Understanding Bowel Control: At what age do you lose control of your bowels?

While approximately 1 in 5 adults over 65 experience fecal incontinence, it is not a normal or expected part of aging. Instead of a specific age marking the loss of bowel control, various underlying medical conditions, lifestyle factors, and gradual changes can contribute to the issue over time.

Quick Summary

No single age marks the loss of bowel control, but the risk of fecal incontinence does increase significantly after age 65 due to various underlying factors, including weakened muscles, nerve damage, chronic health issues, and lifestyle impacts.

Key Points

• Age is not the cause: Loss of bowel control is not a normal part of aging, but a treatable medical condition that becomes more prevalent in older adults.

• Risk factors increase with age: Key risk factors for fecal incontinence include weakened muscles, nerve damage, chronic constipation, and other health issues, all of which are more common after age 65.

• Treatment is often successful: A wide range of effective treatments exist, from conservative options like dietary changes and pelvic floor exercises to advanced therapies and surgery.

• Conservative methods are the first step: Simple, non-invasive strategies like diet modification, bowel training, and pelvic floor exercises often provide significant improvement.

• Seek professional medical help: Given the treatable nature of the condition, it is vital to overcome embarrassment and talk to a healthcare provider for an accurate diagnosis and personalized treatment plan.

• Biofeedback can help retrain muscles: Biofeedback therapy is a proven technique that helps individuals learn to control and strengthen the muscles involved in bowel control.

• Many causes are manageable: Addressing the underlying cause, whether it is chronic constipation, diarrhea, or a medication side effect, is often the most effective approach.

The Reality of Age and Bowel Control

Loss of bowel control, or fecal incontinence, is a sensitive topic that many people feel embarrassed to discuss, leading to social isolation. However, understanding the true nature of this condition is the first step toward effective management and treatment. Rather than a specific age triggering this loss of function, it's the culmination of various age-related and health-related factors. The prevalence of fecal incontinence is higher in older adults, particularly those over 65, and becomes more common with advancing age, especially in those over 80. This increased incidence is tied to a number of physiological changes and conditions common in later life, not a predetermined expiration date for bowel function. It is important to emphasize that this condition is treatable and manageable, and does not have to severely diminish a person's quality of life.

Key Factors That Increase Risk

Several interconnected factors can contribute to the development of fecal incontinence as you get older. Addressing these can often lead to significant improvement or resolution of symptoms.

Muscle and Nerve Damage

• Weakened Muscles: The muscles that control the anal sphincter can weaken naturally with age. Injuries from vaginal childbirth or anorectal surgery can also damage these muscles.
• Nerve Damage: Nerves that sense the need for a bowel movement can be damaged by conditions like diabetes, stroke, and multiple sclerosis. This can result in a diminished awareness of the urge to go to the bathroom.

Chronic Conditions

• Chronic Constipation: Ongoing constipation can lead to fecal impaction, where a mass of hardened stool becomes lodged in the rectum. This can stretch and weaken the anal sphincter, leading to liquid stool leaking around the blockage (overflow incontinence).
• Chronic Diarrhea: Severe or chronic diarrhea can overwhelm the anal muscles, causing leakage. This is sometimes a side effect of medications, or a symptom of conditions like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD).
• Cognitive and Functional Impairment: Conditions like dementia and mobility issues can hinder an individual's ability to recognize the need to use the toilet or to get there in time.
• Other Factors: Other risk factors include physical inactivity, obesity, certain medications, and dietary imbalances.

Management and Treatment Options

An effective management plan for fecal incontinence often involves a combination of lifestyle changes and medical treatments, starting with the least invasive options.

Common Management Strategies

1. Dietary Adjustments: Modifying your diet is a key first step. If constipation is the issue, gradually increasing fiber intake with whole grains, fruits, and vegetables can help. If diarrhea is the problem, reducing caffeine, alcohol, and fatty foods may be recommended.
2. Bowel Retraining: This involves establishing a regular schedule for bowel movements, often after meals, to help retrain the body's natural reflexes.
3. Pelvic Floor Exercises: Strengthening the anal sphincter and pelvic floor muscles with exercises like Kegels can improve control. A doctor or physical therapist can provide proper instruction.
4. Absorbent Products: Using pads or disposable underwear can provide security and protect against embarrassing leaks while other treatments take effect.
5. Medication: Over-the-counter anti-diarrheal or bulking agents may be recommended, depending on the cause.

