Incontinence Advice

Bowel incontinence in the elderly: Methods of caring for them

Bowel incontinence doesn’t have to limit an elderly person’s quality of life. With the right care, management and treatments, it is possible to continue to live fully and comfortably. Learn to manage bowel incontinence effectively in this guide

Bowel incontinence, or faecal incontinence, is the loss of control over bowel movements, often affecting the elderly. This condition can range from an occasional leak of a small amount of stool to having a complete loss of bowel control. In this article, we will discuss various management strategies, such as the use of incontinence products, making dietary and lifestyle changes, the importance of exercises, and when to seek professional healthcare advice. 

Key points:

  • Discover the causes of bowel incontinence in the elderly
  • Learn about lifestyle adjustments that can help to improve symptoms
  • Tips for maintaining dignity and comfort while managing symptoms
  • Understand the treatments available and when and how to seek professional healthcare advice
  • Explore incontinence products for effective bowel incontinence management

 
Bowel incontinence in the elderly

Understanding bowel incontinence

Bowel incontinence is when you cannot control the passing of stool. This can lead to bowel leakage or a sudden urge to use the toilet, where the individual may not always reach it in time. For the elderly, this condition can be particularly challenging due to reduced mobility, but there are effective bowel incontinence treatments available.

Types of bowel incontinence

Bowel incontinence can be categorised into two main types:

  • Urge incontinence: This occurs when you feel a strong need to have a bowel movement but are unable to reach the toilet in time, resulting in an accident. It is the most common type and often relates to problems with the muscles that help control bowel movements.

  • Passive incontinence: In this type, the rectum has reached its maximum capacity to hold stool, but your body does not register the need to go. This leads to passing stool involuntarily, often without awareness. Typically, this is linked to issues with the communication between nerves and muscles.

How common is bowel incontinence?

Bowel incontinence is more common than many might think. Studies suggest that it affects as many as 1 in 10 individuals who see a primary healthcare provider. This number could potentially be higher, as many people do not discuss bowel incontinence, even if they have experienced it.

Signs and symptoms of bowel incontinence

Signs of bowel incontinence can include:

  • Unexpected stool leakage when passing wind.

  • Unexpected stool leakage after being physically active.

  • A strong urge to defecate without sufficient time to reach the toilet.

  • Streaks or stains of stool in underwear.

  • Losing the ability to control your bowel movements entirely.

If you experience these symptoms, it’s important to consult a healthcare professional for a proper diagnosis and treatment plan.

Causes of bowel incontinence

Bowel incontinence can occur for a variety of reasons and is more common as people age. Some primary causes include:

  • Diarrhoea can cause temporary bowel incontinence.

  • Frequent bouts of constipation can weaken your rectal and anal muscles. Straining on the toilet can cause nerve damage. With chronic constipation, the liquid parts of a stool can seep out around the firm stool that’s stuck, leading to incontinence.

  • Ageing, hormonal changes, or childbirth can reduce the strength of muscles around the anus, making it harder to control bowel movements.

  • Conditions like irritable bowel syndrome (IBS) or Crohn’s disease can contribute to faecal incontinence.

  • Conditions such as dementia, stroke or nerve damage in the spine can reduce awareness of the need to defecate, leading to accidents.

  • A prolapse is when weakened pelvic muscles can’t fully support your pelvic organs, such as the rectum, vagina, uterus and bladder, and as a result, the organs slip or sag. This can lead to bowel incontinence.

Children can also experience bowel incontinence. More commonly, they will experience giggle incontinence too but this can ease off after a certain age. With bowel incontinence in children, their stool texture will either be too runny or too hard, and they sometimes avoid using the toilet at all, or do not reach it in time. 

How will the elderly people feel when experiencing bowel incontinence?

Bowel incontinence can have profound physical and mental effects on elderly individuals. 

Physically, it may cause discomfort, irritation, and even skin breakdown due to constant exposure to moisture and stool. This can lead to rashes, sores, or infections if not managed properly.

Mentally, it can trigger feelings of embarrassment, shame, or anxiety, leading to social withdrawal and a loss of confidence. The fear of having an accident in public or around loved ones often results in isolation, impacting overall well-being and quality of life.

Diagnosing bowel incontinence

When diagnosing bowel incontinence, a GP will begin by discussing your symptoms and medical history. This conversation helps determine the possible causes and the next steps for an effective bowel incontinence treatment plan. 


