Self Help
Spincter exercises can help you to improve your bowel control, especially if your main problem is urgency and you do not have a majore defect in the muscles. 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. However, these exercises are unlikely to be helpful if you have an actual break in the muscle, or if your leakage is from a cause other than weak muscles. This si why it is important to have the tests described above if your problem clearly statred after childbirth or another injury, or if you find that exercises are not helping after 2-3 months.
Bowel Retraining
People with urgency often find it helpful to retrain the bowel to hold on for longer.
Bowel habit
Some people find that the bowels resonds well to a regular habit. Reasonably regular mealtimes, with a healthy diet and sitting on the toilet at the time most likely for a bowel action (20-30 minutes after a meal or warm drink), will encourage the bowel to develop a regular pattern for some people. If you know when the bowel is likely to work, you can plan to be in a place that you can deal with this, even if your control is not perfect.
Food
What you eat and when can have a tremendous effect on your bowel. Some foods may make things worse, or better.
Drinks
Some people seem too busy to drink enough for good health. Everyone needs to drink approximately 2-3 pints of fluid a day. Beyond this, the amount you drink probably has little effect on the bowels, as any excess fluid that you drink which your body does not need is processed by your kidneys and passed out a s urine, not from the bowel. Some drinks seem to affect the bowel more than others.
Skin care and Coping with Soreness or Irritation
Anyone who has frequent bowel motions, diarrhoea or accidental leakage (faecal incontinence) 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 down into open sores. These are then difficult to heal. Taking good care of the skin around your back passage can help to prevent these problems from developing.
Controlling Wind and Smells
Having a bowel problem can sometimes mean that you cannot reliably control passage of gas or wind(flatus) from the back passage, or that any wind that you do pass seems to smell offensive. This can lead to feelings of embarrassment. There is no one simple solution to this if it is a problem for you, and different people find different things helpful. Here are a few things that you might like to try.
Bowel retraining
Some people who have had the horrible experience of a bowel accident in public understandably become very sensitive to anything arriving in the rectum. It is a natural reaction to try and prevent an accident by immediately finding a toilet. However, with time this can develop into a bad habit. As soon as you have the slightest feeling that you might need the toilet you drop everything and rush to the nearest toilet.
Most people find that their emotions have an influence on their bowels. If they are worried or anxious it leads to more frequent, more urgent, and looser bowel actions. We know that worry stimulates the bowels to work more often and with greater urgency. If you panic when your bowel is full, this can cause the sense of urgency to become even stronger - the more you panic the more you need to go.
It is easy to see how this can develop into a vicious circle. The more you worry, the worse it gets. The worse it gets, the more you worry. In the end it can almost be a self-fulfilling prophecy - you do not make it to the toilet because you are convinced that you cannot do so.
There is also a tendency, in the attempt to hold on, to tense all your muscles and to hold your breath. If you squeeze with your tummy muscles you will actually be raising the pressure in your abdomen and encouraging your bowel to empty rather than to hold on. You will help to force the stool down and out, rather relaxing and breathing normally and holding it in.
While you are rushing to the toilet, it is very difficult to concentrate on hanging on. When the rectum fills, the internal sphincter opens. You need to be able to contract the external sphincter hard enough and for long enough to allow this to close off again and to prevent an accident. If you are running upstairs or trying to get your clothes out of the way, this makes it difficult to squeeze your external sphincter effectively. Rather than rushing to the toilet there and then, you may do better to sit or stand still, breathe deeply and contract the anal sphincter, for long enough for that urge to wear off.
You may not be able to do this to start with. If the urge is too strong, start by trying to delaying bowel emptying once you are sat on the toilet - if you cannot, there will not be a disaster. Once you are sitting on the toilet with that desperate urge, see how long you can wait until you really have to let go. You may surprise yourself at how much control you really have. See Table for a programme that will gradually help you to resist the urge. This will take a lot of will-power and determination.
If you practice hanging on, and combine this with sphincter exercises (LINK to sphincter exercises), and alterations to diet (LINK to food) as necessary, you should find eventually that it gets easier. The longer you can hang on, the more fluid is absorbed from the stools and so the firmer and less urgent they become. If you are having 2 or 3 bowel actions in quick succession in the morning, you may eventually be able to hang on to the first ones, and so just have one larger bowel action all at once. Also, when you have some successes, you become more confident, panic less, and so things do not feel nearly so urgent. The less you panic, the easier it is to make that urge go away.
