10 Tips to Relieve ABL
By Dr. Heidi Brown
Assistant Professor
University of Wisconsin School of Medicine & Public Health
Contributing Editor

This article was written by Lori Newman of Lifescript.com and features tips from leading ABL experts Dr. Heidi Brown, Dr. Dee Fenner and Dr. Brooke Gurland

It’s embarrassing: runny stool or gas escaping your body at inopportune moments. No wonder 7 of 10 women keep silent for years about bowel accidents, according to research from the National Center for Biotechnology Information. It’s a condition called accidental bowel leakage (ABL), what doctors used to refer to as fecal incontinence, says Heidi Brown, M.D., assistant professor at the University of Wisconsin School of Medicine and Public Health, in Female Pelvic Medicine and Reconstructive Surgery, and a contributing editor to ABLinfo.org. “So many women actually feel shame or guilt – as if they did something to cause it,” she says. About 18 million Americans live with ABL, according to the National Institutes of Health. But it isn’t something women often bring up during a doctor visit. That’s because they don’t realize it can be treated. 

Or they say, “‘I had more pressing concerns to talk to my doctor about’ or ‘I’ve never heard of anyone else having this kind of problem,’” Dr. Brown says. Many people with ABL believe it’s rare. “They’re afraid that they’re the only one suffering like this,” Dr. Brown tells Lifescript. “You’re not alone at all!” says Dr. Brown, lead author of a 2012 study published in the International Journal of Clinical Practice that showed 18.8% of women 45 years and older had experienced at least one ABL incident during the previous year. “Nearly 1 in 5 women over age 40 has experienced ABL, and the onset for 70% of those women occurred before age 60,” she says. “It’s not an ‘old people’s condition’ – although it does become more common as we age.” Whatever their age, women don’t have to live with the embarrassment and suffering that comes with ABL, says Dee Fenner, M.D., a University of Michigan professor of obstetrics and gynecology and past president of the American Urogynecologic Society. “There is help,” she says “We can’t always cure it, but there’s a lot we can do a lot to improve your quality of life.” 

Treatments include medication, enemas, dietary changes, biofeedback and Kegel exercises, she says. Also, specially designed pads for the anal area, called “Butterfly body liners,” have recently become available, easing some of the fear of having an accident that a person with ABL lives with daily. Read on for 10 more tips to help you live better with ABL.

ABL tip #1: Find out the cause 

Talk to your primary care provider. Tell him or her how often you have leakage, how much and what foods seem to bring it on,” Dr. Brown advises. ABL’s causes vary from what you eat to how much you move to what medications you take. So tell your doctor all about your lifestyle and habits. “Many ABL therapies target the cause, so find out what’s causing your particular case,” Dr. Brown says. “The solution needs to be tailored to its cause.” For example, “spicy foods and artificial sweeteners can often trigger ABL,” she says. So can lactose intolerance, Dr. Fenner adds.

Eliminate one or two types of food for two weeks to see if you notice a difference, Dr. Brown advises. Then add one back into your diet the next week and see how you feel. Note whether your bowel leakage improves or worsens. Then share your findings with your doctor. Besides food, the NIH reports, ABL’s many causes include:

  • Diarrhea
  • Constipation
  • Muscle damage or weakness
  • Nerve damage
  • Loss of stretch in the rectum
  • Childbirth by vaginal delivery, particularly if forceps were used
  • Hemorrhoids and rectal prolapse, a condition in which the rectum drops down through the anus
  • An inactive lifestyle

If your ABL is caused solely by hemorrhoids or rectal prolapse, surgery may be a solution, Dr. Fenner says.

ABL tip #2: Change your diet

“When you’re managing ABL symptoms, a healthy diet with lots of fiber is crucial,” Dr. Brown says. “The average American gets only 11 grams of fiber a day, but we need 25-30 grams.” But don’t increase your fiber intake all at once. If you try to double or triple your fiber intake overnight, you’ll probably end up “bloated and gassy,” she says. 

Instead, increase your fiber by 2 to 2.5 grams the first week. If you don’t have a problem, increase it by a little more – up to 5 grams the next week. “Take about four weeks to get from 11 grams to 30 (grams of fiber) so your body can adjust gradually,” Dr. Brown says. Foods high in healthy fiber include: lentils, dried peas and beans, as well as many raw vegetables and raw or dried fruits. “Whole-grain breads, cereals and nutrition bars can be good fiber sources too,” she says. Read the products’ nutrition labels to find out how much fiber each serving contains. Consistency of your stools is the goal, so it may take some time to get the right amount of fiber and liquids in your diet, she says. Discuss your meal schedule and nutritional needs with your physician, because your physical condition, weight and medications will help determine your unique list of foods, Dr. Brown says. If you prefer to increase your fiber intake with supplements, that’s OK, she says. You probably wouldn’t eat higher-fiber food regularly if you don’t enjoy them, she says. 

