online version Improving Bowel Function and Control Patient Information for the Gloucestershire Health Community

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1 GHPI0810_08_07 Contact: Continence Team Review due: August 2010 Improving Bowel Function and Control Patient Information for the Gloucestershire Health Community

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3 Notes Introduction Poor bowel function and/or loss of bowel control can be a devastating and embarrassing problem that can radically affect your everyday life. There are many different causes of this problem, some of which are listed below: Constipation (made worse by ill health, Immobility and poor diet) Certain medicines Bowel disease (such as Crohn's Disease) or neurological disease (such as Multiple Sclerosis) Diarrhoea Excessively strong contractions of the bowel wall, leading to a feeling of urgency and pushing the stools out Damage or weakness of the muscles around the anus resulting in the muscles not being able to hold back the stools until you are able to get to the toilet Whatever the cause, the effects are the same. Your doctor or nurse will be working with you to try and establish the cause of your particular problem to plan the correct treatment for you. In the mean time, this leaflet will give you information to the symptoms you are experiencing. Establishing a regular routine Whatever the cause of your bowel problem, staying regular will help improve your symptoms. The first steps to regular, reliable bowel motions are routine and timing. Generally the bowel is most active after a meal; however drinking warm liquid can also trigger bowel activity. Make good use of this increased bowel activity, by trying to have your bowels opened around the time when your bowel is most active (such as after breakfast or lunch). 12 1

4 Designate this time of the day for bowel movement. You should allow half an hour when you are relaxed and unhurried. Make this a regular event, even if you do not feel that you need to go. Exercise stimulates the bowel to work, leading to easier bowel emptying. Exercise does not have to be rigorous. Simple day to day exercise gained from daily living (such as walking or housework) will help. If you are unable to manage this type of exercise, then a range of motion exercises could be used. Remember: Try to have your bowels opened on a regular basis (even if you do not feel you need to go). Make use of when your bowel is most active Limber up before hand/try a warm drink Adopting the correct position for opening your bowels Sitting in the correct position on the toilet and taking full advantage of gravity, will make it easier for you to empty your bowel. Follow the steps below to achieve the correct and most effective position. Step 1 Sit on the toilet and raise your feet onto a foot rest (a stool, or even a pile of books will do). Your knees should be higher than your hips. Step 2 Lean forwards, with a straight spine and rest your elbows on your knees. Step 3 Bulge out your abdomen and pretend you are gently blowing out candles on a birthday cake. Rest and then repeat step 3. Take as long as you need. Don t sit for ages on the toilet and do not strain, you should be able to empty the bowel with minimal effort. Use a barrier cream, or ointment, as recommended by your doctor or nurse. If you choose your own, try Sudocrem or a small amount of Metanium. These are available from your chemist. Try not to scratch the anal area, however much you are tempted, as this will make things worse. If you find that you are scratching the area in your sleep, you may consider wearing cotton gloves in bed (available from your chemist). If drying the skin after washing is difficult or uncomfortable you may try using a hair dryer on a low setting (use carefully). Try to allow the air to get to the anal area for at least part of every day. Do not struggle on alone. Talk to your nurse or doctor, especially if your skin is broken. If you have persistently sore skin, you may have an infection which needs treating. There are also other products which can be prescribed to help heal the soreness. For further information on bowel incontinence, contact: Gloucestershire Continence Service on (9am -5pm) 2 11

