There are no simple solutions to the difficult problem of an unpredictable or leaking bowel, but there are things you can try that may improve control for you. Different things work for different people. Some of the suggestions below may not be right for you, or you may have tried some already. But you may find that they help with the control of your bowel. Many people with IBD find it difficult to talk about their incontinence. But it is important to mention it to your IBD team so that they can check for any underlying causes and they can also help you to control and manage it.

• Bowel retraining For people with urgency and frequency (needing to rush to the toilet very often), it can help to practice holding on and waiting once you feel the urge. This can feel very difficult, if not impossible, at first. Your rectum and your sphincter muscles, along with your confidence, need developing to help you overcome this problem. See Pelvic floor exercises below for some suggestions on how to do this.

• Biofeedback therapy Biofeedback therapy for bowel incontinence is used as one way of retraining the bowel muscles to improve control and reduce symptoms such as incontinence. This therapy is not yet widely available. But it is worth speaking to your IBD team to see if they are able to offer it, or can refer you to another hospital or centre where it is available.

• Making sure the bowel is empty Sometimes when the rectum is inflamed you can get mixed messages and it can be difficult to feel if you are empty or not when you have been to the toilet. This can be a particular problem for people with an internal ileo-anal pouch. Sometimes, sitting on the toilet with your feet up on a footstool and pushing from your abdominal muscles (rather than holding your breath and pushing) can help.

• Pelvic floor exercises The pelvic floor muscles are located between your legs, and run from your pubic bone at the front to the base of your spine at the back. You may already be aware of pelvic floor exercises, as some women use them to strengthen weakened muscles after childbirth. And both men and women can use these exercises to help when their muscles have become weaker with age and they may be experiencing urinary (wee) incontinence. But pelvic floor exercises can also help with managing bowel incontinence as they strengthen the muscles around your anus. It is important to learn to do the exercises in the right way, and to check from time to time that you are still doing them correctly. At first, it is probably a good idea to set aside some time for these exercises to concentrate on getting them right. But quite soon they should become easy to do wherever you are. As your muscles strengthen, you should be able to hold each squeeze for longer and do more repeats. Gradually doing a little more and feeling that you have worked hard should be your objective. Some people also find that gentle exercise such as swimming and pilates can help to strengthen pelvic floor muscles.

• Antidiarrhea drugs People with bowel incontinence who also have diarrhea or loose stools often find that taking antidiarrhea drugs to firm up the stools is helpful, as these can decrease incontinence and urgency. However, the patient information leaflets that come with all antidiarrhea drugs advise against taking them if you have IBD, particularly if you are having a flare-up of UC. This is because there are risks of side effects, including toxic megacolon (when digestive gases get trapped in the colon, making it swell up) associated with taking these drugs. So, whichever condition you have, do not take any antidiarrhea medicines without first checking with your doctor or our IBD team. 

• Food and drink Some people find altering what they eat helps to reduce their diarrhea and risk of incontinence. For more information about this, see our leaflet Diarrhea and Constipation. 

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PRODUCTS AND TIPS WHICH MIGHT HELP

There aren’t that many products designed specifically for fecal (poo) incontinence, but see below some products and tips available which may help you.

• Pads and pants – Many pads are designed for urinary (wee) incontinence so people often find them unnecessarily thick and bulky, and not the right shape or length. However, there are some fecal incontinence pads available online and from chemists which may be suitable. These pads can help to contain soiling and prevent the skin from getting sore. For more severe or regular incontinence you can obtain larger pads or specially designed padded pants which will prevent leaks staining clothes. Or you may at least be able to get some free samples from the manufacturer’s website. If you are unable to get free supplies, there are many companies with a mail order service.

• Anal plug – This is inserted into the back passage, where it expands to prevent leakage. It can be kept in place for up to 12 hours, though many people find that it is uncomfortable or irritating. It has to be taken out before a bowel movement, so it is not suitable if you have frequent movements. Speak to our IBD team if you are thinking of using an anal plug, as they are not suitable for everyone.

• Continence Clinics – If you would like personal help and advice you might like to consider attending a continence clinic. You may be able to refer yourself or you may have to be referred by your doctor or our IBD team. Stoma care companies also often have useful information.

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