Bowel control problems range from fecal incontinence to constipation. Once your doctor identifies the cause of your bowel control problem, you can discuss the best treatment for you. The type of treatment depends on the cause and severity of the problem. This section offers you additional information on treatment and prevention options for fecal incontinence, as well as constipation.
Anal (fecal) Incontinence – Anal incontinence can be treated in several ways depending on the causes and exam findings.
Diet changes – Anal incontinence in women who experience diarrhea or loose bowel movements will often improve with avoiding spicy foods or stimulants such as caffeine. Alternatively, fiber supplementation (with whole grains, fruits, vegetables, or high fiber cereals) or over the counter fiber supplements can sometimes help make stools more formed, resulting in more complete passage during bowel movements.
Medications – Sometimes medications such as loperamide can be used to treat or prevent diarrhea, decreasing the frequency or looseness of bowel movements.
Biofeedback – Specialized physical therapists can often perform biofeedback to improve sensation and muscle strength. See your doctor for a referral.
Surgery – Damaged anal sphincter muscles can sometimes be repaired with surgery, more successfully when the nerves are working properly. Repair of rectoceles or other forms of prolapse can lead to improved bowel emptying. Fistula repair is generally curative when there are no other factors contributing to the anal incontinence.
Trans-Anal Bulking – The FDA has approved an injectable therapy for the treatment of Anal Incontinence. Solesta is a biocompatible tissue bulking agent, consisting of a viscous combination of stabilized hyaluronic acid and dextranomer-linked beads. The injection is performed in the office and takes less than 10 minutes and is usually painless. Success rates are in the 60-80% range.
Neuromodulation – Recently the FDA approved ( Interstim ) Neuromodulation for anal incontinence which uses a device similar to a pacemaker to help the anal sphincter contract. A test can be performed in the office to see if it will work for you. If successful the pacemaker battery is inserted under the skin of the buttocks in a procedure that does not require you to go to sleep. Success rates are in the range of 80%.
If these simple measures don't work, then you should talk to your primary care physician. If you can't solve these problems together, then a specialist such as a urogynecologist or gastroenterologist should be consulted.
Constipation - Constipation can be treated in several ways depending on the causes and exam findings.
Diet changes - Increasing dietary fiber is the most common way of treating constipation. Eating high fiber foods (with whole grains, fruits, vegetables, or high fiber cereals) or over the counter fiber supplements can sometimes help make stools more formed, softer, and more frequent. It is important to drink enough water, especially when using fiber, to help keep the stools soft. Avoiding starchy foods such as white rice, pasta, or white bread can help prevent constipation.
Medications - When fiber supplementation isn’t enough, your doctor can recommend medications such as stool softeners or osmotic laxatives to help. For patients with irritable bowel syndrome, prescription medications are available. Medications that cause constipation as a side effect should be discussed with your doctor because they can often be switched to others that don’t.
Biofeedback - Specialized physical therapists can perform biofeedback to improve the pelvic muscle strength, tone and endurance. In the difficult cases of pelvic muscle spasm working with a trained physical therapist may yield better results. See your doctor for a referral.
Surgery - For patients with rectoceles or other bowel disorders who don’t improve with the treatments listed above, surgery can sometimes lead to improved bowel emptying.
Sources
American Urogynecologic Society
Original publication date: May, 2008; Content updated: March, 2012