Bowel Problems - Symptoms & Causes

Learn more about bowel problems, bowel leakage and chronic constipation Introduction to bowel problems If you experience bowel leakage and/or chronic constipation you are not alone. Your quality of life may be significantly impacted, as aside from physical discomfort such as bloating. You may also worry about having an accident in public. Learn more about bowel problems
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Introduction to bowel problems

Going to the toilet to have a bowel movement is something most people take for granted and consider it a very private matter. So when you suddenly experience a problem with your bowels, you can feel rather isolated.

The two most common problems people experience are bowel leakage, when you cannot control when your bowel is open and constipation, where you experience difficulty in moving your bowels.

How common is it to have a bowel problem?

It can be embarrassing to speak out about, which is why many people can go for years without telling anyone about their problem. Because many people never visit their doctor or nurse or reveal their symptoms, the exact number of people affected by bowel problems is unknown. But it is more common than you might think:

  • Studies suggest that approximately 2% of the adult population have daily or weekly bowel leakage episodes
  • The prevalence for adults over 65 years is 7%, and in retirement homes it’s as high as 33%
  • Studies indicate that up to 20% of the population have problems with constipation

Without proper treatment and management, bowel problems can seriously affect quality of life and prevent people from doing the things they enjoy.  

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Read more about causes and symptoms of bowel problems and how to take care of your bowel.

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Good to know

Neurogenic bowel is a lack of nervous control which prevents the bowel from functioning effectively What is neurogenic bowel? Neurogenic bowel is a lack of nervous control which prevents the bowel from functioning effectively and is caused by a neurogenic disorder.

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What is neurogenic bowel?

Neurogenic bowel can be described as slow movement of stools, constipation, bowel leakage, and difficulty emptying the bowel. Control of the external anal sphincter muscles may also be disrupted, increasing the risk of bowel accidents. 

There are two main types of neurogenic bowel dysfunction:

  • Reflex bowel  
  • Flaccid bowel

Reflex bowel

Reflex bowel causes loss of the ability to feel when the bowel is full. Although the anal sphincter muscle (the muscle that keeps the anus closed) remains tight, it will open on a reflex basis when the rectum becomes full and, therefore, the bowel can empty at any time unless appropriately managed. Reflex bowel can occur when the spinal cord is damaged above the T12 level.

Spinal cord

Flaccid bowel

Flaccid bowel is when the anal sphincter muscle (that normally keeps the anus closed) becomes relaxed and stays open, often leading to accidental emptying of the bowel. Flaccid bowel is generally caused by damage below the T12 level.

One cause of neurogenic bowel is spinal cord injury (SCI). The impact on bowel function depends on the level of spinal cord injury and where the damage occurs (as mentioned above).

Other possible causes of neurogenic bowel include multiple sclerosisspina bifida and Parkinson’s disease. 

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If you have neurogenic bowel it must be properly managed. Learn more about symptoms and how to take care of your bowel.

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Symptoms of bowel problems can be difficult to talk about Bowel symptoms Symptoms of bowel problems can be difficult to talk about. Knowing the signs and symptoms may help you to discuss this personal issue with a healthcare professional. Learn more about bowel symptoms
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Bowel symptoms

Bowel symptoms can vary depending on the underlying cause. The most common bowel problems people experience are:

Bowel leakage

Bowel leakage is the involuntary passage of stool e.g. you cannot control when your bowel opens, often resulting in bowel accidents.

Constipation

There is no exact science to what constitutes constipation as the symptoms vary from person to person. It is often characterised by decreased bowel movements and straining at defecation.

Overflow incontinence

This ia a combination of bowel leakage and constipation. You can be constipated but still experience loose stool that leaks past the hard stool.

Typical symptoms of bowel leakage

  • Feeling the urge to have bowel movement but not being able to control when your bowels open, resulting in a bowel accident (urge incontinence)
  • Leaking stools (passive incontinence)
  • Soiling of underwear
  • Being unable to control when you pass air (flatus)

Typical symptoms of constipation

  • Inability to have a bowel movement
  • Bloating
  • Discomfort
  • Severe stomach ache
  • Spending long amounts of time trying to pass stool

When to get in contact with your healthcare professional

A lot of people who experience bowel problems may be reluctant to go and talk to their healthcare professional, as bowel problems are very personal and potentially embarrassing subject. It is important to go and seek help, otherwise you may find that your bowel problems start to encroach on daily life.

