Bowel problems and faecal incontinence

Bowel habits are individual but a healthy bowel should result in bowel motions (faeces) that are well formed and easy to pass. Constipation is a factor in difficult bowel movements, but is usually helped by increased fluid intake, dietary changes and exercise. Causes of faecal incontinence can include difficult childbirth, some medical conditions and bowel surgery, and treatment depends on the cause. See your doctor if you have ongoing bowel problems or faecal incontinence.

What is a healthy bowel habit?

A normal bowel varies considerably from one person to another. A person does not have to open their bowel every day to have a healthy bowel habit - bowels are very individual. The range of normal varies from three times a day to once every three days.

Your bowel is healthy if your bowel motion (faeces) are:

• regular (for the individual)
• soft and well formed
• easy to pass 
• leave you feeling that your bowel has been fully emptied.

How do I maintain a healthy bowel habit?

You should:

• drink 6 - 8 glasses (1500 - 2000 ml) of fluid per day (unless advised otherwise by your doctor)
• include dietary fibre such as fruit (including dried fruit), vegetables, nuts, legumes (eg. baked beans, kidney beans, soya beans), wholemeal breads and cereals in your diet
• exercise regularly, preferably walking 20 - 30 minutes at least three to four times a week
• allow sufficient time on the toilet.

Constipation

Constipation is a symptom, not a disease. It can be defined as a change from normal bowel habit, which can cause pain or discomfort; the bowel motion may be hard, dry and more difficult to pass.

Contributing factors include:

• insufficient fluid intake
• inadequate dietary fibre and/or change of diet
• ignoring the call to pass a motion
• poor seating position when moving your bowels 
• lack of exercise and/or decreased mobility 
• some medical conditions and/or chronic illness
• some medications
• long term laxative abuse
• weakness and frailty
• pregnancy
• anxiety, depression and grief
• disorders of the bowel (further investigation generally required).

How can constipation be treated?

The causes of constipation need to be identified so the treatment can be planned. This can be done in partnership with your GP, continence advisor and/or dietitian.

Treatment may include:

• a bowel management programme
• changes in medication
• lifestyle changes
• referral to a specialist.

Faecal incontinence

Faecal (bowel) incontinence is the involuntary passing of faeces and/or flatus (wind) at an inappropriate time or place. It affects approximately 1% of people living in the community. It is a very distressing symptom and can affect a person physically, emotionally, socially and financially.

What can cause faecal incontinence?

Faecal incontinence is a symptom, not a disease. Therefore it must be investigated to identify the cause.

Contributing factors:

• severe constipation
• difficult childbirth
• certain medications
• some medical conditions eg. diseases of the bowel or nervous system
• some bowel surgery
• infections
• radiotherapy.

How can faecal incontinence be treated?

Causes of faecal incontinence need to be identified so that treatment can be planned. This can be done in partnership with your GP, continence advisor and/or dietitian.

Treatment may include:

• introducing a bowel management programme
• changes in medication
• lifestyle changes
• referral to a specialist.

You should see you doctor if:

• blood or mucous is present in your bowel motion
• you are passing watery or loose motions for more than 48 hours
• you have noticed a recent change of bowel habit, eg. constipation and/ or diarrhoea
• you are experiencing incontinence of faeces and/ or urine
• you have pain before, during or after passing a bowel motion.

Also see: Irritable bowel syndrome and Bowel cancer

Further information

Contact the New Zealand Continence Association (details below under 'Further Information and Support').

Original material provided by the New Zealand Continence Association, and edited by everybody, July 2005. Reviewed by everybody, September 2011.