If you suffer from Accidental Bowel Leakage, you are not alone.
Accidental Bowel Leakage (ABL), medically termed bowel or fecal 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. In fact, studies show that 19% of women over the age of 45 experience ABL.1 Additionally, for men over the age of 50, studies indicate that the prevalence of ABL ranges from 8% to 18% and increases with age.2 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.3
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 diarrhea and diarrhea-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 hemorrhoids, 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. Antidiarrheal medication can help treat ABL by hardening the stool, reducing diarrhea 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 incontinence pads or diapers that contain bowel leakage more effectively, but some people may find them excessively bulky.
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 your doctor to assess how appropriate any of these options may be to your situation.
1 Brown et al. (2012), Accidental bowel leakage in the mature women’s health study: prevalence and predictors. International Journal of Clinical Practice, 66: 1101–1108.
2 Rosebud et al. (1999), Prevalence of combined fecal and urinary incontinence: a community-based study. Journal of the American Geriatrics Society, 47: 837-841.
3 Nielsen Mature Women’s Health Survey commissioned by Renew Medical Inc.