This is the loss of bowel control, resulting in a loss of gas, liquid or solid stool. It can affect men and women of any age. It can be a few ‘skid marks’ in the underwear, being unable to control the passing of gas, losing small ‘pellets’ without being aware of the loss, or having an extreme urge to get to the washroom and not making it in time. Whatever the problem, the embarrassment and anxiety it can create can severely affect your confidence, with the fear of repeated accidents always in the back of your mind.
Common causes of bowel leakage
Muscle Weakness: Weakness of, or damage to, the rings of muscle which circle the anus. These are called the external and internal anal sphincter muscles, and they are the most superficial part of the pelvic floor muscles.
The external anal sphincter works to delay a bowel movement if an urge is felt, but it’s not convenient to go to the washroom right away. If it is weak you will have an urgent need to get to the washroom immediately and may loose some bowel contents if you can’t get there in time.
The internal anal sphincter works to keep the anus closed throughout the day, unless there is an urge to empty the bowels. If it is weak you may lose small amounts of stool without being aware that it has happened. This may occur when you’re being particularly active (lifting, running), or after you’ve just emptied your bowels.
Either one or both of these muscles can be damaged. The most likely cause of damage is childbirth, when the muscles may be stretched or torn. If there is a significant tear at the back of the vagina (often called a 3rd or 4th degree tear), it can extend to the anal sphincter.
You may be aware of difficulty controlling your bowels immediately after the birth, or problems may develop many years later as the pelvic floor and sphincter muscles gradually weaken with age or recurrent straining.
The muscles may also be damaged during surgery to the rectum or anus, or as a result of local radiation treatment, and may be weakened by years of straining to empty the bowels.
Diarrhea: If stools are watery it takes much more muscle control to hold the stool safely in the rectum, and it becomes even more of a problem if the pelvic floor or anal sphincter muscles are weak.
Constipation: Surprisingly, constipation can also result in bowel leakage. If there is a large accumulation of stool sitting in the rectum, mucus can seep around the stool and escape through the anus, often accompanied by small pieces of stool.
A pelvic health assessment will identify your specific factors and tailor treatment to your needs and goals. This may include Kegel exercises, modifying Kegels or even stopping them altogether and teaching reverse Kegels. Dietary modifications, abdominal massaging techniques and teaching correct toileting positions may be added to the treatment program.