• Withdrawing from social life, work, and close relationships, leading to loneliness and depression
• Severe embarrassment that stops you from seeking the help that could improve your life

Long-term outlook

The outlook is much more hopeful than many people expect. With the right support, many people improve their symptoms and feel in control again. It may take time to find the best treatment for you, but every step you take to get help is a step towards a better quality of life. You are not alone, and things can get better.

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