Faecal Incontinence Patient advice and information leaflet on the management of faecal incontinence

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1 Oxford University Hospitals NHS Trust Oxford Pelvic Floor Service Faecal Incontinence Patient advice and information leaflet on the management of faecal incontinence

2 What is faecal incontinence? Faecal incontinence is the inability to control the passing of wind or stools (faeces) through the anus (back passage). Some people find that this has a significant effect on their quality of life. It can also affect their confidence and psychological well-being. However, it is a common condition affecting around 10-15% of people in the UK and can be treated with specific exercises. What is a normal bowel motion? A normal stool is brown in colour, although this can vary depending on the foods you have eaten. Normal frequency is between three times a day and three times a week, but most people open their bowels once a day. Normal consistency of stools should be soft and formed. (Bristol Stool Form Scale type 3 or 4) page 2

3 Reproduced by kind permission of Dr K W Heaton, Reader in Medicine at the University of Bristol Norgine Pharmaceuticals Ltd. page 3

4 Emptying the bowel (Reproduced by kind permission of St. Marks Hospital, Harrow) The colon or large bowel absorbs water and fluid from the waste matter and forms it into stools (also called faeces or bowel motions) (Reproduced by kind permission of St. Marks Hospital, Harrow) Stools do not enter the rectum from the colon on a continuous basis, but as a result of mass movements. Mass movements often occur after a meal is eaten, which can then lead to a need to open your bowels. page 4

5 (Reproduced by kind permission of St. Marks Hospital, Harrow) When stool enters the rectum the internal anal sphincter muscle automatically relaxes and opens up the top of the anal canal. This allows the sensitive nerves at the top of the anal canal to detect whether it is wind, diarrhoea (watery stool) or normal stool. (Reproduced by kind permission of St. Marks Hospital, Harrow) Around the internal anal sphincter is the external anal sphincter, which can be deliberately squeezed to delay bowel emptying if it is not convenient to find a toilet. Squeezing the external sphincter pushes the stool out of the anal canal and back into the rectum, where the stool is stored until a convenient time. page 5

6 Treatment Your bowels are a part of your body and it is possible to get back in control of them. This may seem difficult at times, especially when you feel under stress. The following routine will help you regain control. Medication The rectum is designed to hold solid stools; watery stools are more likely to leak and cause faecal incontinence. Loperamide (Imodium ) is an anti-diarrhoeal medication. It is designed to thicken the stools and reduce diarrhoea. Loperamide (Imodium ) works by slowing the passage of food through the colon, allowing more water to be absorbed and creating a formed stool. Different people need varying doses to achieve a formed stool, please follow the advice given to you with the aim of achieving a Bristol Stool type 3 or 4, but to avoid becoming constipated. It is usual to start on a low dose and increase it slowly over several days to judge how your body is responding. We recommend that Imodium syrup is used as it can make it easier to adjust the dose. This will need to be prescribed by your GP. Diet You should eat a healthy balanced diet and drink between litres of water per day (6-8 cups full). Water and squash are best and caffeinated drinks should be kept to a minimum. page 6

7 Pelvic Floor Exercises The pelvic floor is a sheet of muscles that extend from your tail bone (coccyx) to your pubic bone at the front, forming a platform between your legs. They support the bladder, bowel and uterus (in women). The pelvic floor muscles help to control when you pass urine and open your bowels. Having strong, effective pelvic floor muscles can improve or stop any leakage from your bowels. Locating the muscles Choose any comfortable position with your knees slightly apart. Concentrate on the muscles that you would use to stop yourself from passing urine at the front and to stop yourself passing wind at the back. When locating these muscles, try not to: Squeeze your buttocks together Bring your knees together Cross your legs Hold your breath or Lift your shoulders/eyebrows/toes upwards If you do any of these, you are not tightening the pelvic floor muscles correctly. To check that you are tightening the correct muscles: For men: place your fingertips against the skin just behind the scrotum; when you perform this exercise you will feel the muscles tighten and lift up away from your fingers, your scrotum should lift slightly and the base of your penis should move towards your abdomen. For women: insert one or two fingers inside your vagina, when you perform this exercise you will feel the muscles tighten around your finger. page 7

8 The exercise There are two types of exercise slow twitch and fast twitch. It is important that you do both slow and fast exercises every time you exercise the pelvic floor muscles. Slow twitch exercise 1. Tighten and draw up the muscles around the back passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles when you are doing this 2. Tighten and draw up the muscles at the front, as if you are trying to stop the flow of urine 3. Hold for a count of ten. Try not to hold your breath, breathe normally 4. Then slowly relax and let go 5. Repeat five times in total Fast twitch exercise 1. Tighten up the pelvic floor muscles as before 2. Hold for one second then relax 3. Repeat 5 times or until your muscles feel tired Build up to doing 5 slow twitch exercises and 5 fast twitch exercises five times a day. The pelvic floor muscles tire easily and you may notice that it takes a lot of concentration to begin with to do these exercises correctly. When you start, you may not be able to hold for the full ten seconds, hold for as long as you can and try to increase the time holding as your muscles get stronger, this will show your progress. Pilates is an exercise that improves flexibility and strengthens muscle tone, it may help to improve your pelvic floor strength when used with the pelvic floor exercises. There are also pelvic floor stimulator machines available to buy from pharmacies and online, please speak to your specialist nurse for advice. page 8

9 Skin care Anyone who has frequent bowel motions, diarrhoea or accidental leakage (faecal incontinence) may get sore skin around the back passage. This can be very uncomfortable and distressing. Occasionally, the skin may become so inflamed that it breaks into open sores. These sores can be difficult to heal. Taking good care of the skin around your back passage can help to prevent these problems from developing. Tips to prevent soreness: After a bowel action, wipe GENTLY with soft toilet paper Whenever possible, wash around the anus after a bowel action Use warm water only, disinfectants and antiseptics can sting if you have open sores AVOID using products with a strong perfume such as scented soap, talcum powder, or deodorants on your bottom. Choose a non-scented soap (e.g. Simple, or baby soap). Many baby wipes contain alcohol, so should be avoided Pat your bottom dry gently with soft toilet paper or a soft towel. Do not rub Wear cotton underwear to allow the skin to breathe. Avoid tight jeans and other clothes which might rub the area Use non-biological washing powder for underwear and towels Avoid using any creams or lotions on the area, unless advised to do so If you need to wear a pad because of incontinence, use a pad with a soft surface page 9

10 Keep trying If you have had this problem for many years, it is unlikely that it will be solved overnight, so keep trying. These exercises take time and practice. What happens next? All the information in this booklet is part of a pelvic floor retraining programme, which is a 6 month commitment. You will be seen by a specialist nurse approximately every 3 months. After this programme, if further intervention is required, you consultant will discuss other options with you in clinic. page 10

11 More information For further information please visit the Oxford pelvic floor website: The Community Bladder and Bowel Service is available for all adults over the age of 18 with bladder or bowel problems. For more information search Our Services on: The charity called Bladder and Bowel Foundation has a helpline run by health care professionals who can advise and support you with on-going bowel issues. For more information please visit: Contacts Pelvic Floor Services Advice line: Block 24 Tel no: Churchill Hospital Old Road Headington Oxford OX3 7LE page 11

12 If you need an interpreter or need a document in another language, large print, Braille or audio version, please call or Oxford Pelvic Floor Service Version 1, January 2013 Review Date January 2016 Oxford University Hospitals NHS Trust Churchill Hospital, Oxford, OX3 7LE OMI 4882P

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