Comparison of Non-Surgical and Surgical Treatments

Treatment Method	Description	Best For	Typical Success Rate	Considerations
Diet and Lifestyle	Adjusting fiber, fluid intake, and exercise habits.	Mild cases, constipation/diarrhea issues.	Often improves symptoms significantly.	Requires consistent effort.
Pelvic Floor Rehab	Kegel exercises and biofeedback therapy to strengthen muscles.	Muscle or nerve damage, especially after childbirth.	Up to 60% symptom improvement.	Needs guidance from a specialist.
Sacral Nerve Stimulation	Surgically implanted device sends electrical pulses to the sacral nerves.	Moderate to severe cases unresponsive to conservative treatment.	Effective for many patients.	Minimally invasive surgery required.
Injections	Injectable bulking agents thicken the anal walls.	Moderate incontinence, can be done in-office.	Efficacy can vary; long-term effectiveness unknown.	Temporary solution, may need repeat procedures.
Sphincteroplasty	Surgical repair of damaged anal sphincter muscles.	Damage resulting from childbirth or injury.	Variable success, may decrease over time.	Surgical procedure with recovery period.

Biofeedback: A Powerful Tool

Biofeedback is a specialized form of therapy that can be highly effective, especially when paired with pelvic floor exercises. During biofeedback, a small probe with a sensor is inserted into the rectum. This sensor provides visual or auditory feedback on a computer screen, allowing you to see the strength of your muscle contractions. This helps you learn how to properly contract and relax the pelvic floor muscles, which can significantly improve bowel control. It is a useful tool for those who have difficulty sensing when stool is ready to be released.

Seeking Professional Guidance

While simple measures are a great starting point, it's crucial to consult a healthcare provider for an accurate diagnosis and treatment plan. A provider will take a full medical history and may perform tests to identify the underlying cause. Don't let embarrassment prevent you from seeking help, as many people find relief through proper treatment. For further information on treatment options and coping strategies, you can refer to authoritative sources like the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Conclusion

Loss of bowel control is not a foregone conclusion simply because of age. While the risk increases with age due to various factors, it is a manageable and treatable condition. By understanding the causes, exploring available treatments like diet modification, pelvic floor exercises, and advanced therapies, individuals can regain control and confidence. The key is to have an open conversation with a healthcare professional, as simple and effective solutions are often available. Taking proactive steps can lead to a significant improvement in quality of life for those affected by this common issue.

This content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a healthcare provider for medical concerns.

Frequently Asked Questions

At what age do you lose control of your bowels?

There is no specific age at which a person loses control of their bowels. The risk of developing fecal incontinence increases with age, particularly for individuals over 65, but it is not a normal part of the aging process. The condition is often a symptom of underlying health issues rather than age itself.

Is fecal incontinence a normal part of getting older?

No, fecal incontinence is not a normal or inevitable part of aging. While risk factors like weakened muscles and nerve damage become more common with age, the condition is often treatable and can be managed effectively with the right medical care and lifestyle adjustments.

What are the common causes of losing bowel control in older adults?

Common causes in older adults include weakened anal sphincter muscles, nerve damage (from conditions like diabetes or stroke), chronic constipation, chronic diarrhea, and functional impairments like dementia or limited mobility.

Can diet and lifestyle changes help with bowel control?

Yes, dietary adjustments are a common first-line treatment. Increasing fiber to bulk up stools or identifying and avoiding trigger foods (like caffeine and fatty foods) can significantly improve symptoms. Regular exercise and adequate fluid intake are also beneficial.

What is the role of pelvic floor exercises, like Kegels, in bowel control?

Pelvic floor exercises can strengthen the muscles that control the anus and rectum, improving bowel control and reducing leakage. They are often recommended as a part of a comprehensive treatment plan, sometimes combined with biofeedback therapy for better results.

When should I see a doctor about loss of bowel control?

You should see a doctor as soon as you experience problems with bowel control. Because it is a treatable medical condition, a healthcare professional can determine the underlying cause and recommend an effective treatment plan to improve your quality of life.

What are some of the advanced treatments for fecal incontinence?

Advanced treatments for more severe cases include sacral nerve stimulation (a pacemaker-like device for the nerves), injectable bulking agents to narrow the anal opening, and various surgical options to repair damaged muscles.

How can caregivers help seniors manage bowel control issues?

Caregivers can help by encouraging open communication, assisting with diet adjustments, ensuring a regular toileting schedule, and assisting with hygiene to prevent skin irritation. They can also provide emotional support and help find professional medical assistance.