5 Also avoid using products on your bottom with a strong perfume, such as scented soap, talcum powder, baby wipes or deodorants. Choose a non- scented soap, such as baby soap or soap from a specialist company (such as Tena cream). Your Continence Nurse will be able to advise you. When drying the area, BE VERY GENTLE. Pat gently with soft toilet paper or a soft towel. DO NOT RUB. Treat the whole area as you would a new born baby s skin. Wear cotton underwear, to allow the skin to breath. Avoid tight clothing that may rub and irritate the area. Women are usually best to avoid tights. Use stockings or crotch-less tights instead. Use non-biological washing powder for underwear and towels. Avoid using any creams or lotions on the area, unless advised to do so. A few people who are prone to sore skin do find that regular use of a cream can help to prevent this. If you do use a barrier cream, choose a simple one (such as zinc and caster oil). Your doctor or nurse may suggest using a barrier wipe, which forms a protective film over the skin, especially if you have diarrhoea and are opening your bowels very frequently (available on prescription). If you need to wear a pad because of incontinence, try to make sure that no plastic comes into contact with the skin and that you use a pad with a soft surface. The Continence Nurse can advise you on which pads are best. Whenever possible, unless you have been advised not to for other reasons, eat a healthy, balanced diet. Drink plenty and take as much exercise as you can. Some people find that certain food and drink makes them more prone to soreness, especially citrus fruit such as oranges. It may be worth cutting these out on a trial basis, and more permanently if this helps. Using this technique will encourage good co-ordination between nerves and muscles, thus encouraging relaxation of the pelvic floor and bowel emptying to take place If the stool is very hard it can be even more difficult to pass and can even feel as if it has got stuck. The following technique can help in this situation. Hold something soft in your left hand. Rest it on your tummy, on the left side and put your right hand over the top. Rock yourself forward and rest, then rock yourself back and push out the stool. Try this for 5-10 minutes. Remember: Make sure the toilet is comfortable (not too cold) and allow yourself enough time and privacy. Bowel Sphincter Exercises If you are already sore Bowel sphincter exercises can help you to improve your bowel control. Follow all advice on prevention. In addition: When done correctly, these exercises can build up and strengthen the muscles to help you to hold both gas and stool in the back passage. You may find that damp cotton wool is most comfortable for wiping. 10 3

6 Your doctor or nurse will be able to teach you how to do the exercises properly and will give you an information leaflet reminding you of what you have been taught. Bowel sphincter exercises can be a very effective way of improving problems of bowel control, however they do not work overnight. In order to get the best results you must perform the exercises every day for 3-6 months. This may sound like hard work, but be assured; your perseverance will be rewarded. Advice for Diarrhoea, Bowel Frequency and Urgency If you experience diarrhoea or bowel urgency (having the sudden feeling of wanting to have your bowels opened), you may find the following advice helpful: Avoid caffeine and high fat foods as these stimulate the bowel and can cause it to contract or spasm, which may cause bowel urgency. Avoid foods that contain Sorbitol (an artificial sweetener often used in sugar free sweets and chewing gum). Avoid Antacids that contain Magnesium, as these can also cause diarrhoea. In some cases, milk and milk products can make diarrhoea worse. Reduce your use of these foods to see if the diarrhoea improves. If you think that this maybe a problem, talk to your dietician or doctor. Lactose free milk or Soya products maybe better tolerated. Some people find that removing the skins, seeds and membranes from fruit and vegetables makes these foods easier to digest. Canned or well cooked fruit and vegetables may also be easier to digest. Try eating several small meals throughout the day. Limit your use of fruits, berries, rhubarb, legumes (lentils & kidney beans), peas, corn, broccoli, spinach and nuts. They make With some anal conditions, it is very difficult to wipe your bottom effectively, a little always seems to get left. This stool starts to make you sore. Sometimes, the area around the anus becomes infected. If you have incontinence of the bladder and bowel, you will be more likely to get sore as the urine and faeces react together. People who are not eating a healthy balanced diet, are not drinking enough, or not taking much exercise, are more prone to skin soreness, as are people who are generally unwell and are not very active or mobile. Tips to prevent soreness With careful personal hygiene, it is often possible to prevent soreness, even if you have a bowel problem. After a bowel action, always wipe GENTLY with soft toilet paper, or ideally the newer moist toilet paper (available from larger pharmacies and some supermarkets). Discard each piece of paper after one wipe so that you do not re-contaminate the area. Whenever possible, wash around the anus after a bowel action. A bidet is ideal (portable versions are available). If this is not possible, you maybe able to use a shower attachment with your bottom over the edge of the bath. Use a soft disposable cloth with warm water. Avoid flannels and sponges as they can be rough and are difficult to keep clean. Sometimes, a little ingenuity is needed, especially if you are away from home. Some people find that a small plant spray, watering can or jug filled with warm water makes washing easy on the toilet or over the edge of the bath. A spray cleanser from a specialised company (such as Tena mousse) may be helpful, ask your Continence Nurse for advice. Do not be tempted to use disinfectants or antiseptics in the washing water, as these can sting and many people are sensitive to the chemicals in them. Plain water is best. 4 9

