Do You Poop Your Pants? Should be Asked Older
Patients by All Physicians
Bowel leakage affects 1 in 5 women over 40, yet few
seek help for this fixable medical problem
22, 2013 - “Do you poop your pants?” is a question few physicians ask
their adult patients, but one that Dana Hayden, MD, colorectal surgeon
at Loyola University Health System, believes should be at the top of the
list. She points out that 15 million women ages 40 and older (1 in 5)
suffer from accidental bowel leakage, which is not a part of normal
“It is a medical condition and there is treatment
available,” says Hayden. “People with this condition become inhibited,
stop socializing and do not even complete everyday routines such as
grocery shopping or going to church because they fear an accident.”
Loyola is one of the first medical institutions to
offer a new outpatient procedure for fecal incontinence that often
results in immediate improvement. In the new procedure, a gel is given
through four injections into the wall of the anal canal.
“The gel is a natural substance that helps bulk up
the muscle area around the anus to prevent leakage,” says Hayden.
“Treatment takes about 10 minutes to complete and patients are able to
go home without any negative side effects other than mild soreness.”
The injections do not usually cause pain and
anesthesia is not necessary.
Characteristics of fecal incontinence include:
• The inability to hold in gas
• Passing stool (waste matter from the bowels) while passing gas
There are many reasons for fecal incontinence, says
Hayden.. “Poor diet, frequent diarrhea or constipation, weakening of
anal sphincter muscles and damage to the rectum or surrounding nerves,”
says Hayden. “Women during childbirth often experience muscle or rectal
wall damage, and it can also be caused by surgery or injury.”
Tests to diagnose fecal incontinence may include:
• Manometry. “This
is a test that checks the tightness of your anal muscles,” says Hayden.
“ They may be too weak to function.”
ultrasound. “This test checks the structure of your muscles. There
may be something wrong, causing them not to work.”
• Stool tests.
“These tests check to see if there’s a reason for diarrhea (such as
“A camera fitted into a thin tube is used to see if there are problems
such as tumors, inflammation, or scar tissue in the rectum or colon.”
• DRE (digital rectal
exam). “This physical exam is used to identify patients with fecal
impaction and overflow.”
Rather than relying on expensive and often faulty
paper pads and sanitary products as a temporary fix, Dr. Hayden strongly
encourages patients with fecal incontinence to talk with their
physician. “As a specialist, I often partner with the patient and their
primary care physician on care through a variety of treatments,” she
says. “The new injection is not surgical, is an outpatient procedure,
does not rely on medication, has few side effects and is highly
Says Hayden, treatment for fecal incontinence
• Dietary changes.
“Adding fiber to your diet can add bulk and make it easier to control
your stools if they are watery. Sometimes avoiding certain foods like
coffee, tea, or chocolate can help as well.”
“Some medicines help you make bowel movements on a regular basis. These
are called laxatives. Other medicines slow down the movement of stool
through the bowel.”
• Bowel training.
“These are exercises that help you relearn how to control bowel
movements. One kind of bowel training is called biofeedback.”
“Strengthening exercises (called Kegel exercises or pelvic floor
exercises) can help control fecal leakage. They involve contracting the
muscles of the anus, buttocks, and pelvis, and then holding as hard as
possible for 5 seconds, and then relaxing. A series of 30 of these
exercises should be done three times a day.”
tissue-bulking agent. “Materials are injected to improve the bulk
and thickness of the anal walls.”
• Surgery. These
procedures include sphincteroplasty, colostomy, sphincter replacement
and sacral nerve stimulation. “Many of these procedures involve the
repair or replacement of a part of your anus or sphincter. With sacral
nerve stimulation, a transmitting device is implanted under the skin of
the upper-buttock area to send electrical impulses to the nerves that
control the sphincter.”
Talking with a physician and acknowledging the
problem is the first step. “Help is here and you do not have to live
with incontinence,” says Hayden. “It is critical that everyone
understands that normal aging does not include loss of bowel control.”
Fecal incontinence happens when you cannot control your bowels long
enough to get to a bathroom. Healthcare professionals will diagnose
adults with fecal incontinence if this happens more than once for at
least a month. Between 2% and 7% of adults have fecal incontinence. Most
of these persons are older adults in poor health.
Fecal incontinence can be very upsetting and inconvenient, but you
should not let being embarrassed by it stop you from getting help from
your healthcare provider. There are a wide variety of treatments for
If you have urinary incontinence, you have trouble controlling your
bladder and leak urine. You may have to urinate so suddenly and
forcefully that you’re unable to make it to the toilet on time. Or you
may leak urine when you cough or sneeze, or “dribble” urine.
Urinary incontinence (UI) is increasingly common as people grow older,
but it is not a normal part of aging. It is not something older adults
should think they just have to “put up with.” It is treatable.
Untreated urinary incontinence can lessen the quality of your life, and
also lead to other complications like infections and falls. Treatment
can improve it. If you have urinary incontinence, don’t feel
embarrassed to talk with your healthcare professional about it. He or
she can help manage this condition.
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