Bowel Incontinence

While attempts to bring urinary incontinence out of the closet are gaining momentum, its embarrassing twin — bowel incontinence — remains secretly hidden in the dark recesses of that same closet.

“Bowel incontinence is much more debilitating, much more devastating because you can’t just wear a pad and go out in public. It is so stigmatized because of the odor issue that it greatly affects one’s social life,” explained Dorothy B. Doughty, president of the Wound, Ostomy and Continence Nurses Society (WOCN) based in California.

“It’s humiliating, never talked about, people make fun and that’s very painful. People become shut-ins, never wanting to leave their homes. It’s so embarrassing that it’s difficult to track numbers because so many people never want to even discuss it.”

WOCN estimates that 2 to 7 percent of the population suffer from it.

Bowel incontinence has various causes, including spinal cord injuries, neurologic problems, spina bifida and severe dementia. Damage to the nerves that control the anal sphincter is a leading cause. In women, childbirth can also result in continence problems.

“Sometimes vaginal deliveries can cause tears in the rectum,” said Doughty, a registered nurse and nurse practitioner. “But if you ask someone if they have bowel incontinence, they often times will say no, they have diarrhea. But they are not the same thing.”

According to Doughty, there is a difference between diarrhea, which is characterized by a liquid stool that is difficult to control, and would fall under the category of a bowel disorder. With bowel incontinence, the stool is normal and control is highly difficult.

The good news is there is help in most cases. Many continence centers across the country have expanded their regimens to include bowel incontinence programs, which depending on the case, can offer help in developing control. Gastroenterologists offer diagnosis and protocol for management, including medication and possibly surgery.

As for children, Doughty cautions parents to watch for signs of encopresis — a problem where children hold their bowel movements. This can cause extreme blockage that can stretch out the rectum, resulting in small amounts of liquid feces to leak out, resembling diarrhea. “The problem is really one of severe constipation, and while it is natural for some children to go through a stage of controlling their bowel movements, repeat occurrences can cause damage to sensory awareness in the rectum,” she said. Help should be sought from a pediatric gastroenterologist or continence center.

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