Bowel control disorders affect the normal pattern of emptying your stools. For example, you may have bowel movements less frequently, hard bowel movements, abnormal consistency of bowel movements, or diarrhea. When it comes to bowels, we are all different. Get to know your normal pattern and be alert to persistent changes such as:
Fecal incontinence/Accidental Bowel Leakage
Fecal incontinence (FI) is also called anal incontinence or accidental bowel leakage. Leakage of bowel gas, mucus, liquid stool, or hard stool. Loose stools and diarrhea, three or more times per day. Or, a feeling of urgency and great need to get the bathroom for a bowel movement.
About 8% of women struggle with FI. The percentage of woman affected increases with age. And, researchers think more women are likely affected, but many are too embarrassed to seek treatment.
Causes of fecal incontinence
There are many causes of fecal incontinence, including injury caused during childbirth, damage to the anal sphincter or nerves, pelvic organ prolapse, fistula, and abnormal stool consistency.
Pregnancy can increase the risk of fecal incontinence. It is more common in women who deliver vaginally than women who have a C-section. Giving birth vaginally increases your risk. For example, an episiotomy or tearing of the tissues around the vagina and rectum can result in damage to the nerves and muscles around the rectal canal.
Anal Sphincter Injury
During vaginal childbirth, the anal sphincter muscles can be damaged or torn. These muscles allow us to control bowel movements. It is estimated that as many as 40% of women experience muscle injuries in this area during childbirth.
Injury is more commonly with episiotomy or forceps delivery. Sometimes these injuries are not visible underneath the skin—and so, the injury is not repaired. In addition, during surgery to fix an anal fissure, the surgeon may need to cut these muscles. This can cause decreased strength resulting in problems controlling passage of bowel movements. Ultrasound can help to detect these injuries. And in some cases, surgery is done to repair the damage.
Injury to the anal sphincter nerves can cause decreased sensation and muscle strength, both of which can contribute to FI. Vaginal delivery, chronic constipation, or illnesses that affect the nerves such as diabetes and spinal cord injury can cause the nerve damage. Typically, the nerve damage that occurs during vaginal delivery improves one or two years after childbirth.
Several types of prolapse can affect the ability to control bowel contents.
- Rectocele: A rectocele is a hernia of the bowel upward into the vaginal canal. It causes a bulge that can sometimes result in difficulty completely evacuating stool.
- Rectal prolapse: Rectal prolapse is a condition where the rectum slides out through the anal opening. Distortion of the anal opening can result in damage to the sphincter muscles and bowel leakage.
- Hemorrhoids: Hemorrhoids are caused by enlarged blood vessels near the anal opening. These can make it difficult to clean near the anus, resulting in seepage of bowel contents.
Abnormal openings or connections (tracts) known as “fistulas” can develop between the rectum and vagina: Fistulas can occur:
- After vaginal delivery or vaginal surgery. However, this is an unusual occurrence.
- Spontaneously as a result of diverticulitis or other bowel conditions
- In patients who have received radiation in the area between the rectum and vagina.
Abnormal Stool Consistency
Bowel movements with normally-formed consistency are easiest to control. FI can be caused by both:
- Diarrhea or loose bowel movements, because of both looser consistency and increased urgency.
- Severe constipation.
Constipation is 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.
Constipation is very common, affecting about 1 in 3 women.
Causes of Constipation
Constipation occurs for several reasons. It may be related to diet or changes in nerve for pelvic floor muscle functioning that can affect the bowels. Lifestyle choices, medicines, or supplements, pelvic floor disorders, and other health problems may also impact bowel movements.
The most common reason for constipation is not having enough fiber in your diet. This is very common in women who eat a typical American diet, and getting enough fiber to fix this problem often requires planning and supplementation. Some foods, especially those high in starch such as white rice, pasta, or white bread, are more likely to lead to constipation. Constipation may also be due to lack of fluids in your diet. Some women do not drink enough fluids to keep their stool soft. When there is not enough fiber or water in your diet, bowel movements are more likely to be hard or irregular.
Medicines and Supplements
Talk with your doctor about your medicines and supplements, as many can cause constipation as a side effect. Ask about alternative medicines without constipating effects. Medicines that treat bladder urgency, depression, blood pressure, and pain affect bowel movements. Iron and calcium supplements can cause constipation.
Pelvic Floor Disorders
Pelvic pain may prevent relaxation of pelvic floor muscles, leading to problems having bowel movements. Straining excessively with bowel movements may lead to pelvic floor disorders. Rectoceles do not cause constipation. Prolapse, including rectoceles and rectal prolapse, can make constipation worse.
Irritable bowel syndrome, kidney disease, colitis, thyroid disorders, neurological conditions (such as multiple sclerosis or spinal cord injuries), and cancer are other medical conditions that can impact the bowels. Talk with your doctor if you have these conditions or are concerned about them.