Incontinence and Constipation

An individual’s ability to control bowel function is termed ‘continence’. Normal continence is not innate but is a highly complex process involving cognitive (conscious thought) function, autonomic (subconscious) function, spinal reflexes and local reflexes and sensations to and from the rectum and anus. Normal continence is learned as part of toilet training at a young age, where all these nervous connections are made and trained.

The two terms most frequently used to describe problems with normal bowel function are ‘incontinence’ and ‘constipation’.

Constipation

Constipation is the infrequent passage of a hard stool which can be difficult to pass. Constipation can be subdivided into two main causes: slow transit constipation and obstructed evacuation. Slow transit constipation is where the stool moves slowly through the colon and most of the water is reabsorbed back into the body from the stool. This makes it hard and small and difficult for the body to move through the system. Obstructed defaecation is where the transit through the bowel is normal but the patient has the feeling that something is blocking its passage through the anus. This symptom is very common in women who have had difficult deliveries and may also have had a hysterectomy. Both slow transit and obstructed symptoms can manifest as part of the Irritable Bowel Symptom complex.

The causes of slow transit constipation are numerous and some information is provided below.

Dehydration:
Not drinking enough fluid is a simple way for the stools to become dry and hard. Drinking more can be a simple way to address this problem. Alcohol does not count as it is in itself dehydrating.

Lack of fibre:
The body will find it easier to reabsorb fluid from the stool thereby making them hard and dry if there is nothing in the stool that can hold the fluid there. The main constituent of our diet that absorbs and retains water in the stool is fibre. A normal fibre intake includes both wheat and vegetable fibre and increasing the intake is another simple way to help with constipation. Be aware that excessive fibre can cause fermentation in the bowel and produce large amounts of wind.

Other causes of slow transit constipation include neurological and muscular abnormalities but are fortunately rare.
Patients with theses conditions often have a history of bowel problems that can go back to childhood.

Obstructed defaecation is a difficulty in evacuating (passing) the stool through the anus.
There is frequently a sensation of something blocking the passage of the stool. This is a particularly common problem and commonly affects women who have had difficult deliveries (especially with forceps or an episiotomy) requiring stitching or who may have had a hysterectomy. This changes the normal anatomy of the pelvic organs especially the uterus and vagina, and as the vagina and rectum are closely associated to one another, can often produce disorders of bowel function.

If you feel that your constipation needs some medical attention and they have not been improved by the simple measures above and you would like to contact Dr. Gold to discuss things in further detail please click here.

Incontinence

Incontinence is defined as the inability to hold on to ones waste until it can be passed at the desired time. There is urinary and faecal incontinence. This site is concerned only with faecal incontinence.

The muscles around the anus and rectum that control our continence are collectively known as the pelvic floor muscles. Some of these muscles work on their own and cannot be controlled voluntarily. Others respond to our control and the inter-relationship between all of these muscles is incredibly complicated. However, for the vast majority of people they work perfectly and there are no problems.

However, sometimes problems can arise that makes it difficult to hold onto one’s stool. The two main types of incontinence are “urge incontinence” which is a sudden desperate need to run to the toilet due to the feeling that an accident is going to happen, and sometimes does. The other type of incontinence is “passive incontinence” where the stool or wind is lost without any warning at all. Sometimes this is only a small a amount of wind, sometimes but more rarely it can be whole stool.

There are numerous causes of incontinence. The most common causes are childbirth and hysterectomy and women suffer from incontinence problems as a result far more than men. Other causes that can affect both men and women are ageing, previous anal or pelvic surgery, neurological conditions such as MS and neuropathy, muscular disorders and sometimes other rare illnesses.

Quite frequently the muscles become disordered such that a combination of both constipation and incontinence can coexist.

Pelvic floor exercises are often recommended but it is important that the actions and control of the muscles is understood properly. These pelvic floor or ‘Kegel’ exercises if done incorrectly can also make things worse.

If you feel that your incontinence is becoming a problem and needs some medical attention and you would like to see Dr Gold to discuss things in further detail please click here.

For a consultation and assessment of your condition please contact Dr. Gold.