The bowel is the lower part of the digestive system. It begins after the stomach with the small bowel (small intestine), and includes the large bowel (colon/large intestine), and rectum, ending at the anus. The purpose of the bowel is to absorb nutrients and fluid from the food and drink we intake, before it is removed from the body as waste.
Food is moved along this path of organs by a series of muscles. At the top of the system they unconsciously contract and relax, and at the bottom you voluntarily control them. For waste to exit the body it passes into the upper anal canal (rectum), which is supported by the levator ani muscles of the pelvic floor. The nerve endings in the rectum are stimulated by the waste, giving you the urge to have a bowel movement. This stimulates the internal sphincter muscle to involuntarily relax and open. You consciously keep your external sphincter contracted, until you are on a toilet, at which point you can voluntarily relax it to allow for defecation. When you strain to move your bowels the puborectalis muscle, of the pelvic floor, moves from an angle of 90° to 135° to release its pressure on the anal canal to make the movement of waste easier.
The coordination of these muscles and sphincters is essential in order to have a smooth bowel movement. Issues can arise if you have a weak or damaged pelvic floor and sphincters, or if the muscles often spasm. These can lead to incontinence, where you involuntary leak stool and/or gas.
Individuals suffering from bowel incontinence (also known as anal incontinence) rarely seek treatment. Whether for fear of embarrassment, or maybe it's seen as inevitable with age or childbirth. Even though incontinence is rarely life threatening, it can be much more than an inconvenience, severely effecting your quality of life. You can suffer from social isolation in an attempt to avoid the embarrassment, depression and anxiety. Up to 15% of the population seek treatment for bowel incontinence, with the number of individuals suffering likely to be much higher.
As with most medical issues, the earlier you seek treatment, the quicker the resolution. A GP will diagnose the type of incontinence you are suffering from by the causes and when it occurs. This leads to a specific treatment plan being developed, which looks to resolve issues permanently by amending your lifestyle alongside any conservative therapy's and medical support.
Types of Bowel Incontinence
Bowel incontinence can be diagnosed even more specifically by the matter that leaks:
- Faecal Bowel Incontinence - Inability to control leakage of faeces (stool) and gas.
- Flatus Bowel Incontinence - Inability to control the leakage of gas.
- Double Incontinence - Due to both bladder and bowel incontinence having many of the same causes, you can also experience double incontinence (also known as combined incontinence), where urine, stool and gas can involuntarily leak.
Age UK. (2018). Incontinence. [online] Age UK, 2018. [viewed 18/04/18]. Available from: https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/incontinence/
Carter, D. (2014). Gastroenterology. Conservative treatment for anal incontinence. [online] 2(2), p85-91. [viewed 26/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020129/#__ffn_sectitle
University of Michigan. (2008). Bowel Function Anatomy. [online] University of Michigan Health System. [viewed 25/04/18]. Available from: https://medicine.umich.edu/sites/default/files/content/downloads/bowel-function.pdf