Bowel incontinence, also called fecal incontinence or accidental bowel leakage, is exactly what the name sounds like. It’s the loss of control over your stool, causing feces to leak unexpectedly. Managing bowel incontinence isn't easy, especially when few people are willing to trade tips and strategies. But as experts in pelvic floor physical therapy, bowel incontinence is one of our favorite topics (there's no such thing as TMI here), and we love to share information that can help you get relief.
It may be hard to believe, but research shows that more than 1 in 10 women are dealing with bowel incontinence. But just because it's common doesn’t make it normal or "okay." Living with chronic bowel incontinence can lower your quality of life and produce symptoms that can contribute to depression and anxiety. On the upside, bowel incontinence is both manageable and treatable for most people.
What are symptoms and causes of bowel incontinence?
While it seems like constipation should be completely unrelated to bowel incontinence, it's actually one of the leading causes. With constipation, large, hard, dry stool can become difficult and even impossible to pass. Over time, this can cause the rectum to become less sensitive to the presence of stool. Liquid stool, on the other hand, has no problem slipping out, as it can sneak around impacted stool — oftentimes with the person having no awareness that it's even happening. Beyond constipation, there are many other reasons why someone may be experiencing bowel incontinence.
If you’re experiencing bowel incontinence, you’ll likely be familiar with scenarios such as these:
- Bowel urgency: Knowing you need to poop, but as soon as the feeling comes on it’s an emergency
- Chronic constipation
- Chronic diarrhea
- Leaking stool, gas, or mucus that you can’t control
- Streak marks in your underwear
- Anxiety, social anxiety, depression and other hits to your mental health and social life
Individuals with vaginal anatomy are more likely to have risk factors for bowel incontinence, such as diarrhea, constipation, and straining during bowel movements. If you experience vaginal childbirth, you can also develop muscle or nerve damage that can further contribute to bowel incontinence.
Other causes of bowel incontinence can include:
- Muscle or nerve damage caused to the sacral area by diseases like diabetes or multiple sclerosis
- Weak or impaired pelvic floor muscles caused by pregnancy, childbirth, heavy lifting, chronic coughing, surgery, or obesity
- Various bowel diseases such as Crohn’s Disease
Ideally, everyone should be able to easily and consistently control the passage of stool, but the gastrointestinal system is complex. Stool elimination requires a coordinated team effort between the stool and the muscles, nerves, and organs involved. A lot of the process happens automatically, without your conscious control. Thankfully, there are some ways that you can consciously improve control over your bowel function and improve symptoms of bowel incontinence, including optimizing your pelvic floor muscle function and paying attention to your diet.
How you can improve your bowel incontinence
Bowel incontinence is typically the symptom of a larger issue, so it's always important to seek treatment from a medical professional, whether it's your primary care provider or a gastroenterologist. They will help you determine what's going on in your body that could be contributing to the problem, and use that information to find the best treatment options. There are also lifestyle changes you can start making to help alleviate symptoms. A great place to start is to look at how your diet may be affecting the consistency of your stool.
Stool consistency — how thick, thin, wet, or dry your stool is — can have a direct impact on how easy it is to control the passage of stool. The Bristol Stool Chart below is a helpful tool for tracking and describing stool consistency.
For the best bowel control, you want to aim for a consistent stool consistency of type 3 or 4. In these scenarios, your poop has enough weight and bulk that your body can sense when your rectum is ready to be emptied, but it’s not so thin that your muscles and nerves have a hard time sensing and controlling what is being passed down there. What can help is getting enough water and fiber in your diet.
Managing fiber intake TO REDUCE bowel incontinence
It’s important to keep in mind that all bodies are unique and there’s no one size fits all approach to overcoming incontinence, but altering your fiber intake may help alleviate the symptoms of bowel incontinence.
There are two kinds of fiber: insoluble & soluble.
Insoluble fiber is found in foods like whole-grain cereal. While it can help keep you regular and might be a healthy addition to your breakfast, it is also most often the type of fiber that causes digestive distress. Insoluble fiber cannot be completely digested in your body—for that reason it is passed through the intestines, undigested, and adds bulk to stool. If you’re someone who has trouble digesting insoluble fiber, it might be beneficial to experiment with reducing or eliminating it from your diet to see if your stool consistency improves. Insoluble fiber absorbs water in the digestive system and has the potential to help improve constipation.
