Why Aging Affects Bowel Control
Several physiological changes associated with getting older can impact a person's ability to maintain bowel control. While these changes are a natural part of aging, they can make individuals more susceptible to developing or experiencing a progression of fecal incontinence.
Weakening Anal Sphincter Muscles
With age, the muscles that make up the anal sphincter—the rings of muscle at the end of the rectum—can lose strength and elasticity. The internal sphincter muscle is involuntary, while the external sphincter is under conscious control. As both weaken over time, their ability to hold stool and gas effectively diminishes, increasing the likelihood of accidental leakage. This age-related atrophy has been documented in studies, showing a measurable decrease in sphincter pressure in older adults compared to younger ones.
Nerve Damage and Decreased Sensation
Another crucial factor is the potential for nerve damage, or neuropathy, which can impair the complex nerve signals between the rectum, anus, and brain. These signals are vital for sensing the presence of stool and coordinating the sphincter muscles. Conditions that are more prevalent in older adults, such as diabetes, stroke, and multiple sclerosis, can damage these nerves. This can lead to a decreased ability to feel when the rectum is full, a condition known as impaired rectal sensation. A person might not even realize they are leaking stool (passive incontinence) because the warning signals are not sent or received properly.
Chronic Constipation and Diarrhea
Persistent constipation is a major contributor to fecal incontinence, and it is a common issue for many seniors. Chronic straining during bowel movements can stretch and weaken the anal muscles and nerves over time. In a cycle of cause and effect, this can lead to a situation called fecal impaction, where a hard mass of stool becomes lodged in the rectum. The muscles and intestines stretch to accommodate the blockage, and over time, watery stool can leak around the impacted mass. Similarly, chronic diarrhea, which is often harder to contain than solid stool, can worsen or trigger incontinence.
Medical Conditions that Worsen Incontinence
Beyond the normal aging process, several medical issues can exacerbate or cause fecal incontinence. Understanding these can help in addressing the underlying problems.
Pelvic Floor Disorders
In women, childbirth trauma can cause significant damage to the pelvic floor muscles and nerves. While this damage might not cause problems initially, it can contribute to incontinence many years later as the muscles weaken further with age. Rectal prolapse, where the rectum protrudes through the anus, is another pelvic floor disorder that is often caused by chronic straining and can lead to incontinence. A rectocele, where the rectum bulges into the vagina, can also be a factor.
Dementia and Cognitive Impairment
For seniors with cognitive issues like Alzheimer's disease or other forms of dementia, fecal incontinence is a significant risk factor. These conditions can disrupt the brain's ability to interpret signals from the rectum or simply cause the individual to forget to use the toilet. In some cases, the person may not be able to communicate their need to a caregiver.
Other Factors
Other contributors include certain medications, especially long-term use of laxatives, and medical procedures that affect the anal or rectal area. Emotional distress, changes in environment, and decreased mobility can also play a role.
Managing and Treating Worsening Incontinence
Fortunately, there are many effective ways to manage and treat fecal incontinence, even as it progresses. The treatment approach depends on the underlying cause and severity.
Lifestyle and Dietary Modifications
- Dietary Adjustments: Keeping a food diary can help identify trigger foods that cause diarrhea, such as spicy, fatty, or greasy foods, and caffeine. Similarly, increasing fiber intake through vegetables, whole grains, and supplements can help manage constipation.
- Fluid Intake: Staying properly hydrated is important for preventing constipation. Drinking water throughout the day, rather than large amounts at once, can help regulate bowel movements.
- Weight Management: Excess weight puts pressure on the pelvic floor muscles. Losing weight can reduce this pressure and improve symptoms.
- Scheduled Toilet Visits: Regular bowel training can help establish a more predictable pattern. Aiming to use the toilet at the same time each day, often after a meal, can help retrain the bowel.
Exercises and Physical Therapy
- Pelvic Floor Exercises (Kegels): These exercises help strengthen the muscles that control bowel movements. A physical therapist can provide guidance on proper technique, which often involves squeezing and holding the pelvic floor muscles for several seconds at a time.
- Biofeedback Training: This therapy uses special sensors to help individuals learn how to properly contract their pelvic floor muscles and sense when stool is ready to be passed.
Medical and Surgical Treatments
- Medications: Anti-diarrheal drugs, bulk-forming agents, or stool softeners may be prescribed depending on the root cause.
- Nerve Stimulation: Sacral nerve stimulation involves implanting a device that sends small electrical impulses to the nerves controlling bowel function, which can improve muscle control.
- Surgery: If muscle damage is the cause, surgical options like sphincteroplasty to repair the muscles may be considered.
Comparison of Treatment Options
| Feature | Lifestyle/Dietary Adjustments | Pelvic Floor Exercises & Biofeedback | Medications | Surgery | Nerve Stimulation |
|---|---|---|---|---|---|
| Effectiveness | Moderate to high, depending on the cause | Moderate to high, requires consistency | High, for specific underlying issues | High, for specific anatomical problems | High, for nerve-related issues |
| Invasiveness | Non-invasive | Non-invasive, sometimes with devices | Non-invasive | Invasive | Minimally invasive |
| Time to See Results | Days to weeks | Several weeks to months | Days to weeks | Weeks to months (post-recovery) | Weeks to months |
| Best for... | Mild to moderate cases, chronic issues | Strengthening weakened muscles | Diarrhea, constipation, inflammation | Sphincter damage, prolapse | Nerve damage, sensation issues |
| Considerations | Requires consistent effort, may not solve severe cases | Requires dedication to see results | Possible side effects, requires diagnosis | Recovery time, risks | Implanted device, requires procedure |
What to Do Next
The most important step is to talk to a healthcare provider. Many people feel embarrassed discussing fecal incontinence, but it's a common and treatable condition. An accurate diagnosis is necessary to determine the best course of action. Keeping a diary of symptoms, foods, and bowel movements can be a very helpful tool for a doctor.
For more information on managing incontinence, visit the National Institute on Aging's resource page: https://www.nia.nih.gov/health/bladder-and-bowel-health/bladder-health-and-urinary-incontinence.
Conclusion
While it is true that fecal incontinence get worse with age, it is not an inevitable or untreatable condition. The combination of natural muscle and nerve changes, alongside common geriatric conditions like diabetes and cognitive impairment, increases risk and can lead to a progression of symptoms. However, with the right approach—including dietary changes, pelvic floor exercises, and medical treatments—many older adults can effectively manage or significantly reduce their symptoms and improve their quality of life. Open communication with a healthcare provider is the first and most critical step toward finding a successful solution.