THE “HOLDING ON” PROGRAMME
Currently when you need to have your bowels open you find that you have to rush to the toilet. Your rectum (where you store the stool), your sphincter muscles and your confidence need retraining to help you overcome this problem.
Next time when you need to have your bowels open:
1. Sit on the toilet and hold on for as long as you can before opening your bowels. If you can only manage a few seconds, don’t worry, it will gradually get easier. Whatever you can manage now, you are aiming to double it, and then double it again.
Gradually increase this to 5 minutes.
Don’t worry if you’re not able to do this for the first few times but keep practising.
2. When you have mastered this, repeat the above but hold on for 10 minutes before opening your bowels. It may be helpful to take something to read with you. This stage is harder but remember you’re on the toilet and therefore “safe”.
3. Once you are able to delay opening your bowels for 10 minutes sitting on the toilet now is the time to begin to move away from the toilet. Therefore the next stage is when you want t open your bowels to sit near the toilet either on the edge of the bath or on a chair inside or just outside the toilet area. Now hold on for 5 minutes. Once you are able to do this, repeat the exercise increasing to 10 minutes.
4. When you are able to delay opening your bowels for 10 minutes whilst off the toilet you should now gradually move further away. Maybe sitting on the bed in your bedroom. As your muscles are now becoming stronger you should be able to hold on for 10minutes and as you feel more confident, increase the distance between you and the toilet.
Gradually you will find that you can increase the distance and the time away from the toilet. This may take some time to master but obviously the more practise you have at both your sphincter exercises and this programme it will happen sooner rather than later.
Bowel habit
Some people find that the bowel responds well to a regular habit. Reasonably regular mealtimes, with a healthy diet, and sitting on the toilet at the time most likely for a bowel action (20-30 minutes after a meal or a warm drink), will encourage the bowel to develop a regular pattern for some people. If you know when the bowel is likely to work, you can plan to be in a place that you can deal with this, even if your control is not perfect.
For many people a warm drink at breakfast will stimulate the call to stool half an hour later. However, with a busy life and everyone trying to use the bathroom at the same time in the morning, it can be difficult to allow enough time for your bowels to get into a good habit. If you are having bowel problems, it is important to allow the time to empty you bowels. If you skip breakfast or dash for the train immediately after a cup of coffee, or if you only half empty because someone else is waiting, you will not maximise your chances of establishing a regular predictable habit.
When you do open your bowels, it is important to get into a good position to get as empty as possible. Unfortunately, modern toilets are not ideal for this as the most natural position is squatting. You can get close to this by supporting your feet on a low stool (or maybe a couple of telephone directories) and leaning forward slightly with your elbows on your knees. Take your time - try not to feel rushed on the toilet. Try to relax!
If you regularly have to get up at night to have a bowel action, changing you eating patterns and avoiding eating too late and restricting your caffeine intake in the evening (see below) may help.
People with a nerve disease, and those who are generally frail and dependent on assistance from others, need to have their bowel care actively planned in order to avoid problems, particularly severe constipation, which can lead to overflow bowel leakage.
Food
Can food have an effect?
Yes! The bowel is designed for processing food, and so naturally what you put in can have an effect on what comes out. However, it is not easy to offer advice on this as it seems to vary from person to person, and there is very little research on which foods can make incontinence better or worse. What will make life a nightmare for one person seems to have no effect at all on someone else. And of course eating and drinking should be a pleasure, not just to keep us alive, so it would be a great pity to make life a misery by constantly worrying about what you eat or drink.
It is worth experimenting a little to see if you can find anything that upsets your control. Food rich in fibre is the most common contributor to poor bowel control, but other foods such as spicy or hot food, can upset some people. If you think that there may be a link with what you eat, try keeping a dairy to see if there is a pattern.
Moderating your fibre intake
Fibre is one of the waste products from your food that your body cannot digest and use. Generally, in Western countries, our diet does not contain as much fibre as it should for good health, and we are often told that fibre is good for yo and that you should eat more. This is generally good advice, and if your stools are very loose, or contain alot of mucus, fibre may help you to obtain more formed stools.
