How to stop bowel incontinence in the elderly? Expert strategies for managing control

Affecting a significant portion of older adults, bowel incontinence can be a distressing and often embarrassing condition, but it is not an inevitable part of aging. This authoritative guide provides actionable strategies on how to stop bowel incontinence in the elderly, covering a range of effective treatments and lifestyle adjustments.

Quick Summary

Manage bowel incontinence in the elderly by identifying underlying causes and implementing a tailored treatment plan, which can include simple dietary adjustments, bowel retraining, and specialized pelvic floor exercises to improve muscle control and reduce symptoms.

Key Points

• Start with Conservative Management: Begin treatment with lifestyle and dietary changes, such as modifying fiber intake and identifying trigger foods, to manage stool consistency and regularity.

• Strengthen Pelvic Floor Muscles: Simple and discreet exercises like Kegels can strengthen the anal sphincter and pelvic floor muscles, improving bowel control over time.

• Establish a Bowel Routine: Bowel retraining, which involves scheduled toileting and proper positioning, helps train the body to have predictable bowel movements, reducing accidental leakage.

• Explore Medical and Surgical Options: For more persistent cases, medical interventions like anti-diarrheal medication, biofeedback therapy, or advanced procedures such as sacral nerve stimulation can provide effective solutions.

• Prioritize Dignity and Hygiene: Practical management includes using absorbent products and maintaining excellent skin care to prevent irritation and boost confidence for seniors with incontinence.

Understanding Bowel Incontinence in Seniors

Bowel, or fecal, incontinence is the inability to control bowel movements, leading to accidental stool leakage from the rectum. While not a normal part of aging, several age-related factors can contribute to its occurrence. These include weakened pelvic floor and anal sphincter muscles, chronic constipation or diarrhea, and nerve damage that can interfere with the signals between the rectum and brain. Other potential causes include certain medical conditions like diabetes or dementia, and physical injuries to the pelvic area.

The Role of Diet and Lifestyle Changes

Simple, conservative approaches are often the first line of defense and can significantly improve symptoms for many seniors.

Dietary Adjustments

Managing bowel function through diet is crucial, whether the issue is loose stools or constipation.

• Increase fiber intake: If constipation is the cause, increasing soluble fiber (like that found in oats, beans, and bananas) can bulk up the stool and make it easier to pass. Aim for 25-30 grams per day. If diarrhea is the issue, focusing on bulking fibers can also help solidify stool.
• Stay hydrated: Drinking plenty of water is essential for preventing constipation. It is recommended to drink at least eight glasses of water per day, unless otherwise advised by a doctor.
• Identify trigger foods: Keep a food diary to track what you eat and if it correlates with episodes of incontinence. Common triggers include caffeine, alcohol, artificial sweeteners, fatty foods, and dairy products (if lactose intolerant).
• Eat smaller, more frequent meals: This can help regulate bowel activity and prevent the gastrointestinal system from being overloaded, which can be a trigger for urgency.

Bowel Retraining Techniques

For seniors who have difficulty sensing the need to defecate, bowel retraining can be an effective way to establish a predictable schedule.

1. Scheduled toileting: Set a regular time each day, often after a meal, to sit on the toilet. A warm drink like tea or coffee can stimulate the bowels. Consistency is key to training the body.
2. Positioning: Encourage a squatting-like position on the toilet, which can be achieved with a footstool. This helps align the rectum for more complete emptying.
3. Use of suppositories or enemas: In some cases, a doctor might recommend the temporary use of suppositories or enemas to help establish a regular bowel pattern. This should only be done under medical supervision.

Exercises for Strengthening Pelvic Muscles

Weakened pelvic floor muscles can lead to reduced control. Targeted exercises can help strengthen these muscles and improve continence.

Kegel Exercises

These exercises are for strengthening the pelvic floor muscles. They can be performed discreetly while sitting or lying down.

• How to do them: Contract the muscles used to stop the flow of urine or hold back gas. Hold this contraction for a few seconds, then relax. Repeat 10-15 times, multiple times a day.
• Focus on proper form: Ensure that the abdominal and gluteal muscles are relaxed while performing the exercise, focusing only on the pelvic floor.

Biofeedback Therapy

For those who struggle with Kegel exercises, biofeedback offers a way to visualize and understand muscle activity. A trained therapist uses sensors to provide real-time feedback on muscle contraction strength, helping the individual learn how to effectively strengthen and control the correct muscles.

