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Bowel Control Questions

Questions & Answers

What are bowel control problems?

Bowel control disorders affect the normal pattern of emptying your bowels. For example, you may have bowel movements not often enough, you may have very loose or hard bowel movements, you may have abnormal consistency of bowel movements, or you may not be able to hold in the bowel material. Common types of bowel control problems include:

  • Accidental Bowel Leakage (ABL, also called anal incontinence or fecal incontinence): Leakage of gas, mucus, liquid stool, or hard stool. Often happens when you have loose stools and diarrhea. Or, a feeling of urgency and great need to get the bathroom for a bowel movement.
  • Constipation: Difficulty passing bowel movements or the need to strain for bowel movements. You will be irregular and have hard stools. Plus, you may need to support the back wall of the vagina to pass stool that is trapped in a pocket or a bulge.

These problems can be caused by some medical conditions, certain medicines, injuries from childbirth, or as side effects from other surgeries or radiation. 

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How can I help my bowel control problems?

Making changes to your diet is the best first step. For both ABL and constipation, increasing intake of soluble and insoluble fiber is very helpful. It helps draw water into the stool, making the stool a soft, formed mass that are more easily held in the rectum than watery stool but is also easy to pass when it’s time to defecate. Aim for 25 to 35 grams of fiber per day.

If you are experiencing ABL, you can also try eating at regular times helps to regulate bowels, avoiding spicy foods or stimulants such as caffeine, which speed up transit time in the bowel. Also, try reducing intake of artificial sweeteners (sorbitol, mannitol, xylitol), which can induce diarrhea. 

Constipation can be prevented by avoiding starchy low-fiber foods, such as white rice, pasta, or white bread, and increasing your intake of foods that contain indigestible carbohydrates and other compounds that are natural laxatives. Try to avoid using narcotics and other medications that can slow down the bowels. 

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Who should treat my bowel control problems?

Your primary care physician should be your first stop for bowel control problems. They may refer you to a specialist for a more thorough evaluation of your symptoms, such as a urogynecologist, colorectal surgeon, or gastroenterologist. Sometimes you need a team of doctors to help manage several aspects of these conditions. The evaluation should always begin with discussion of the symptoms and physical examination.

Chronic bowel diseases such as Crohn’s Disease, ulcerative colitis or irritable bowel syndrome should be treated by a gastroenterologist.

Most of all, tell SOMEONE. It’s never normal to leak stool, and you’re not alone. Reach out and speak up so that you can start to get better.

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Where does a urogynecologist fit into my treatment?

Often a team of doctors will handle your bowel problems, and this specific answer depends on your diagnosis. It’s often best to start with your primary care doctor, or maybe your regular gynecologist to help know the next step.

Chronic bowel diseases such as Crohn’s Disease, ulcerative colitis or irritable bowel syndrome should be treated by a gastroenterologist.

If you need surgery on the bowels, that is usually done by a colorectal surgeon.

If you have a rectocele (bulging of the rectum into the vagina), a fistula, or problems with the pelvic floor, seek out a urogynecologist. At your first visit, the urogynecologist will take your history and do a thorough pelvic exam. After that, it depends on the diagnosis. Your urogynecologist may discuss prolapse treatments if you have a rectocele, discuss other ways to diagnose a fistula, or refer you to a pelvic floor physical therapist for help with the pelvic floor muscles. For some of these problems, surgery may help, and your urogynecologist may discuss that with you.  The urogynecologist will also involve a pelvic floor colorectal surgeon if that surgery needs to be done together by both surgeons. 

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Will I need surgery to treat these issues?

Most women find relief through diet changes, over-the-counter medications and/or pelvic floor PT for bowel control problems. It depends on your diagnosis, but not every woman needs surgery. Your physician will help you assess whether surgery is necessary.

Bowel control surgery is a big decision. Consult with a colorectal surgeon or urogynecologist. And, consider getting a second opinion before moving forward.

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I just had a baby - why can’t I control my stool?

Congratulations! As you’ve probably learned by now, having a baby is a big, exciting event. Lots of things about life change with a new baby, but it doesn’t mean you have to leak stool.

Everything may not be solved at your six-week postpartum visit. It might take longer. It’s also OK to call with these concerns before your scheduled appointment. Be sure to mention your symptoms to your doctor, who may consult a urogynecologist. A urogynecologist can help with complicated laceration repairs or persistent bothersome symptoms after simple treatment options have been tried without success. Seeing a pelvic floor physical therapist may improve your symptoms more quickly.

If you had a vaginal delivery, the process of delivering the baby causes damage to the muscles and nerves of the pelvis. Some of this will heal over time. Your urogynecologist may suggest doing pelvic floor physical therapy to help the muscles and nerves recover. You also need a careful exam to make sure the vaginal walls healed after your delivery, especially if you had a large episiotomy or tear.

Even if you had a C-section, the weight of the pregnancy over the last nine months or so can cause some damage on its own. 

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