Conservative Management

Fecal incontinence is the inability to control bowel movements, causing unexpected leakage of either liquid or solid stool from the rectum. If you’re struggling with fecal incontinence, you don’t need to suffer in silence. Patrick Nosti, MD, FACOG, at Urogynecology of Kansas City, offers innovative treatment solutions. Find out more by booking an evaluation today.

UROGYNECOLOGY OF KANSAS CITY
| 913.262.3000

Many women find that dietary fiber helps them to keep fecal incontinence in check. Talk with your doctor about starting an over-the-counter fiber supplement. But go slow when you start fiber! A rapid increase in the amount of fiber in your diet can cause bloating and discomfort, so be sure to slowly increase your fiber by a few grams every day to avoid this. The goal is 25-35 grams of fiber each day. Also, it is important to drink enough water, especially when using fiber, to keep the stools soft.

In addition, physical therapists who specialize in pelvic floor problems can work with you to strengthen the pelvic floor muscles and on different positions that might make defecating easier. In some cases, they perform biofeedback to improve the pelvic floor muscle strength, tone, endurance and sensation. In the difficult cases of pelvic muscle spasm, a trained physical therapist can be extremely helpful to break those spasms.

For both kinds of bowel control problems—accidental bowel leakage and constipation—the following treatment option conservative (non-surgical) options:

Lifestyle and Behavior

Diet and fitness

  • Try eating a high fiber diet. Most experts recommend eating between 25-35 grams of fiber a day. Increase fiber slowly as it can cause gas and bloating.
  • Try to eat your meals at a predictable time each day and eat roughly the same quantity of food day-to-day at each meal. If you will not be near a toilet about 30-60 minutes after you eat, consider eating less to stimulate the bowels less.
  • It’s especially important for your bowels to eat breakfast – this will stimulate the bowels to start moving.
  • Drink little or no caffeine, which is a diuretic and also increases bowel motility. It can leave your stools hard and difficult to pass.
  • Coffee often stimulates the bowels – if you have problems with urgency or ABL, stop drinking coffee.
  • Exercise daily. Try to do this at the same time every day.
  • If you have loose stools or diarrhea, try to avoid offending foods. Certain foods may worsen diarrhea and accidental bowel leakage such as lactose, artificial sweeteners, carbonated beverages, and spicy or greasy foods. Keep a food diary to help recognize foods which may be worsening your symptoms.

Hygiene

  • Dry toilet paper can irritate the skin. If you have ABL, overcleaning and rubbing the anal area with dry toilet paper can stimulate more seepage of stool. Try alcohol-free moist wipes instead. Try to pat dry instead of wiping vigorously.
  • If you have ABL, doing two tap-water enemas before you leave home will clean out the rectum and prevent accidents.
  • Wear cotton underwear to allow the skin to breath.
  • If you are getting skin irritation, try using cotton pads, or try not using pads at all. Apply a barrier cream such as zinc oxide and calamine lotion to the skin to help avoid getting infections or sores. 

Pelvic floor muscle exercises (Kegels)

  • Strengthening your pelvic floor muscles may help with your symptoms.
  • Biofeedback and electrical stimulation may be used as part of this to help improve the effect.
  • If your problem is constipation, you may need to learn how to relax your pelvic floor muscles. A pelvic floor physical therapist can help you with different positions that make defecating easier.

Bowel Training

  • Try to keep your bowels of a regular schedule. Find a consistent time after a meal every day to try to have a bowel movement when you are not rushed. If you empty your bowels early in the day, this may help. The best time to try having a bowel movement is 20 to 30 minutes after eating breakfast. Sit on the toilet for 10 minutes and relax. Try using a stool in front of the toilet to elevate your feet and keep your knees bent. This may help the pelvic muscles relax and allow the bowel movement to pass. Do not strain. If you do not have a bowel movement, go back to your normal activities. It may take a few days to get into a regular pattern.
  • Change your position on the toilet: Put a stool or a stack of books in front of the toilet. Place your feet on that, elevating the knees above the hips. This can make defecating easier if you have trouble. 

Physical therapy for the pelvic floor with biofeedback

  • Pelvic floor physical therapists are specially trained to help with pelvic floor disorders. See your doctor for a referral or check www.apta.org

Devices

Pessary

A silicone insert worn inside the vagina may be recommended. This is typically used to treat vaginal prolapse. It may be helpful to correct a rectocele, which can collect stool that leaks out later.

Eclipse™ Vaginal Insert

This is a small balloon device that is inserted into the vagina and inflated so that it puts pressure onto the rectal area. This helps with better bowel control. You need to be fitted for this in a doctor’s office, but then you will be taught how to manage it on your own. This was recently approved for use to treat fecal incontinence and therefore it may only be available in some physician offices. It continues to be evaluated to determine which women it may help the most.

Adhesive Patches

There are several available patches that help contain the stool during certain activities. For example, you can wear one during exercise, and then remove it. One example of these is Butterfly® pads, which can be ordered online.

Anal Plugs

This is a silicone anal insert or foam cup used to temporarily occlude the anal canal to prevent stool leakage. Examples of these include Renew® inserts and Peristeen® products. 

Medications

Taking these medications just before going out can help you control your bowels. Your doctor may recommend medicine to treat or prevent diarrhea, decreasing the frequency or looseness of bowel movements.

  • Fiber supplementation: over the counter medicine
  • Loperamide (Imodium®): over the counter medicine.
  • Diphenoxylate and atropine (Lomotil®): Prescription medicine.
  • Amitriptyline: Prescription medicine

Other medicines that may help with incontinence include cholestyramine, hyoscyamine, clonidine, and topical phenylephrine. Sometimes an enema, which is performed prior to leaving the house, may be helpful. Emptying the rectum like this prevents there from being stool present to leak out while you are away from the toilet.

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