4 Ways to Manage ABL
By Dr. Heidi Brown
Assistant Professor
University of Wisconsin School of Medicine & Public Health
Contributing Editor

1. Get the Facts

Learning about ABL can help you identify ways to improve symptoms.  ABL affects tens of millions of women and men, but most of us don’t talk about it. One in ten US adults experience ABL symptoms at least monthly.

There are lots of reasons someone might experience ABL. Many common conditions are associated with ABL, such as irritable bowel syndrome, chronic diarrhea, obesity, diabetes, and urinary incontinence. ABL sometimes follows damage of the muscles or nerves of the pelvic floor, which can happen after childbirth or treatment for cancer or prostate problems.  ABL is more common after menopause and as we get older in both men and women.

There are different types of ABL.  ABL affects different people differently. Some people have ABL only when their stool is too loose; others have it when they are constipated. Some people lose stool and others lose mucus. ABL can happen with urgency, where someone is rushing to the bathroom and doesn’t make it in time, or it can happen without urgency, after a bowel movement. Sometimes ABL happens without a person even being aware of it.

Treatments are available for ABL, and vary based on different types. Fiber can help change the consistency of the stool to make it easier to control. Avoiding certain foods can decrease symptoms. Pelvic floor muscle exercises can strengthen the muscles of the pelvic floor to provide more control. Over-the-counter and prescription medications can regulate bowel movements and control urgency. Absorbent pads and barrier creams can protect skin. A technique called biofeedback can help increase the nerve sensation and improve the muscle strength of the pelvic floor.

If these strategies do not provide relief, there are other treatments available, including office procedures that bulk the anal canal or provide nerve stimulation to improve bowel control. There are surgical procedures to provide more lasting nerve stimulation, or in some cases, repair defects caused by trauma from an accident or a vaginal birth.

Ask your health care provider for more information about treatments for ABL.  Your healthcare provider can be your partner in helping identify ways to reduce and improve symptoms.

2. Track Your Progress

ABL is different for everyone, so tracking your diet, food and beverages can help you identify things that make your ABL better or worse. You can use diaries to record the timing, frequency, and consistency of your bowel symptoms, as well as the timing and what you eat and drink. After you have completed the diaries for one week, look them over to see if you recognize any patterns. For example, you may notice more accidents and looser stools after eating spicy foods. You may not be able to recognize a pattern, but the information you have collected will be helpful when you talk to a health care provider about this problem. Fiber is an important part of bowel control for a lot of people. Fiber can help treat both constipation and diarrhea. Fiber pulls water into stools to soften hard stools when we are constipated, but has to be taken with plenty of water in that case. Fiber can also bulk up stools and absorb excess water when our stools are too loose. A Fiber Diary can help you record your fiber, food, and fluid intake as well as the impact of those things on your stool consistency.

Click on the links below to download useful diaries from the Michigan Bowel Control Program.

Bowel Diary (stool consistency, frequency, accidents, straining, & difficult bowel movements)

Food Diary (breakfast, lunch, dinner, and snacks – you can also add medications)

Fiber Diary (record your food, fiber, and fluid intake, and see their impact on your stool consistency)

3. Focus on Stool Consistency

Stool consistency can make ABL better or worse. If stools are liquid or loose, they are harder to hold onto (just like it is hard to hold water in your cupped hands). If stools are too hard, like little pebbles, they can slip out easily. It is easiest to control and eliminate stools that are well-formed, like logs.

Fiber is an important part of achieving appropriate consistency for a lot of people, and it can be helpful in treating both diarrhea and constipation.  When stools are too loose, fiber can absorb excess water to bulk up the stools and make them more formed.  When we are constipated and stools are too hard, fiber can pull water into stools to make them softer – but in that case, fiber has to be taken with plenty of water.

A Fiber Diary can help you record your fiber, food, and fluid intake as well as the impact of those things on your stool consistency. Fiber comes in lots of different forms, so you can experiment to find the sources of fiber that you enjoy. Some examples of high-fiber foods include; kidney beans, navy beans, black beans, lentils, peas, and artichokes.

You can consult web sources to find the fiber content in many natural foods. There are cereals and nutrition bars that are good fiber sources as well, and you can consult their nutrition labels for details about how much fiber they contain. You can also take fiber supplements available over the counter if you don’t enjoy any of these food options. If stool remains loose even after supplementing with fiber, you may be able to use an over-the-counter anti-diarrheal medication like loperamide (Imodium).

If your stools remain hard even after supplementing with fiber and drinking plenty of water, you may be able to use a gentle laxative such as milk of magnesia or miralax. You should not take both anti-diarrheals and laxatives at the same time. If you cannot achieve your goal stool consistency with these lifestyle changes, ask your health care provider for help. He or she may recommend consultation with a specialist.

4. Exercise

Pelvic floor muscle exercises can strengthen the bowl of muscles that support the pelvic floor, which can help ABL. It is important to make sure you are contracting the correct muscles. For women, it is the muscles around the urethra, vagina, and rectum. For men, it is the muscles around the urethra, scrotum, and rectum. Pelvic floor muscle exercises should not include the muscles of the buttocks or abdomen. To test whether you are contracting the correct muscles, you can try to stop your urine flow in a controlled fashion by contracting these muscles – but you should not make a habit of stopping your urine flow routinely, because it can confuse the bladder and the pelvic floor. When you first start, you may not be able to hold the muscles tight for very long, but as you gradually increase your strength, you will be able to hold a squeeze for up to ten seconds. A good goal is to perform ten squeezes three times a day. 

Please visit the Michigan Bowel Control Program website for instructions on pelvic floor muscle exercises for women and men.

Last Updated 1/12/2015

Dr. Heidi Brown is a Urogynecologist and Assistant Professor in the Department of Obstetrics and Gynecology at the University of Wisconsin School of Medicine and Public Health.
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