Medical Treatments and Advanced Options

When conservative methods are insufficient, a healthcare provider may suggest medical interventions. It is crucial to consult a doctor to determine the underlying cause and the most appropriate course of action.

Medications

• Anti-diarrheal medication: Over-the-counter options like loperamide (Imodium) can help control diarrhea, a common cause of bowel incontinence.
• Bulk laxatives: For incontinence caused by chronic constipation, bulk-forming laxatives or fiber supplements can make stools softer and more solid.

Advanced Procedures and Surgery

• Sacral Nerve Stimulation: A small, implantable device sends mild electrical pulses to the sacral nerves, which control the muscles of the bowel and rectum, to improve function.
• Bulking Agent Injections: Injections of material into the anal sphincter can help thicken the muscle, allowing it to close more tightly.
• Surgery: If incontinence is caused by structural damage, such as from a childbirth injury or rectal prolapse, surgical repair (sphincteroplasty) may be an option.

Practical Management and Caregiving

For seniors and caregivers, managing daily life with bowel incontinence involves practicality and dignity.

• Incontinence products: Absorbent pads or disposable underwear can provide peace of mind for daily activities, especially during the initial stages of treatment.
• Skin care: Maintaining clean and dry skin is vital to prevent irritation. Using barrier creams and gentle, fragrance-free wipes is recommended. For more expert information, visit the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website on the treatment of fecal incontinence.
• Be prepared: Always carry a small bag with cleaning supplies, extra clothing, and pads when leaving the house.

Comparison of Treatment Approaches

Treatment Method	Best for...	Pros	Cons
Dietary Changes	Mild cases or managing stool consistency.	Non-invasive, easy to start, can resolve many issues.	Requires consistent effort, may not work for severe cases.
Pelvic Floor Exercises	Muscle weakness.	Non-invasive, can be done anywhere, builds muscle strength.	Takes time to see results, may need biofeedback for proper form.
Medication (OTC)	Constipation or diarrhea-related issues.	Readily available, can provide quick relief.	Side effects like dependency or constipation are possible.
Medical Devices (SNS)	Nerve-related incontinence.	Highly effective for many, can be life-changing.	Invasive, requires surgery for implantation.
Surgical Repair	Structural damage to the sphincter.	Can be a permanent fix for specific causes.	Invasive, recovery time needed, potential for complications.

Conclusion

Bowel incontinence in the elderly is a manageable condition, not an inevitable outcome of aging. By starting with conservative and accessible strategies like dietary adjustments, regular bowel habits, and targeted exercises, many individuals can see significant improvement. When these measures are not enough, a range of effective medical treatments and advanced procedures are available. Consulting a healthcare professional is the first and most crucial step to getting an accurate diagnosis and creating a personalized treatment plan. With patience and the right approach, seniors can regain their confidence and improve their quality of life.

Frequently Asked Questions

Is bowel incontinence a normal part of aging?

No, bowel incontinence is not a normal or inevitable part of aging. While risk factors increase with age due to muscle and nerve changes, it is a medical condition that can often be treated and managed effectively.

What foods should be avoided if I have bowel incontinence?

Foods and drinks that commonly worsen bowel incontinence include caffeine, alcohol, artificial sweeteners, fatty or greasy foods, spicy dishes, and dairy products if you have lactose intolerance. Keeping a food diary can help you identify your specific triggers.

How can pelvic floor exercises help with bowel incontinence?

Pelvic floor exercises, or Kegels, help strengthen the muscles that control the anal sphincter and rectum. Stronger muscles improve your ability to hold in stool and resist sudden urges to defecate, thus enhancing bowel control.

What is biofeedback and how does it help?

Biofeedback is a therapy that uses special sensors to monitor and display your muscle activity. A trained therapist helps you use this feedback to learn how to properly contract and relax the pelvic floor muscles, improving your muscle control and sensation.

When should I consult a doctor about bowel incontinence?

You should consult a doctor if you experience any accidental bowel leakage, as it is a treatable condition. A doctor can accurately diagnose the cause and recommend the most effective treatment plan for your specific situation.

How can caregivers help manage bowel incontinence in seniors?

Caregivers can assist by helping with dietary changes, establishing and maintaining a regular toileting schedule, ensuring access to incontinence products, and providing compassionate support to protect the senior's dignity.

How do I prevent skin irritation from bowel incontinence?

To prevent skin irritation, clean the anal area gently with a mild, unscented cleanser or wipe after each bowel movement. Ensure the area is completely dry, then apply a protective barrier cream containing zinc oxide or lanolin.