However, we know that for some people with bowel control problems, fibre can make matters worse. Fibre keeps fluid in the bowel rather than letting it be absorbed. If you havenormal formed stools fibre will make your bowel motions softer, and so more likely to leak. Fibre also helps to stimulate the bowel, and so can make you pass a motion more often with greater urgency.
We are not suggesting that you eat an unhealthy diet, but it may be worth experimenting a little to see which foods make your control worse or better. This is very individual, our bodies do not react all the same, and it is a case of trial and error to see which foods, if any, cause problems for you. You should always eat some fruit and vegetable each day - do not cut these out completely. Start by avoiding fibre supplements such as unprocessed bran, and deliberately high fibre foods (such a s bran cereal) and the fruit and vegetable that have a particularly high fibre content.
Foods rich in fibre
- WHOLEMEAL BREAD
- WHOLEGRAIN CEREALS (eg shredded wheat, weetabix, branflakes, porridge, muesli)
- WHOLEMEAL PASTA
- BROWN RICE
- BEANS (including baked beans)
- PEAS AND CHICK PEAS
- LENTILS
- SWEETCORN
- WHOLEMEAL BISCUITS (eg digestive, rye crispbread, oatcakes)
- FRUIT (especially if eaten with skin or pips)
- VEGETABLES (especially if eaten with skin or seeds, such as jacket potatoes)
- NUTS, SEEDS AND DRIED FRUIT (such as sultanas, raisins, dried apricots)
Other foods to consider
Some people find that milk products and chocolate make their stools looser. If you have had a course of antibiotics this can upset your bowel and live natural yoghurt or yoghurt can help to restore a more regular habit.
Conversely, some foods help to make stools firmer and therefore easier to control for some people. Arrowroot biscuits, marshmallow sweets and bananas each help some people. A high fat intake can slow down the speed with which food travels through the bowel, but this is obviously not healthy for other reasons and so cannot be recommended.
Artificial sweeteners
Artificial sweeteners are sugars whch cannot be absorbed by your body, so that they tast sweet but do not make you put on weight. They can be very useful if you are counting your calories and trying to lose weight. But for some people they can make the stools loose, or even cause diarrhoea as they act as a laxative. If you have problems with bowel control, this can make things worse, and it amy be worth cutting out all artificial sweeteners and seeing if this helps. These artificial sweeteners are in most foods and drinks branded as "low calore", including "diet" drinks and low sugar chewing gum.
DRINKS
Some people seem too busy to drink enough for good health. Everyone needs to drink approximately 2-3 pints of fluid a day. Beyond this, the amount you drink probably has little effect on the bowels, as any excess fluid that you drink which your body does not need is processed by your kidneys and passed out as urine, not from the bowel.
What you drink can make a difference to some people, and again this is individual and is worth experimenting. Alcohol seems to cause the bowels to be loose and urgent for some people, but less for others. Different types of alcoholic drink can affect you in different ways. You may find that beer is better than wine, or that white wine is better than red, or vice-versa.
Caffeine
Some people have a bowel that seems to be very sensitive to caffeine, which is in coffee, tea, cola drinks and expensive chocolate. Caffeine seems to stimulate the bowel, and so make the stools move through faster. This means that less fluid is taken from the stools, which are then looser and more urgent. Try to spend at least a week without any caffeine (you can buy decaffeinated tea, coffee and cola at supermarkets), to see if this helps you. If things are better without caffeine, you then have a choice of whether or not to drink it. If you drink alot of caffeine do not stop it all suddenly as you may get headaches: try to gradually cut down.
Tips on controlling wind and smells
Having a bowel problem can sometimes mean that you cannot reliably control passage of gas or wind (flatus) from the back passage, or that any wind that you do pass seems to smell offensive. This can lead to feelings of embarrassment. There is no one simple solution to this if it is a problem for you, and different people find different things helpful. Here are a few things that you might like to try. Remember that we are all a lot more sensitive to our own smells than other people are. If you know that you have passed wind, you may be looking for a smell that noone else has noticed.
