Magazine article The Exceptional Parent

An Overview of Bowel Incontinence: What Can Go Wrong?

Magazine article The Exceptional Parent

An Overview of Bowel Incontinence: What Can Go Wrong?

Article excerpt

This article is Part 1 of a multi-part series that presents the most timely educational information, innovative approaches, product and technology solutions as well coping and stigma-fighting tools available on the subject of incontinence.

Bowel incontinence, also called fecal incontinence, is the loss of control over liquid or solid stools. It can occur at any age--as a child, teenager, or adult. Severity can range from infrequent leakage of a small amount of stool to total loss of bowel control. Some persons might feel the urge to have a bowel movement but be unable to control it before they can get to a bathroom. Others may lack sensation and experience leakage of stool without warning. It can be a source of frustration for the person with incontinence and for his or her family. A person's loss of bowel control, or concern that it will happen, can cause feelings of unease around friends or at work or school. He or she may withdraw and miss out on opportunities.

In contrast to incontinence, continence is the ability to control bowel movements. The process of maintaining continence is complex. It involves functions, both under conscious (voluntary) and automatic (involuntary) control.

Maintaining Continence

Continence depends on properly functioning muscles and nerves in and around the rectum and anal canal. This makes possible the orderly movement of waste material (feces or stool). The stool moves through the large bowel (colon), rectum, and anus. Muscles and nerves act together to propel waste contents and sense its presence. They also interact to permit voluntary storage and elimination.

The sigmoid colon is at the lower part of the bowel. It helps to slow the passage of stool before it moves into the rectum. The rectum is more elastic than the rest of the bowel. This allows it to stretch to store fecal material. When stool moves into the rectum, nerves detect expansion and signal the sensation that it is time to have a bowel movement.

Below the rectum, between the hip bones, is the area known as the pelvic floor. This area is made up of many different muscles. These muscles support the organ systems within the pelvis and lower abdomen. They also are necessary to maintain continence. Some of these muscles are under conscious control (the pub-orectalis and the external anal sphincter). Contracting them prevents leakage of stool when fullness is felt in the rectum. The internal anal sphincter is an involuntary muscle. It automatically helps to prevent leakage from the rectum. When it's time to have a bowel movement, all these muscles must relax so the stool can pass through the anus.

Most children in the U.S. become toilet trained between the ages of two and three years. It is an important developmental milestone. Children with learning delays often need more time to achieve continence. Yet in many instances, continence still is an achievable goal.

While for some children toilet training is delayed, other obstacles can make continence a challenging goal. Physical problems, nerve damage, and stool retention and constipation all can result in incontinence. The most common of these problems is stool retention and constipation. Most constipation in children has a functional cause. That means that the symptoms are real, but there is no sign of injury, infection, or physical abnormality.

Incontinence Causes

Bowel incontinence occurs when something is wrong within the complex mechanisms of the body that maintain bowel function and continence. It can result from a variety of factors. There may be functional impairment or structural damage to certain muscles or nerves. It can occur both in persons with a normal and an abnormal pelvic floor. Bowel incontinence is rarely due to a single factor.

In those with a normal pelvic floor, common causes include diarrhea, disorders of the nervous system, or constipation. Diarrhea causes incontinence when bowel control is overwhelmed by a sudden or urgent need to pass loose stool. …

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