The GP might conduct a physical examination, which could include:


  • A thorough abdominal examination to feel for any irregularities.

  • A rectal examination, where the doctor checks the muscles and tissues inside the rectum with a gloved finger.


To gather further information, the GP may request a stool sample for laboratory analysis or refer you to a specialist for additional tests, such as:


  • Blood tests to identify any underlying health conditions.

  • Colonoscopy, which involves using a thin, flexible tube with a camera to inspect the inside of your bowel.

  • Ultrasound scans to visualise the structure of your bowels and surrounding organs.

Treatment options for bowel incontinence

The treatment plan for bowel incontinence depends on the cause often begins with lifestyle adjustments and non-invasive approaches. 


Your GP may recommend the following:


  • A balanced diet that promotes an ideal stool consistency, which may involve incorporating more fibre and plenty of fluids. Identifying trigger foods may be recommended if this is thought to be a possible cause of the incontinence.

  • Current medication may be reviewed to make sure it is not contributing to bowel incontinence. Additional medication may be prescribed, aimed at reducing stool frequency or adjusting stool consistency.

  • The use of incontinence pads or pants to manage leakage.

  • Small devices may be recommended that can be inserted into the rectum to help prevent stool leakage.

  • Surgery may be recommended for people where the above treatments will not work; for example, people with a sphincter defect may benefit from a sphincter repair or, in certain cases, the creation of a stoma.

Specialists can also provide advanced bowel incontinence treatments, which may include:


  • Kegel exercises to strengthen the pelvic muscles around the anus and improve control.

  • Biofeedback therapy, which uses sensors to provide feedback and train the relevant muscles for better bowel management.

  • Bowel retraining, which focuses on establishing a consistent routine for bowel movements.

  • Advanced techniques for more effective emptying of the lower bowels.

Incontinence products for bowel incontinence

Incontinence products can help manage bowel incontinence effectively and improve quality of life for the wearer. 

Options include:

For ongoing use, professional advice is recommended to ensure the most suitable products are chosen. Contact your NHS health centre to be put in touch with your local specialist nurse or continence team.

Tips to manage bowel incontinence in the elderly

Managing bowel incontinence effectively involves a combination of preparation and lifestyle adjustments:


  • Be prepared: Always carry spare pads and pants when going out. Scented bags for soiled items can be useful to manage odour discreetly. A helpful tool is the ‘I Can’t Wait’ Toilet Card, which indicates that you have a medical condition and need urgent access to a toilet.

  • Plan ahead: Inform friends or family about your needs if travelling long distances to ensure regular stops are scheduled.

  • Skin care: Maintain good hygiene by washing regularly and drying with a soft towel. Changing pads frequently can prevent irritation. If the skin becomes red or sore, ensure that pads fit well and do not rub. Be sure to opt for MoliCare incontinence skin care products for effective management and protection. Allow the air to get to the area by wearing loose-fitting clothing. Consult a healthcare professional for further advice on skincare.

  • Dress for convenience: Choose clothes with elastic waistbands or Velcro fastenings to make dressing and undressing easier.

  • Home adaptations: Consider equipment like handrails or a commode for added support at home. A care needs assessment by local social services can help identify and provide necessary adaptations.

In conclusion, bowel incontinence in the elderly is a physically and mentally challenging condition; however, with the right approach, it can be managed effectively. Lifestyle changes, incontinence products and treatments recommended by healthcare professionals offer multiple ways to improve comfort and quality of life. Understanding the causes, seeking professional advice and incorporating practical strategies can help elderly individuals manage their symptoms and live with confidence and dignity.

FAQs

What are the non-surgical treatments for bowel incontinence?

Non-surgical options include dietary changes (e.g., increasing fibre intake), bowel training, pelvic floor exercises (known as Kegel exercises), medication (such as antimotility medication, which slows down the passage of stools, enabling more control over bowel movements), and biofeedback therapy to improve muscle control.

How does diet play a role in managing bowel incontinence?

Diet can significantly impact bowel regularity and consistency. Increasing fibre intake can help firm up stool if diarrhoea is a problem, while adequate hydration and a balanced diet can assist in maintaining overall digestive health. Certain foods and drinks can irritate the bladder and bowels and trigger loose stools, so they may need to be avoided.

Can physical therapy help with bowel incontinence?

Yes, physical therapy focusing on the pelvic floor can help strengthen the muscles, improving bowel control. This can also improve general co-ordination and control.
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