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 Many people are often too embarrassed to seek help over losing control of their bowels, however it’s really important to seek medical advice to rule out a multitude of other conditions which may cause this.
What exactly is Faecal Incontinence? People with faecal incontinence have difficulty controlling their bowel. As a result, they pass faeces, or stools, at the wrong time or in the wrong place. They may also pass wind without control or totally lose control and soil themselves.Whilst a lack of bowel control is a very distressing symptom, it is not all that common in MS. What causes Faecal Incontinence ? It can result from damage to the coordination of the bowel mechanism caused by MS or diarrhoea from overuse of laxatives. Faecal incontinence can also be a by-product of constipation, with poorly formed stools overflowing around impacted stool. How can Faceal Incontinence be treated? The first step is to obtain a referral to a Continence Advisor via a Neurologist, GP or in some areas of the U.K. a person may seek one out and ‘self-refer’. This will lead to a bowel assessment to determine the cause of the problem, for example if it’s caused by the spilling over of liquid bowel contents due to constipation or faulty bowel mechanism due to MS. Medication:
If symptoms are mild, infrequent, and not due to impaction with overflow, Loperamide is safe and very effective. This can benefit patients with soiling or passive leakage and those with urge incontinence and can be used as required or continuously. It belongs to the group of medicines known as antimotility drugs . It works by slowing down the movement of the intestine so that food remains in the intestine longer and water is more effectively absorbed and making the stool more formed. Loperamide is available in chewable tablet, capsule and oral liquid form and is also known as Immodium, Arret, Diocalm and many other brand names. Other medications include Codeine Phosphate available on prescription only, for more severe cases as well as other anti-cholernegic drugs i.e. those which work by reducing contractions in the colon. Dietary management:
This includes introducing bulking substances such as fibre which absorbs stool water thereby thickening the consistency of stool. Avoiding lactose:
Lactose intolerance is common in MS with some being unable to digest lactose so this will often lead develop diarrhoea Sphincter exercises:
Sphincter exercises can help you to improve your bowel control, especially if the main problem is urgency. When done correctly, these exercises can build up and strengthen the external anal sphincter to help you to hold both gas and stool in the back passage. A specialist nurse or physiotherapist can teach you these exercises. Sometimes a course of biofeedback therapy will be suggested. This involves using a computer or machine to show you how your muscles are working, and how well you can co-ordinate the use of these muscles with a full bowel, and to teach you how to improve your control. A disposable enema or manual evacuation of faeces:
This is used in more extreme cases of MS where a person is usually totally immobile and not recommended for mild cases. After the bowel has been cleared, preventive measures must be taken with an adequate intake of fluids, fibre and exercise to enhance normal stool consistency. Anal Plugs:
These are available after consultation with a Continence Advisor usually as a temporary measure . e.g. trips outside the home. Skin care for people with Bowel Incontinence:
Anyone who has frequent bowel motions, diarrhoea or accidental leakage may get sore skin around the back passage from time to time. This can be very uncomfortable and distressing. Occasionally, the skin may become so inflamed that it breaks into open sores which are then difficult to heal. Taking good care of the skin around your back passage can help to prevent these problems from developing. Some tips: - After a bowel action, always wipe gently with soft toilet paper, or ideally the newer moist toilet paper (available from larger pharmacies and some supermarkets). Discard each piece of paper after one wipe, so that you are not re-contaminating the area you have just wiped.
- Whenever possible, wash around the anus after a bowel action. A bidet is ideal (portable versions are available). If this is not possible, you may be able to use a shower attachment with your bottom over the edge of the bath. Or use a soft disposable cloth with warm water Avoid flannels and sponges, as they can be rough and are difficult to keep clean. Sometimes a little ingenuity is needed, especially if you are away from home. Some people find that a small plant spray, watering can or jug filled with warm water makes washing easy on the toilet or over the edge of the bath.
- Do not be tempted to use disinfectants or antiseptics in the washing water as these can sting, and many people are sensitive to the chemicals in them. Just plain warm water is best.
- Avoid using products with a strong perfume such as scented soap, talcum powder, deodorants on your bottom. Choose a non-scented soap (e.g. 'Simple', or a baby soap). Many baby wipes contain alcohol and are best avoided.
- Wear cotton underwear to allow the skin to breathe. Avoid tight jeans and other clothes that might rub the area. Women are usually best to avoid tights and to use stockings or crotchless tights instead. Use non-biological washing powder for underwear and towels.
- Avoid using any creams or lotions on the area, unless advised to do so. A few people who are prone to sore skin do find that regular use of a cream helps to prevent this. If you do use a barrier cream, choose a simple one (such as zinc and castor oil), use just a small amount and gently rub it in. Large amounts stop the skin from breathing and can make the area sweaty and uncomfortable. Make sure that the old layer of cream is washed off before applying more. Some people are allergic to lanolin, and creams containing this should be avoided.
- Your doctor or nurse may suggest using a barrier wipe which forms a protective film over the skin, especially if you have diarrhoea and are opening your bowels very frequently (available on prescription).
- If you need to wear a pad because of incontinence, try to make sure that no plastic comes into contact with your skin and that you use a pad with a soft surface. The Continence Nurse can advise you on which pads are best.
Note: Women are advised always to wipe front to back, i.e. away from the bladder and vaginal openings as bacteria from the bowel can infect the bladder and vagina if you wipe from back to front. Further Information The Bladder and Bowel Foundation.
Bladder & Bowel Foundation
SATRA Innovation Park
Rockingham Road
Kettering, Northants, NN16 9JH Tel: 01536 533255
E-mail: info@bladderandbowelfoundation.org Website: http://www.bladderandbowelfoundation.org/ Open Monday to Friday, 9.30am to 4.30pm © Multiple Sclerosis Resource Centre (MSRC)
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