Food and Eating
There is no doubt that some foods have a tendency to lead to more wind production than others. Often this is foods high in fibre, which the normal bacteria in the bowel digest, producing gas as a by-product. However, this is very individual, and food that produces a lot of wind for one person may not do so for someone else. It is worth experimenting a little, to see if eating certain foods makes things worse for you, and if avoiding those foods then helps. The following list is not exhaustive and you may find that something not on this list is windy for you:
Beans (including baked beans and kidney beans) Eggs
Peas, lentils and other pulses Shellfish
Nuts (especially peanuts) Milk & milk products
Salad (especially cucumber) Muesli
Bran cereal or other foods high in bran Jacket potato skins
Brown rice or wholemeal pasta Leeks, swede & parsnips
Cabbage, cauliflower, carrots and broccoli Onions
Radishes Dried fruits
Hot spicy food, especially if you are not used to it, can increase the speed with which food travels along the bowel and increase wind production. Rich, fatty food affects some people.
Sometimes the way in which you eat means that you swallow a lot of air with your food. Try eating a little more slowly, chew each mouthful carefully (especially if the food is high in fibre), take care not to swallow air, and avoid talking too much while you are actually eating. If you are in a hurry, do not be tempted to wash down halfchewed food with a gulp of drink. Eating little and often, rather than one huge meal a day can make it easier for your intestines to cope and decreases wind production. Regular meal times can help, as an empty bowel produces more wind and gurgles. However, it is important not to get into the habit of taking too many snacks between meals. All of this does not mean that you should make your life difficult or miserable by having to think about everything that you eat and not eating foods that you particularly like. But do try to eat a balanced diet, and to notice if any of the above makes a difference for you. Then you have a choice.
Drinking
Caffeine (in tea, coffee and cola) has a tendency to increase bowel activity for some people and may increase wind. Try decaffeinated tea and coffee for a week or so to see if this makes a difference. Fizzy carbonated drinks and beer (or lager) can also increase wind for some people. Usually you will burp this up, but a few people seem to experience more wind with these drinks. Excess alcohol intake will cause more wind than usual the next day for most people.
Eating and drinking at the same time can also increase the amount of air that you swallow, so try drinking before or after food, rather than with it. Some people find that herbal tea calms their bowel and that less wind seems to be produced. Camomile, peppermint and fennel teas are each found useful by some people.
Personal hygiene
- If you are troubled by any leakage from the bowel, good personal hygiene will be important in avoiding smells.
- After a bowel action, always wipe GENTLY with soft toilet paper, or ideally 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 overthe 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 warmwater is best.
- AVOID using products with a strong perfume such as scented soap, talcum powder or 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 using any creams or lotions on the area, unless advised to do so.
Sphincter strengthening exercises
Sometimes doing some exercises to strengthen the muscles and their speed of reaction can improve your control of wind. Please ask you nurse, doctor or physiotherapist if this is likely to be helpful for you.
Controlling or disguising smells
- If you are producing a lot of wind that you cannot control, some of these ideas may be of help.
- Try to ensure good ventilation of the room you are in.
- Use an aromatherapy oil burner, scented candle, joss stick or incense stick, or a dish of pot pourri (remember to renew regularly as the scent wears off).
- Use aerosol air freshener with care - some smell very obvious, or even worse than the smell you are trying to disguise!
- There are many solid block air fresheners that work all the time - available from chemists or supermarkets.
- Essential oils such as lavender or lemon oil can be useful.
- Try striking a match and then blowing it out immediately and allowing the small plume of smoke to drift into the room. You may like to keep a box of matches and an egg cup for the used match in your toilet.
Products which some people find helpful
There is almost no scientific research on this, so we cannot actually recommend any products. But some people do tell us that something has been helpful. Again, this is very individual. Some people find that one or more of the following products reduces wind, or reduces the smell from wind:
- Peppermint oil
- Pepto-bismol, Rennies and other over-the counter indigestion medicines
- Charcoal tablets
- Mint tea
- Cardomom seeds (chewed)
- Aloe Vera capsules or juice
- Probiotic drink (from the yoghurt counter at the supermarket e.g. Yakult, Actimel)
- Acidophilus (from health food shop).
If you can find a good health food shop, advice is often available on a wide range of other products which may be worth trying.
Deodorants
Your chemist may stock some deodorants specifically designed to control smells from urine or faeces. Neutradol spray or gel (MS George Ltd), Atmocol (Seton Healthcare), Chironair (Sims Portex), Daydrop (Loxley Medical) are among the most commonly available.
Related products