When you eat may be as important as what you eat if you’re trying to avoid an ABL accident, she adds. Eat your meals at regularly scheduled times. That ensures more regular bowel activity.

ABL tip #3: Drink plenty of water

Drinking more water is often the solution for constipation, hard or pebbly stools, Dr. Fenner says. If you’re increasing your fiber intake to bulk up loose stools, however, drink more water too, she advises. The ideal stool is log-shaped but not hard, Dr. Fenner explains.

ABL tip #4: Avoid caffeine

That’s because caffeine is a stimulant for bowels and bladder, Dr. Brown says. “Eliminate caffeine for two weeks and see if your symptoms improve,” she advises. Coffee isn’t the only source of caffeine. It’s in chocolate and many teas.

ABL tip #5: Check your medications

Tell your doctor about every medication you’re taking. “Some diabetes medications cause diarrhea, so they can aggravate ABL,” says Brooke Gurland, M.D., a colorectal surgeon at Cleveland Clinic’s Digestive Disease Institute. Consult with your doctor about your diabetes medication, and explain that you also have ABL. 

ABL tip #6: Consider biofeedback

When weakness of the pelvic floor muscles triggers ABL, biofeedback might help you regain control. “Biofeedback is a mindfulness technique that helps increase your nerve sensation and improves the muscle strength of the pelvic floor, Dr. Brown says. Consult a physical therapist who specializes in pelvic floor issues to find out whether biofeedback can help relieve your ABL symptoms, Dr. Brown recommends.

ABL tip #7: Take probiotics

Taking antidiarrheal medications and probiotics may improve your overall gut health, which may, in turn, improve your ABL symptoms, Dr. Gurland says. “If you have chronic diarrhea that frequently leads to leakage, however, your doctor needs to know,” she says. That’s because chronic diarrhea can be a sign of a more serious condition, such as inflammatory bowel disorder, Dr. Gurland says.

ABL tip #8: Stay active and do Kegel exercises

Regular physical activity is important to maintaining bowel regularity, with or without ABL. Exercise also helps you maintain a healthy weight, which relieves the pressure that abdominal fat can put on the pelvic organs, including the anal sphincter and urinary tract, Dr. Brown says. 

Doing Kegel exercises regularly helps fight both urinary and bowel incontinence, Dr. Fenner says. “Like any kind of strength training, strengthening and controlling the muscles of the pelvic floor helps our body function better,” she says. For best results, Kegels must be done with proper technique, she says. “First, you practice them lying down,” she says. “Do 10 squeezes and work up to being able to do longer, stronger holds. Then transfer that same activity to when you’re standing up – because that’s when you’re likely to need it.” A physical therapist specializing in pelvic floor muscles can help you get started. The therapist can show you how to find, control and exercise the levator ani muscle, which is the exterior anal sphincter for bowel control, Dr. Fenner says.

ABL tip #9: Practice good toilet hygiene

Wash your bottom gently with a soft cloth or toilet tissue, using only warm water or a mild soap. “Stay away from disposable wipes because they tend to produce a lot of itching and irritation if you use them too much,” Dr. Gurland says. For women experiencing bowel leakage regularly, “I advise them to use a barrier cream – as you’d use for diaper rash – to protect the skin around the anus,” she says. 

ABL tip #10: Keep a food/fiber/fluid/bowel movement diary

Women often don’t remember what they ate or drank in the hours or days before an ABL accident. That makes it difficult for your doctor to determine the cause, especially when it’s been a few weeks or months between the leakages and the doctor visit, Dr. Fenner says. Need help remembering? Keeping a diary can help you track your foods, fiber and fluids as well as the consistency of your bowel movements, she says. Remember to take it with you to each doctor visit. Worrisome changes in stool consistency should always be evaluated by your physician, Dr. Gurland says. If you become constipated, develop chronic diarrhea, or your stool becomes pebbly and stays that way, have it checked out sooner, not later, she says.

“Any change in bowel habits needs an evaluation [because] it could imply something’s going on with the colon,” Dr. Gurland says. “So have [your] colon and anus checked. It could be irritable bowel syndrome (IBS), Crohn’s [disease], some other digestive issue or, rarely, it could even be cancer.” 

Last Updated 4/8/2015

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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