Bowel Leakage & Faecal Incontinence
Bowel leakage can be difficult or embarrassing to talk about, but it is a health concern that deserves appropriate assessment and support.
Faecal incontinence, also called bowel incontinence, is the involuntary loss of stool. It can range from small amounts of staining or difficulty controlling wind through to being unable to reach the toilet before a bowel motion.
There are many possible reasons bowel leakage can occur. Understanding your bowel habits, stool consistency, pelvic floor function and medical history can help identify what may be contributing to your symptoms.
Bowel Leakage & Faecal Incontinence: Why Am I Having Trouble Controlling My Bowels?
What Is Faecal Incontinence?
Faecal incontinence refers to difficulty controlling the passage of stool.
It can present in different ways. You may notice:
Small amounts of stool staining your underwear
Difficulty controlling loose stools
Leakage associated with bowel urgency
Not reaching the toilet in time
Difficulty controlling wind
Leakage without feeling a strong urge beforehand
Difficulty cleaning completely after a bowel motion
Changes in bowel control following pregnancy or childbirth
Even occasional bowel leakage is worth discussing if it is concerning you or affecting your everyday life.
Bowel control relies on several systems working together, including the pelvic floor muscles, anal sphincters, nerves, rectum and the consistency of your stool.
Because of this, faecal incontinence doesn't always have one single cause.
Possible contributing factors include:
Loose or frequent bowel motions
Bowel urgency
Constipation
Pelvic floor dysfunction
Changes to the anal sphincter muscles
Pregnancy and vaginal childbirth
Significant perineal tearing or obstetric anal sphincter injury
Previous pelvic or bowel surgery
Neurological conditions
Changes in rectal sensation
Some gastrointestinal conditions
An assessment can help determine which factors may be relevant to your individual symptoms.
Why Am I Leaking Bowel Movements?
Can Constipation Cause Bowel Leakage?
Surprisingly, yes.
Constipation doesn't always mean that you aren't opening your bowels at all. You may still be passing bowel motions while experiencing incomplete emptying or retained stool.
In some cases, softer or more liquid stool can pass around harder stool within the bowel, resulting in leakage or soiling.
Straining and long-term constipation can also place additional demand on the pelvic floor.
If you're experiencing both constipation and bowel leakage, it's important to consider both symptoms together rather than treating them as completely separate problems.
Can Childbirth Cause Faecal Incontinence?
Pregnancy and childbirth can influence the muscles, connective tissues and nerves involved in bowel control.
For some people, bowel symptoms may develop following vaginal birth, particularly following significant perineal trauma or an injury involving the anal sphincter.
Symptoms don't necessarily appear immediately after having a baby. Some people notice changes later, or when other factors affecting pelvic floor function occur.
If you have experienced a third- or fourth-degree tear or have noticed changes in bowel control following birth, discussing these symptoms with an appropriately trained healthcare professional is important.
Not necessarily.
Pelvic floor strength can be relevant to bowel control, but strength is only one part of pelvic floor function.
The pelvic floor also needs appropriate coordination, endurance, sensation and the ability to contract and relax at the right time.
Stool consistency, bowel urgency, sphincter function, nerve function and other medical factors can also influence continence.
This is why simply doing more pelvic floor strengthening exercises isn't necessarily the right approach for everyone experiencing bowel leakage.
Does Bowel Leakage Mean My Pelvic Floor Is Weak?
Stool consistency has a significant influence on bowel control.
Loose or watery stool can be more difficult for the bowel and sphincter muscles to contain than a well-formed bowel motion. This means someone may experience bowel leakage despite having reasonable pelvic floor strength.
If loose stools or diarrhoea are contributing to your symptoms, identifying why your stool consistency has changed is an important part of management.
Depending on your presentation, this may require assessment from your GP, dietitian or another healthcare professional alongside pelvic health care.
Why Is It Harder to Hold in Loose Stools?
What Is the Difference Between Bowel Urgency and Faecal Incontinence?
Bowel urgency is the sudden, strong need to open your bowels that can be difficult to delay.
Faecal incontinence occurs when stool is involuntarily passed.
You can experience significant bowel urgency without actually leaking. However, some people experience both — a sudden urge followed by difficulty reaching the toilet in time.
Pelvic floor rehabilitation may form part of management for some people with faecal incontinence, but the appropriate exercises depend on what's contributing to your symptoms.
Management isn't necessarily about repeatedly squeezing your pelvic floor.
Assessment may consider strength, endurance and coordination, as well as your ability to respond appropriately when you experience bowel urgency.
Your bowel habits and stool consistency are also important parts of the picture.
Can Pelvic Floor Exercises Help With Bowel Leakage?
How Can Pelvic Health Care Support Bowel Leakage?
A pelvic health assessment can help explore your bowel symptoms and determine whether pelvic floor dysfunction may be contributing.
Depending on your individual presentation, assessment and management may consider:
Pelvic floor strength and endurance
Pelvic floor coordination and relaxation
Bowel habits and stool consistency
Bowel urgency
Constipation and incomplete emptying
Toileting position and technique
Pregnancy and birth history
Breathing and pressure management
Exercise and movement
Strategies for managing bowel urgency
Where symptoms suggest that further medical, gastrointestinal or specialist assessment is required, referral or collaborative care may also be recommended.
When Should I Seek Help for Bowel Leakage?
If you're experiencing bowel leakage, difficulty controlling wind, significant bowel urgency or changes in your ability to control your bowels, it's worth discussing this with a healthcare professional.
You don't need to wait until symptoms become severe or frequent before asking for help.
New or unexplained changes in bowel function, blood in your stool, black stools, unexplained weight loss, persistent diarrhoea, significant abdominal pain or new bowel symptoms associated with neurological changes should be medically assessed.
Pelvic Health Care in Healesville & the Yarra Valley
At Yarra Valley Women's Health, our pelvic health osteopaths provide individualised assessment and management for bowel concerns including faecal incontinence, bowel urgency, constipation and pelvic floor dysfunction.
Our aim is to provide a comfortable environment to discuss symptoms that can sometimes feel difficult to talk about, while helping you better understand your pelvic health and the management options available to you.