I am a Urogynecologist, which means I care for patients with pelvic floor disorders including accidental bowel leakage (ABL), urinary leakage, and pelvic organ prolapse. While many patients have already discussed their urine leakage or prolapse with someone else, the conversation in my office is usually the first time ABL symptoms come up. Travel, jobs, intimacy, friendships, and exercise can all be affected by ABL. Most people with ABL do not realize how common it is, and how many things can be done to improve symptoms. Here’s what you need to know.
DIETARY AND LIFESTYLE CHANGES
Sometimes small changes to your lifestyle can make big differences in your quality of life.
1. Optimize stool consistency
ABL is less likely to happen when your stools are well-formed than when you are constipated or have loose stools. If your stools are on the loose side, gradually adding fiber can help to bulk your stools and make them firmer. If you have issues with constipation (firm, hard pellets that are hard to evacuate), increasing fiber can help too – but you have to make sure you drink plenty of water. Getting exercise and staying active can also help improve constipation. Remember that changes in stool consistency can be a sign of a medical problem, so it is important to discuss these changes with your doctor.
2. Strengthen your pelvic floor
The pelvic floor is a bowl of muscles that wraps around from your pubic bone in the front to your tail bone in the back. You can strengthen these muscles to improve bowel and bladder control. To do a pelvic floor muscle contraction, pretend that there is an elevator in your vagina or anus. Start with the elevator on the ground floor, and then tighten and lift the muscles to bring the elevator up to the fifth floor. Hold it there for five seconds and then bring the elevator up to the tenth floor and hold for another five seconds. When you have completed the squeeze, make sure to bring the elevator all the way to the basement and leave it there for ten seconds, because relaxation is just as important as contraction of these muscles. Start doing these exercises while lying in bed or on the floor. When you get better at them, you can do them sitting and standing. Do not do these exercises on the toilet, because you should be relaxing these muscles when you are evacuating urine or stool. You can find more information on Tips to Exercise Your Pelvic Floor Muscles here.
OVER-THE-COUNTER SOLUTIONS
1. Fiber supplements
You can get fiber from many foods and supplements. In any drug store there are lots of fiber supplement options, so you can select the ones that work best for you.
2. Anti-diarrheal medicines
If you have loose stools and urgency to have a bowel movement that leads to ABL, over-the-counter anti-diarrhea medicines like Immodium can be helpful. It is important to start with small doses of this medicine to avoid getting constipated. Remember that changes in stool consistency should be discussed with your doctor.
3. Anti-constipation medicines
Sometimes ABL happens because of having too much stool in the rectum, so using products to help evacuate your bowels can improve symptoms. There are different types of laxatives, and the safest ones are usually osmotic laxatives, which act by pulling water into your stool. It is important, however, to talk to your doctor about laxative choices.
4. Absorbent protection products
For light to moderate ABL, Butterfly Body Liners are a discreet, new absorbent protection product that adheres comfortably in between the buttocks. Butterfly provides a hygienic way to manage ABL that relieves the worry about staining. Sometimes people give up activities when they have even light to moderate ABL. Using an absorbent pad like Butterfly can help you feel more secure remaining active. You can visit this website to learn more.
5. Skin protection
The tissue around the rectum is very gentle and sensitive, and it can get irritated when ABL flares up. Moist, non-alcohol containing wipes can be used to dab the area clean, rather than wiping with a wood-based toilet paper. If feasible, cleaning the area with water is also soothing for the skin. Zinc oxide or Desitin can be applied in a thin film to keep the skin protected from constant moisture.
Most people with ABL can cure their symptoms through these tips and tricks. However, if these tricks do not help, you may want to seek additional therapy. Talk to your health care provider. If she or he cannot help you, ask for a referral to a pelvic floor physical therapist and a specialist who can treat ABL (a Gastroenterologist, Colorectal surgeon, or Urogynecologist).
MEDICAL SOLUTIONS
1. Pelvic floor physical therapy with biofeedback
Ask your doctor for a referral to see a physical therapist who is certified in pelvic floor muscle training. A pelvic floor physical therapist can coach you in your pelvic floor strengthening (learning kegels) and can also perform a therapy called biofeedback, which improves your awareness of what is happening in the bowels. You can visit this website to find pelvic floor physical therapists near you:
2. Nerve stimulation
Often times ABL happens because the nerves and muscles that coordinate bowel storage and emptying have become weak and are no longer coordinated with one another. There is a therapy called sacral neuromodulation that stimulates the nerves that control the bowels using a thin wire placed through the skin of your back that connects to a battery (like a pacemaker) implanted under the tissue of the buttocks. Most doctors provide this treatment in the two phases. For the first phase, you keep a diary of your symptoms for two weeks, and then your doctor places the wire in your back and connects it to an external battery. For two weeks, you track your symptoms with the wire in place and a temporary battery connected to it. Together, you and your doctor review your symptoms and decide whether the therapy is helping. If the therapy is helping, your doctor will then connect the wire to a permanent battery placed under the tissue of the buttocks. If the therapy is not helping, your doctor will remove the wire and you do not have anything left in your body. Both the wire and battery placements are usually done in the operating room so that you can be comfortable, but you do not need to spend the night in the hospital and the activity restrictions are minimal. You can visit this website to learn more about this therapy.
3. Bulking injection
Sometimes ABL happens because the muscles lining the wall of the anal canal have become so weak that they do not stay together. Your doctor can use an anoscope (a little plastic tube with a light at the end of it) to inject a bulking material (similar to collagen) to move the walls of the anal canal closer to one another. The injections are done through a tiny needle and there are no nerve fibers where the needle is inserted, so you do not feel the injection. This procedure can be repeated 3-6 months later if more bulking is needed to move the walls of the anal canal more closely together. This procedure is performed by some doctors right in the office and by others in the operating room, but either way you do not need to spend the night. You can visit this website to learn more about this therapy.
4. Vaginal insert
The Eclipse™ is an insert that is placed in the vagina like a tampon. You use a small pump to inflate a balloon attached to the insert, which presses on the rectum to prevent unwanted passage of stool. You can deflate the balloon when you want to have a bowel movement and can remove the insert yourself. Your doctor can fit you with this insert in the office. At this time, this insert is not commercially available, but you may be able to use it through participation in a clinical trial. Visit this website to learn more.
5. Surgery
Sometimes acute disruption of the muscles of the pelvic floor because of traumatic child birth or an accident can cause ABL, and surgical correction of the muscles may improve symptoms. This surgery is called sphincteroplasty, and while it may help in the short run, the long-term success rates are less promising. If your symptoms start immediately after a birth or traumatic accident, muscle repair may make sense. However, if your symptoms develop months or years after the injury, chances are high that it is not just the muscle injury that is causing the problem, so correcting the muscle injury may not solve the problem – and may even make things worse. There is also a surgery where the bowel is brought up to the skin of the abdomen so that your stool comes into a bag rather than exiting through your bottom. This surgery, called a permanent colostomy, may be offered to you if your muscles and nerves have been damaged by cancer or radiation. It makes sense to try all your other options before trying this surgery, since it cannot be reversed.
Remember, you are not alone. ABL is common, and there are things you can do to improve your symptoms. A physical therapist or doctor can also help, so make sure to discuss your symptoms with a health care provider. Changes in stool color or consistency should always be discussed with your doctor.
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