The Role of Your Sphincters in Bowel Control
To properly understand the changes that can occur with age, it's important to know how your anal sphincters work. You have two main rings of muscle that control the passage of stool:
- The Internal Anal Sphincter: This is an involuntary, smooth muscle that should be constantly closed to prevent leakage. As with other smooth muscles in the body, it can lose elasticity and strength over time.
- The External Anal Sphincter: This is a voluntary, skeletal muscle that you can consciously squeeze to hold back stool and gas. Unlike the internal sphincter, this muscle can be strengthened with targeted exercises.
These two muscles, along with the nerves that control them and the muscles of the pelvic floor, work together in a complex system. When any part of this system is compromised, it can lead to issues with bowel control, or fecal incontinence.
Why Your Sphincter May Weaken Over Time
The natural aging process is a significant risk factor for sphincter weakness and related bowel control problems, but it is not the only cause. Several contributing factors can weaken these muscles and the nerves that serve them:
- Aging: As we age, muscles throughout the body lose mass and strength, including those in the pelvic floor and anal area. The internal sphincter's elasticity naturally declines.
- Childbirth: Vaginal delivery, especially difficult ones or those involving forceps or episiotomies, can damage the pelvic floor muscles and nerves, and this damage can manifest as incontinence many years later.
- Chronic Constipation: Long-term straining to pass hard stool puts immense pressure on the anal sphincters and pelvic floor, causing them to stretch and weaken over time. Fecal impaction, a severe form of constipation, can also cause leakage as liquid stool bypasses the obstruction.
- Nerve Damage: Conditions such as diabetes, multiple sclerosis, or injuries to the spinal cord or head can damage the nerves that control the anal sphincters and sense stool in the rectum.
- Rectal Surgery or Trauma: Surgical procedures in the anal area, or other trauma, can cause direct damage to the sphincter muscles or nerves.
- Inactivity: A sedentary lifestyle, particularly common in frail older adults, can increase the risk of chronic constipation and subsequent sphincter weakness.
Practical Steps for Improving Bowel Control
Fortunately, for many people experiencing bowel control issues, there are non-invasive and highly effective treatments available. Don't suffer in silence—these are medical conditions that can be managed and improved.
Lifestyle and Dietary Changes
Simple changes to your daily routine can have a significant impact on managing symptoms:
- Increase Dietary Fiber Gradually: Fiber adds bulk and consistency to stool, making it easier to control. Good sources include fruits, vegetables, and whole grains. Adding bulk laxatives like Metamucil can also help.
- Stay Hydrated: Drinking plenty of water is crucial for preventing constipation. Aim for eight 8-ounce glasses of water per day.
- Keep a Food and Symptom Diary: This can help you identify foods that trigger diarrhea or loose stool, such as caffeine, alcohol, or dairy.
- Establish a Routine: Regular bowel training, by trying to have a bowel movement at the same time each day (e.g., after a meal), can help regulate your system.
Strengthening Exercises
Just as you can strengthen other muscles, you can improve the voluntary external anal sphincter and pelvic floor muscles. Pelvic floor physical therapy, often using biofeedback, can help you learn to do these correctly.
Here's how to do Kegel exercises for bowel control:
- Identify the muscles: Squeeze the muscles you use to stop yourself from passing gas or urinating. You should feel a tightening and lifting sensation. Your buttocks and tummy should not move significantly.
- Practice slow contractions: Squeeze the muscles tightly and hold for 5 to 10 seconds. Relax for 10 seconds. Repeat 5 times.
- Perform quick contractions: Squeeze and relax the muscles as quickly as you can, 5 to 10 times. This helps build endurance for moments of urgency.
- Repeat throughout the day: Perform these exercises in multiple sets throughout the day, in various positions like sitting, standing, or lying down.
Comparing Treatment Options
Different severities of bowel incontinence require different approaches. Here is a comparison of conservative and advanced treatments.
| Feature | Conservative Management | Advanced Treatments |
|---|---|---|
| Methods | Diet changes, fiber, hydration, Kegel exercises, bowel training. | Biofeedback therapy, medications, sacral nerve stimulation, surgery (e.g., sphincteroplasty, colostomy). |
| Invasiveness | Non-invasive, low risk. | Invasive, requiring medical procedures or surgery. |
| Timeframe | Often effective in weeks to months with consistent effort. | Can offer more rapid or permanent results for specific issues. |
| Best For | Mild to moderate cases; foundational therapy for most. | Persistent cases unresponsive to conservative measures; severe muscle or nerve damage. |
When to Consult a Professional
While at-home management is a great starting point, persistent or worsening symptoms warrant a visit to a healthcare provider. A doctor can help determine the specific cause of your incontinence through a physical exam and other diagnostic tests, such as anal manometry or ultrasound. Conditions like chronic constipation, fecal impaction, or nerve damage from diabetes need proper diagnosis and medical treatment. For further information and guidance, the Mayo Clinic provides a comprehensive overview of fecal incontinence.
