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.

The Bristol Stool Scale is a way to talk about shapes and types of stool.

Stool consistency plays an important role in connection with bowel dysfunction.

Every person will have different bowel habits, but the important thing is that your stools are soft and easy to pass – like types 3 and 4.
Type 1 and 2 stools are hard. They can be difficult to pass and indicate constipation.
Type 5, 6 and 7 stools are soft to liquid and hard to retain. This make it difficult for the persons with faecal incontinence to remain continent.

If you can describe your stool consistency with help of the Bristol Stool Scale, it is easier for your doctor or healthcare professional to help you.¹⁺²

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 realization 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 possible³

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 emptying⁴

Bowel disorders are very common. Still, 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.

References

¹Bowel Dysfunction A Comprehensive Guide for Healthcare Professionals, Chapter 6 and 7 by Brigitte Collins and Elissa Bradshaw, Springer International Publishing Switzerland 2016

²Heaton, K W & Lewis, S J 1997, ‘Stool form scale as a useful guide to intestinal transit time’. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 – 924. Retrieved on 2/3/2007.

³NICE Guidance. https://www.nice.org.uk/guidance/cg49/resources/faecal-incontinence-in-adults-management-pdf-975455422405

⁴Based on the Rome IV criteria for constipation