Soluble fiber is often sourced from vegetables and legumes (think lentils, kidney beans, cauliflower, kale, and other cruciferous vegetables). Soluble fiber is found in many nutrient-dense foods, but it can be hard to digest — especially if your body isn’t accustomed to digesting large amounts of these foods. Soluble fiber slows down digestion and can improve diarrhea which can, ultimately, help to overcome accidental bowel leakage.
Tweaking your fiber intake may improve bowel incontinence and inconsistent stool, but it may take some time. It’s best to increase fiber intake slowly and incrementally in order to reduce stress on your digestion.
Lastly, don’t forget to hydrate. If you want a recipe for constipation, it would be adding fiber into your diet without also increasing your water intake. Each day, try and drink around half your weight of water in ounces. Or look to your urine color to check your hydration status. You want to drink enough water so you are comfortably able to hold urine for 2-4 hours throughout the day, and your urine color is very light yellow, to clear.
Together, fiber and proper hydration can help you move towards a stool consistency that is easier to control. Paying attention to the rest of your diet, and cutting out common foods that make bowel incontinence more likely, is often the next step to take.
10 Foods that contribute to bowel incontinence
While it’s always important to see a medical professional and rule out underlying conditions, bowel incontinence can often be alleviated through diet and lifestyle shifts. Check out these common food triggers that may be making your bowel incontinence worse:
1. Sugar Alcohols
Xylitol, sorbitol, mannitol. All these “tol” foods might be great for adding a little sweetness to your day while managing blood sugar levels, but your body isn’t built to absorb sugar alcohols — meaning they come right back out the other end and can cause or worsen diarrhea.
There’s a reason that hangovers are often accompanied by the runs — alcohol can wreak havoc on your digestive system as your body works overtime to eliminate the toxin from your system.
3. Caffeinated Beverages
Coffee earned the worst-ever nickname “poop juice” because the caffeine in it acts as a stimulant to your bowels, causing stool to move faster and potentially exacerbating issues with stool consistency.
Unfortunately, chocolate has enough caffeine in it to affect those who are sensitive to caffeine and its effects.
5. Dairy products
Whether it be milk, yogurt, cheese, or ice cream, many people are sensitive or allergic to dairy products, leading to digestive distress. Diarrhea is often the result of food that our bodies are unable to digest and absorb and dairy is a perpetrator for many individuals.
6. Fruits containing fructose
Fruits like apples and pears contain high levels of fructose and can be difficult to digest. If you experience fructose malabsorption, the fructose in these foods can make its way to the small intestine where it ferments, causing gas, bloating, diarrhea, and accidental bowel leakage.
7. High fructose corn syrup
High fructose corn syrup is found highly concentrated in many processed foods like breakfast cereals, soda, and concentrated fruit juice. Just like the fructose found in certain fruits, it can lead to gas, bloating, diarrhea, and potentially ABL.
8. Onions, garlic, artichokes, and other high fructan foods
Fructans are another difficult-to-digest carbohydrate that is, unfortunately, found in a lot of nutrient-dense food. If you suffer from bowel incontinence it might be best to avoid high-fructan foods.
9. “Greasy” fast foods
Many fast foods contain trans fats and are fried in oil that oxidizes at high temperatures. Fast foods such as french fries and fried chicken contain little nutritional value, causing your body to process them quickly and excrete the majority of the food without extracting nutrients.
10. Spicy foods
Sorry to throw hot wings under the bus, but those oh-so-good, too hot to handle meals could be speeding up your digestion and causing (or worsening) diarrhea.
It isn't typically necessary to eliminate all of these foods to improve bowel incontinence. The trick is to find the foods that are having the biggest impact. Try keeping a food journal to track progress and get a better idea of how shifting your diet impacts stool consistency and bowel incontinence. Tracking everything that goes in (and comes out, including stool consistency) may help you better understand how your diet is impacting your bowel incontinence.
What else can you do if you have bowel incontinence?
One of your best allies against bowel incontinence may be your pelvic floor muscles. Consider seeing a pelvic floor physical therapist in conjunction with making dietary changes. Your pelvic floor PT will work with you to investigate how the foods that you eat and stressors in your life may be causing bowel incontinence. They may also look at your bathroom body mechanics and see if they can change how you are sitting so that you can better empty. Your PT will also thoroughly assess your pelvic floor muscles in order to best understand how to strengthen and reconnect with these muscles that surround your vagina, urethra, and anus.
Although bowel incontinence may be incredibly stressful right now, know that you have options. Your health care provider and pelvic floor PT can help you take control of your bowels and feel more comfortable and confident in your body. You might think it will be difficult or embarrassing to talk to a medical professional about when and how you poop, but we promise it will be easier than you think — and the benefits will be more than worth it.