7 Peppermint oil Charcoal tablets Wind-cheaters Aloe Vera capsules or drinks Cranberry juice Pre & Pro biotic drinks (such as Yakult or Actimel), available from the supermarket) Advice on Skin Care for People with Bowel Problems Why is good skin care important? Anyone who has frequent bowel motions, diarrhoea or accidental leakage may, from time to time, get sore skin around the back passage from time to time. This can be very uncomfortable and distressing. Taking good care of the skin round the back passage can help to prevent this problem from developing. Why may I get sore skin? There are several different reasons why your skin may become sore. The scientific reason for itching is that it is due to chemicals contained in the bacteria of the bowel motions. Your bowel contains digestive juices and acid, which breaks down your food to enable your body to use the nutrients in it. If you have very fluid bowel motions, the diarrhoea will still contain these juices and acid, which start to eat away any skin they come into contact with. If you have faecal incontinence, the small quantity of juices and acid left in even normal stool can damage the skin. If you open your bowels very frequently, repeated wiping can damage the sensitive skin of your anus. diarrhoea worse for some people. In some situations, it maybe appropriate to reduce the amount of fibre in your diet until the diarrhoea has resolved, then gradually resume a normal diet (Refer to Dietary Fibre information leaflet). Controlling Wind and Smells When you have a bowel problem, you may find that you cannot always control the passage of wind from the back passage and any wind you do pass may seem to smell offensive. There is no single solution for this problem, however different people find different things helpful, so here are a few things you might like to try. Food and Eating There is no doubt; some foods tend to create more gas than others, especially foods high in fibre (particularly soluble fibre). The effect of certain foods is very individual, so what causes wind for one person, may not cause wind for another. It is worth experimenting a little to see if certain foods make things worse for you and whether avoiding these foods helps. Below is a list of foods that commonly cause wind. The list is not exhaustive and you may find something not on the list that causes you wind. Beans (including baked beans and kidney beans) Peas, lentils and other pulses Muesli Bran cereal or other high bran foods Brown rice or wholemeal pasta Nuts (especially peanuts) Cabbage, cauliflower, carrots and broccoli Eggs 8 5

8 Shellfish Milk and milk products Salad (especially cucumber & lettuce) Jacket potatoes skins Leeks, Swede and parsnips Apples, raisins and prunes Onion Chewing gum Slimming foods and sugar free products often contain fructose or sorbitol, which can cause problems, as can hot spicy foods and rich, fatty foods Sometimes, the way in which you eat means that you swallow a lot of air with your food. Try eating a little more slowly. Chew each mouthful carefully (especially if the food is high in fibre) and take care not to talk too much while you are actually eating. Even if you are in a hurry, do not be tempted to rush your food or wash down half chewed food with a gulp of drink. Eating little and often, rather than one huge meal a day, can make it easier for your intestines to cope and can decrease gas production. Regular meal times can also help, as an empty stomach produces more wind and gurgles. Drinking Caffeine in tea, coffee and cola has a tendency to increase bowel activity for some people and therefore, may increase wind & urgency. Try decaffeinated tea and coffee for a week or two, to see if this makes any difference. Fizzy carbonated drinks, beer and lager also increase wind for some people. Usually, you will burp this up, but few people seem to experience more wind with these drinks (excess alcohol can cause more wind than usual the next day). Bowel Sphincter Exercises Sometimes doing exercises to strengthen the muscles and their speed of reaction, can improve your control of wind (see section on bowel sphincter exercises). Controlling and Disguising Smells If you produce a lot of wind that you cannot control, some of these ideas might help: Try to ensure good ventilation of the room you are in. Use an aromatherapy oil burner, scented candle, joss stick or dish of pot pourri (but remember to renew it regularly as the scent wears off). Use aerosol air fresheners with care. Some smell very obvious, or even worse than the smell you are trying to disguise! There are many solid block air fresheners that work all of the time (available from chemists and supermarkets) Essential oils, such as lavender or lemon oil, can be useful. Try striking a match and then blowing it out immediately and allowing the plume of smoke to drift into the room. Your chemist may stock some deodorants specifically designed to control smells from urine or faeces. Neutradol spray or gel (MS George Ltd), Atmocol (Seton Healthcare), Chironair (Sims Portex), and Daydrop (Loxley Medical) are among the most commonly available. Products which some people may find helpful There is no scientific research on this, so the following suggestions are simply products that some people have found helpful in reducing wind or the smell from wind. Again, this is very individual and may or may not be helpful to you. 6 7