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Read more about causes of bowel problems and how to take care of your bowel.

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Most common causes of bowel problems Causes of bowel problems Having bowel problems is not a disease in itself. There is usually an underlying cause as to why your bowels are not functioning properly.

Most common causes of bowel problems
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Causes of bowel problems

It is important to understand that having bowel problems is not a disease in itself. There is usually an underlying cause as to why your bowels aren’t functioning properly. Common causes of bowel problems can be related to either neurogenic or non-neurogenic disorders.

Neurogenic disorders

If you have a neurogenic disorder, you may have neurogenic bowel as it is likely the nerves in your spinal cord, controlling bowel function, are damaged. Some neurogenic conditions causing bowel problems include:

Non-neurogenic disorders

Bowel problems can also be caused by a number of non-neurogenic conditions including:

  • Obstetric trauma - complications after childbirth, where the sphincter muscles have been damaged leading to the inability to control when you go to the toilet. 
  • Cancer of the colon or rectum: Cancer of the colon or rectum describes the uncontrolled growth of cells that may cause bowel dysfunction. Some people have an inherited condition called familial polyposis, where large numbers of projecting, swollen and thickened areas of membrane called polyps, which develop on the inner lining of the colon. These polyps can eventually become cancerous.
  • Anorectal malformation from birth - even with surgical correction, you can still experience bowel leakage episodes. 
  • Inflammatory bowel disease: Inflammatory bowel disease (IBD) is a collection of conditions characterised by inflammation of the large and/or small intestine. 

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Read more about neurogenic bowel and how you take care of your bowel.

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How the bowel works - learn more about the main functions

How the bowel works

The bowel (intestine) is the lower part of the digestive system; a continuous tube that runs from the mouth to the anus. The digestive system absorbs nutrients from the food we eat and eliminates the waste products we cannot use.

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How the bowel works

How the bowel functions

The bowel is divided into the small intestine and the large intestine (colon, rectum and anus). The main function of the small intestine is to absorb nutrients released from the food digested in the stomach. The large intestine absorbs water from food and forms semi-solid and solid food waste into stools, which are eliminated from the body through the anus. Waste product is moved along the digestive system by a wave of involuntary contractions (peristalsis).

The digestive system

The waste product is temporarily stored in the rectum. During normal defaecation, when the rectum becomes full, it sends signals to the brain resulting in the urge to open the bowel. The two anal sphincters relax and allow stools to pass through the anus and out of the body. 

If your bowel does not work effectively, you may experience bowel leakage and/or constipation.

Bowel leakage

Bowel leakage is the involuntary passage of stool e.g. you cannot control when your bowel opens, often resulting in bowel accidents.

Constipation

There is no exact science to what constitutes constipation as the symptoms vary from person to person. It is ofen characterised by decreased bowel movements and straining at defaecation. 

Neurogenic bowel

Neurogenic bowel is a lack of nervous control which prevents the bowel from functioning effectively and is caused by a neurogenic disorder like spinal cord injurymultiple sclerosis and spina bifida.

Find out more

Learn more about symptoms and causes of bowel problems and neurogenic bowel.

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Frequently asked questions about bowel problems Frequently asked questions about bowel problems Find answers to the most commonly asked questions about bowel problems.


FAQ's about bowel problems
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Frequently asked questions about bowel problems

This FAQ is intended as a guide to commonly asked questions. Please always consult your healthcare professional regarding bowel problems. 

How does the bowel work?

The bowel is the last section of the digestive system and is divided into the small intestines and the large intestines (the colon, rectum and anus). The main function of the small intestine is to absorb nutrients from food digested in the stomach. The main function of the large intestine is to absorb water and to form stools from any waste products that cannot be used by the body. Stools are discharged from the body via the rectum and anus. View a video of how the bowel works.

What is bowel leakage?

Bowel leakage occurs when you cannot control when your bowels open, resulting in a bowel accident. The condition can range from minor leakage and soiling of underclothes to complete and uncontrolled emptying of the rectum. 

What is constipation?

The symptoms vary from person to person but are often characterised by decreased bowel movements, bloating, discomfort, straining and spending long amounts of time try to pass stool. 

What are the causes of bowel problems?

Bowel problems can be caused by a number of different conditions – some relatively minor and some potentially life threatening. Neurogenic causes include spinal cord injury, spina bifida and multiple sclerosis. Non-neurogenic causes include obstetric trauma (sphincter muscle damage after childbirth), cancer of the bowel or colon, Inflammatory bowel disease. This list is by no means exhaustive.

