What is bowel dysfunction?
Bowel disorders are very common
Constipation, faecal incontinence, and sometimes also a combination of both, is referred to as a bowel dysfunction or bowel disorder. Constipation is related to difficulties emptying the large bowel due to e.g. infrequent bowel movements or stool that is hard to pass.
People suffering from bowel incontinence (faecal incontinence) cannot control their bowel movements and stools (faeces or poo) leak from the rectum, because of some underlying condition.
Bowel incontinence
Bowel incontinence is the loss of bowel control. This can range from sometimes leaking a small amount of stool and passing gas, to not being able to control bowel movements. Some people with bowel incontinence feel the urge (urge faecal incontinence) to have bowel movements, but may not be able to control the passing of faeces before reaching a toilet. Other people do not feel the sensation of a pending bowel movement (passive faecal incontinence) and will pass stool or wind without knowing it.
Incontinence may be a problem if:
- There are sudden urges to pass stool and it is not possible to make it to the toilet in time
- Underwear is soiled without the realisation of needing the toilet
- Sometimes, when passing wind, stool is also unwillingly leaked
- One is afraid of leaving home without knowing where the next toilet is located
- The fear of “accidents” prevents one going out, if at all possible
Constipation
Constipation can seriously impair the quality of life of those affected: Symptoms of constipation can present as infrequent bowel movements, straining during bowel movements, a sensation of incomplete evacuation and the difficult passing of hard stool. This may cause other issues such as bleeding, haemorrhoids, or pain. Some people have more of the above symptoms, while others suffer from only one symptom.
Constipation is likely if:
- A stool occurs less than 3 times a week
- The stool is often difficult to push out
- The stool is often dry, hard, or lumpy (Type 1-2)
- It is accompanied by the feeling of incomplete emptying.
Bowel disorders are very common. Many people do not seek advice because they do not know where to go for help. They may also be afraid or ashamed to talk about their problems. Please keep in mind that you are not alone. If you are experiencing symptoms of a bowel disorder, make an appointment with your doctor or healthcare professional. They can help you, diagnose the cause of your symptoms and suggest treatment options.
What causes bowel dysfunction?
Bowel problems, whether constipation or faecal incontinence, are often just symptoms and not diseases in themselves. It is important to find the cause of a bowel function problem. For some, the cause is complex and has many contributing factors. For others, it may be related to certain conditions, such as age, results of childbirth or results of surgical intervention, or to diseases, such as neurological conditions.
For this reason, it is important to avoid self-diagnosis, but to enlist the support of a healthcare professional who can identify and treat any underlying causes.
An overview of the different causes and diseases relating to bowel dysfunctions can be found below:
Anorectal malformation
Children born with anorectal malformation (ARM) or Hirschsprung’s disease have a spectrum of anomalies of the rectum and anal canal. Even after undergoing surgical procedures, these children often still have problems controlling their bowel movements.
Neurological disorder
Neurological disorders can lead to symptoms of incontinence or constipation. Some of the neurogenic diseases listed below can cause bowel problems:
- Spinal cord injury
- Multiple sclerosis
- Spina bifida
- Parkinson’s disease
Following bowel surgery
After the treatment of rectal cancer (rectum resection), problems may occur. Someone struggling with frequent or fragmented bowel movement, urgency, and emptying difficulties, has some of the typical symptoms of “low anterior resection syndrome” (LARS). These symptoms can last for 3-9 months after surgery, but in some cases, they will stay up to 18 months or longer.
Childbirth
There may be difficulties in the control of bowel movements due to damage to the anal sphincters during childbirth, sometimes even after undergoing surgical repair.
A result of one or more childbirths can be a weak pelvic floor causing bulging of the front wall of the rectum into the back wall of the vagina (rectocele). A rectocele may cause problems in complete emptying of the rectum (incomplete evacuation), resulting in soiling episodes.
Lifestyle and age
Lifestyle can also influence bowel function. Lack of exercise can create a weak pelvic floor causing faecal incontinence. On the other hand, doing regular exercise has a positive effect on faecal incontinence as well as constipation.
Adequate intake of fluid and eating a balanced diet, including fibre, can increase control of the bowel.
As we age, the bowel function changes and the risk of constipation, as well as stool incontinence, increases. Bowel dysfunctions are very common in the geriatric population, and therefore many people wrongly consider it a normal part of aging. As a result, older people and their relatives are often reluctant to seek help.
How does bowel dysfunction affect your life?
Bowel dysfunction may impact quality of life.
Bowel problems are usually not life threatening. However, they can certainly affect your daily life.
Living with bowel problems can have considerable influence on your quality of life – both on your personal life and your hobbies, and it may also result in decreased ability to work. Many people with bowel dysfunction become isolated. They decline invitations and other social activities because they are afraid of uncontrolled bowel movements.
Hygienically
– Additional effort and costs for hygiene
– Need for special underwear
– Precautions regarding clothing choices
Psychologically
– Feelings of guilt / depression
– Loss of self-esteem
– Shame, embarrassment
– Fear of lack of control and smells
Physically
– Limiting physical activity
– Ceasing exercise
– No weekend walks or cycling
Professionally
– Absence in the workplace
– Reduced efficiency and flexibility
– Job loss
Sexually
– Avoiding sexual contact & intimacy
Mobility
– Planning according to the accessibility of toilets
– Staying home, no travelling or vacations
– Lack of flexibility in where or how to spend free time
Social
– Decreased social interactions
– Isolation
– Lack of acceptance from the outside world
– Problems in the family
It can be frustrating to live with an “invisible” illness that causes a great deal of discomfort and inconvenience, and which can be difficult for family or friends – and even your doctors or health care provider – to spot. Bowel problems are still a taboo for most. Therefore, some do not receive help to treat their condition.
Furthermore, bowel problems with bowel dysfunction are different for everyone, making it difficult to find effective treatments. One way to improve the quality of your life is by becoming an expert on your own symptoms. You should find a good health professional who can support and help you, and let your partner and other loved ones know about your situation.
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