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Health & Medicine for Senior Citizens

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

Nov. 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 aging.

“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

• Passing stool during normal activities

• Passing stool before reaching the toilet


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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.”

• Anorectal 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 infection.)”

• Sigmoidoscopy. “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 effective.”

Says Hayden, treatment for fecal incontinence includes:

• 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.”

• Medication. “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.”

• Exercise. “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.”

• Injectable 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.”

More About Incontinence

Fecal Incontinence

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 this condition.


Urinary Incontinence

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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