What is neurogenic bowel?

Neurogenic bowel describes a lack of nervous control which prevents the bowel from functioning effectively. The effect on bowel function depends on where the spinal cord is damaged.

How can bowel problems affect my lifestyle?

Bowel leakage and constipation can be very uncomfortable, and they also have a significant impact on our quality of life. Apart from the frequent physical discomfort and bloating, you may worry about having an accident in public. It makes it important to find a way to take care of your bowel.

What can I do to manage my bowel problems?

Bowel problems can often be improved by changing diet; there are also several types of medication that can help. Transanal irrigation can be used to help prevent constipation and bowel leakage.

Find out more

Read more about Peristeen®, a bowel irrigation system, for predictable bowel management.

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Frequently asked questions about bowel irrigation Frequently asked questions about bowel irrigation Find answers to the most commonly asked questions about bowel irrigation.


FAQ's about bowel irrigation
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Frequently asked questions about bowel irrigation

This FAQ is intended as a guide to commonly asked questions. Please always consult your healthcare professional regarding bowel irrigation. 

What is bowel irrigation?

Bowel irrigation is where water is introduced into the bowel using a rectal catheter. The water stimulates the bowel and flushes out the stool, leaving the lower half of the bowel empty. It is important to do it regularly to prevent constipation and the risk of bowel accidents. Read more about Coloplast’s bowel irrigation system, Peristeen®

Where can I get Peristeen®?

In order to use Peristeen, you need to get a prescription from your GP or nurse. You must also always consult an experienced specialist healthcare professional before starting up the irrigation procedure and you must receive thorough instruction from a healthcare professional before using this product. 

How often should I irrigate?

Most people start with irrigating every day. It takes approximately 3 months to establish a regular routine. Once you have an established routine, irrigating every other day may work well. With time and practice you will find out what works best for you. What is important, is to remember to irrigate regularly to prevent constipation and minimise the risk of bowel accidents. Always ask your doctor or nurse for advice.

What time of the day is best for irrigating?

Try to get into a routine where you irrigate around the same time of the day. Eating and drinking helps the bowel’s natural movement, so about 30 minutes after a meal is a good time. But do not be afraid to change the routine slightly to suit your day-to-day routine.

Can I travel with the irrigation equipment?

Yes – remember to bring your irrigation system along with lots of disposable catheters as they may not sell them everywhere. If you are going to use the system abroad, use bottled or cooled boiled water in places where the tap water is not safe to drink. Remember in different time zones your body may take a while to get used to a new routine. You may also be eating different types of food, which can affect the bowels.

What should I do if I leak between irrigations?

If you experience bowel leakage between irrigations, it may be due to insufficient emptying of your bowel due to constipation or hard stool. Alternatively, you may be using too much water during irrigation. Contact your doctor or nurse to help you adapt to your bowel plan. A Peristeen® Anal Plug may help if the problem persists. 

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For more information, watch the video about getting started with Peristeen.

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How to take care of your bowel Taking care of your bowel Finding a reliable way to empty your bowel is essential in order to avoid unwanted complications like bowel leakage and constipation. How to take care of your bowel
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Taking care of your bowel

Why is bowel care so important?

Having a good bowel care routine will improve your physical and emotional well-being and help you to:

  • Have regular and pain-free bowel movements
  • Prevent bowel leakage and constipation
  • Improve your quality of life

Options available to help manage bowel problems

To manage both bowel leakage and constipation, there are a number of treatment options available in increasing order of invasiveness:

Bowel Management Option Pyramid

  • Conservative treatment
  • Digital stimulation
  • Trans anal irrigation, also known as bowel irrigation e.g Peristeen®
  • Sacral nerve stimulation
  • Antegrade colonic irrigation (ACE)
  • Sacral anterior root stimulation
  • Stoma

It is most likely that you will be offered conservative treatments first, such as moderating diet and fluid intake and/or taking medication, such as bulking agents, laxatives and enemas. 

Bowel irrigation

If your bowel problems are not solved using conservative methods, and you are still experiencing bowel accidents or having difficult emptying your bowel, then bowel irrigation may help. Bowel irrigation can prevent bowel leakage and constipation by making sure that bowel movements are regular and predictable. 

Find out more

Read more about Coloplast’s bowel irrigation system, Peristeen®, that can help you manage your bowel problems.

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