Treatment options for bowel incontinence 

Treatment
Pros
Cons

Lifestyle changes and exercises

Dietary changes

Changing your diet may help control symptoms of diarrhoea or constipation associated with bowel incontinence

  • Often a simple way to reduce symptoms
  • May be able to treat bowel incontinence associated with both constipation and diarrhoea
  • May not be possible to avoid certain foods
  • Some diets may not be suitable for certain people, such as a high-fibre diet for constipation
  • Not effective for bowel incontinence associated with muscle or nerve damage
Pelvic floor muscle exercises

A type of exercise programme used to treat bowel incontinence after childbirth

  • Effective at treating incontinence associated with childbirth
  • Free and simple to do
  • May provide treatment without the need for surgery or medication
  • It is possible to do them whilst going about your everyday business
  • Must be done several times daily, and for years afterwards
  • May take up to 15 weeks to make a difference
  • Is not suitable for treating all types of incontinence
Biofeedback

An aid to pelvic floor muscle exercises that uses a small sensor placed in the bottom to tell if the right muscles are being exercised

  • May help increase the effectiveness of pelvic floor muscle exercises
  • May help provide treatment without the need for surgery or medication
  • Some people may find the procedure uncomfortable or embarrassing
  • Is not suitable for treating all types of incontinence
Bowel retraining

A type of treatment which aims to establish a regular time for emptying the bowels for people who have nerve damage in their rectum, or recurring constipation

  • Free and simple to do
  • May provide treatment without the need for surgery or medication
  • Requires commitment to regular times of day in order to be effective
  • May take some time before it makes a noticeable difference
  • Is not suitable for treating all types of incontinence

Continence products

Disposable body pad

Contoured pads that are placed inside underwear to soak up liquid stools or fitted pads used for heavy bowel incontinence

  • Available for free on the NHS
  • Available in pharmacies and some supermarkets
  • Effective in absorbing stool leakage
  • Disposable
  • Can be used for mild, moderate and heavy incontinence
  • Need for regular replacement
  • Larger pads are needed for heavy bowel incontinence which some people may find embarrassing or uncomfortable
  • May not provide a long-term solution
Anal plug

Made of foam and designed to be inserted into your bottom for up to 12 hours to prevent episodes of soiling

  • Available for free on the NHS
  • Effective in preventing stool leakage
  • Disposable
  • Need for daily replacement
  • May slip out during use
  • May cause discomfort
  • Some people may find them embarrassing to use
  • May not provide a long-term solution

Medication

Medication for diarrhoea

Loperamide hydrochloride is a medication widely used to treat diarrhoea which slows down the movement of stools through the digestive system, allowing more water to be absorbed from the stools

  • Can be prescribed in low doses to be taken regularly over a long period of time
  • Available on prescription from a GP
  • Effective in treating diarrhoea
  • Cannot be taken during pregnancy
  • May not be usable when breast-feeding
  • May not be suitable for someone with irritable bowel syndrome or liver problems
Medication for constipation

Laxatives are used to treat constipation - Bulk-forming laxatives are usually recommended, which help your stools to retain fluid and make them easier to pass

  • Most people can use laxatives
  • Effective in treating constipation
  • Available on prescription or from pharmacies and some supermarkets
  • Not suitable for long-term treatment
  • Possible side effects, such as bloating, flatulence and abdominal pain
  • May not be usable when pregnant or breast-feeding
  • May not be suitable for someone with irritable bowel syndrome or liver problems

Invasive procedures and surgery

Enemas

A small tube is placed in the anus and a special solution is used to wash out dried, hard stools which have collected in the rectum and anus (faecal impaction)

  • Effective at treating faecal impaction
  • Some people may find this procedure embarrassing or uncomfortable
  • Only useful for treating specific types of bowel incontinence
Endoscopic heat therapy

Heat is applied to the muscles that control the rectum (sphincter muscles) through a thin probe in order to scar the tissue and tighten the muscles

  • Less invasive than other types of surgery
  • Some evidence to show that it can be effective in treating bowel incontinence
  • Fairly new procedure with limited testing
  • Limited availability
  • Potential side effects include discomfort, bleeding and damage to the anus
Sphincteroplasty

An operation to repair damaged sphincter muscles that are causing bowel incontinence by removing some muscle tissue and overlapping the remaining tissue to provide extra support to the muscles.

  • Shown in some studies to be an effective treatment for bowel incontinence
  • Some evidence shows that symptoms may gradually return over the long-term
  • May need to take part in biofeedback training
  • May have to have repeat surgery if symptoms return
Injectable bulking agents

Bulking agents, such as collagen or silicone, are injected into the sphincter muscles to provide extra strength

  • Shown in some studies to be an effective treatment for bowel incontinence
  • Chance of pain or infection at injection site
  • Chance of the bulking agents leaking
  • Long-term results are not fully known yet
Stimulated graciloplasty

The sphincter muscles are removed and then replaced with muscles taken from the thigh - a pulse generator is placed into the abdomen, which releases an electrical current to make the replacement muscles act like a natural sphincter

  • Shown in some studies to be an effective treatment for bowel incontinence
  • Chance of an infection developing which needs further surgery
  • Chance of electrical or technical problems with the pulse generator
Artificial sphincter

A cuff is inserted under the skin around the anus - fluid is pumped in and out of the cuff to control the opening and closing of the anus.

  • Shown in some studies to be an effective treatment for bowel incontinence
  • Chance of infection and injury during surgery
  • Chance of the cuff becoming dislodged which requires further surgery to correct it or remove it
  • Lack of good-quality evidence about long-term effectiveness
Sacral nerve stimulation

Electrodes are inserted into the lower back and connected to a pulse generator which releases pulses of electricity and contracts the sphincter so stools cannot pass through - a magnet is used to interrupt the pulse in order to open the sphincter

  • Shown in some studies to be an effective treatment for bowel incontinence
  • Some evidence to show it allows greater control over opening bowels
  • May feel some pain after this surgery
  • Chance of an infection developing which needs further surgery
  • Chance of electrical or technical problems with the pulse generator
Tibial nerve stimulation

A fine needle is inserted into the tibial nerve just above the ankle and an electrode is placed on the foot - a mild electric current is passed through the needle to stimulate the nerves which control bowel function

  • Shown in some studies to offer a reduction of symptoms
  • Can be repeated if necessary
  • Chance of symptoms returning in the long-term
  • Chance of side effects from the procedure such as stomach ache, numbness and inflammation
Colostomy

The colon is cut and brought through the wall of the stomach so stools can be passed into a colostomy bag attached to the opening - this is only recommended when other surgical options are unsuccessful

  • May lead to a better quality of life for those with severe bowel incontinence
  • May lead to diet restrictions
  • Need to change bag regularly
  • Some people may find it distressing to have a colostomy
  • Potential complications of a colostomy such as a discharge of mucus from the rectum (rectal discharge) or the intestines pushing through the weakened abdominal muscles (parastomal hernia)