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Date issued: August 2022

For review: August 2024 

Ref: A-327/surgery/AC/loss of bowel motions in adults v3

PDF:  Loss of bowel motions in adults final April 2020 v2.pdf[pdf] 521KB

What causes faecal incontinence?

There are many different possible causes of loss of bowel control, resulting in bowel leakage (faecal incontinence). Faecal incontinence is the inability to control the passing of wind or poo (stools, faeces) through the anus (back passage). Some people find this has a significant effect on their quality of life. It can also affect their confidence and psychological well-being. However it is a common condition affecting 10-15% of people in the UK and can be treated.

Some of the most common reasons are:

Some common reasons

Reason	This can be caused by
Damage / weakness to the anal sphincter muscles	Childbirth Operations Injury Rectal Prolapse
Diarrhoea / loose stools	Infection Inflammatory bowel disease Irritable bowel syndrome Surgery to the bowel
Constipation with overflow	Immobility (not being able to move around, lack of exercise) Illness and/or long term health conditions Diet Certain medications Some neurological conditions / injuries i.e., MS, Parkinsons
Nerve injury	Spinal injury Multiple Sclerosis Stroke
Pelvic Floor Dysfunction. Inability to correctly relax and co-ordinate pelvic floor muscles.	Can relate to pressure on the pelvic floor from pregnancy and vaginal childbirth. Overusing the pelvic floor muscles. Pelvic surgery. Overweight. Getting older. Injury to the sphincter muscle.
Prolapse	Pregnancy. Difficult labour and delivery or trauma during childbirth. Delivery of a large baby. Being overweight or obese. Menopause. Chronic constipation or straining with bowel movements. Chronic cough or bronchitis. Repeated heavy lifting.
Surgery / Treatment. Anterior resection syndrome. Sphincter Surgery / Radiotherapy	Bowel surgery with some removal of the rectum for cancer.

One of the most common causes of faecal incontinence is damage to one or both of the sphincter muscles (external or internal muscles) or pelvic floor weakness.

The external anal sphincter muscle, is a circle of muscle which surrounds the opening to your bowel. It is responsible for delaying bowel emptying once your rectum fills and you feel the urge to empty your bowel. This muscle may become weak, or may even have a tear inside where it cannot be seen.

If you have a weak or damaged external anal sphincter muscle you are likely to experience ‘urgency’. This means that you may feel that you have to empty your bowel as soon as you feel the sensation of something in your rectum. It can also mean that, if you don’t reach the toilet in time, you may experience urge faecal incontinence (accidental loss of poo on the way to the toilet). This is because the weak or damaged muscle cannot squeeze hard enough to stop the poo coming out. The symptom of urgency can also occur for other reasons, so your Consultant / Nurse / Physio will look at your overall symptoms.

The internal anal sphincter is on the inside of your anus. It is the muscle that we have no control over. If you have a damaged internal anal sphincter muscle you are likely to have passive incontinence. This is when soft poo or small pellets of poo just leak out without you realising. This may be either after you have emptied your bowels (often lasting an hour or two following each bowel action) or when you are carrying out a physical task (such as walking, bending or exercise). You may find you have great difficulty in wiping clean after bowel emptying and many people find that however much toilet paper is used for wiping, it still comes away with poo on it.

If you have damage to both sphincters this may lead to leakage without being aware of it as well as urgency and urge incontinence.

Pelvic floor dyscoordination / weakness can be improved with intensive physiotherapy. It can mean needing to be reviewed every couple of weeks and there will be an expectation that you do the exercises as recommended by the physio. Like any muscle in the body, you need to perform your exercises in order to see an improvement.

A normal poo is brown in colour, although this can vary depending on the foods you have eaten. Normal frequency is between 3 times a day and 3 times a week, but most people open their bowels once a day.

Normal consistency of poo should be soft and formed (Bristol Stool Chart type 3-4) 

Emptying the bowel

The colon or large bowel absorbs water and fluid from the waste matter and forms it into poo (also called faeces, stools or bowel motions).

Poo do not enter the rectum from the colon on a continuous basis, but as a result of ‘mass movements’. ‘Mass movements’ often occur after a meal is eaten, which can then lead to a need to open your bowels.

When poo enters the rectum the internal anal sphincter muscle automatically relaxes and opens the top of the anal canal. This allows the sensitive nerves at the top of the anal canal to detect whether it is wind, diarrhoea (watery poo) or a normal poo.

Around the internal sphincter is the external sphincter, which can be deliberately squeezed to delay bowel emptying if it is not convenient to find a toilet. Squeezing the external sphincter pushes the poo out of the anal canal and back into the rectum, where the poo is stored until a convenient time. 

Treatment

Diet can obviously make a difference to bowel control by altering the consistency of the poo. The following are general rules but everyone reacts slightly differently so good results can be achieved with trial and error.

You may find it helpful to keep a diary of your eating and bowel habits (example of page 34).

Food / Drinks which may exacerbate faecal incontinence in people with loose or soft stools.

Food and drinks

Food Type	Examples / rationales
Fibre	Fibre supplements, wholegrain cereals/bread. Porridge / oats may cause fewer problems than whole wheat-based cereals
Fruit & vegetables	Rhubarb, figs, prunes and plums are best avoided as they contain natural laxative compounds. Beans, pulses, cabbage and sprouts.
Spices	For example, chilli or curry
Artificial Sweeteners	May be found in special diabetic products such as chocolate, biscuits, conserves and in some sugar free items such as nicotine replacement gums
Alcohol	Especially stout, beers, cider and ales
Lactose	While small amounts of milk (for example in tea or yoghurt) are often tolerated, an increase in the consumption of milk may cause diarrhoea. For more information on lactose intolerance see https://www.nhs.uk/conditions/lactose-intolerance/
Caffeine	Excessive intake of caffeine may loosen stool and thus increase faecal incontinence. Limit tea & coffee to 2-3 cups a day.
Fizzy Drinks	Can cause more wind
Vitamin and mineral supplements	Excessive doses of vitamin C, magnesium, phosphorus and /or calcium supplements may increase faecal incontinence
Olestra fat substitute	Can cause loose stools

Dietary fibre or roughage is the indigestible portion of food derived from plants.

There are 2 main components:

Insoluble fibre which does not dissolve in water. Insoluble fibres tend to accelerate the movement of food through the system. The body can’t digest this fibre so it passes through the bowel, helping other food and waste products move through the bowel more easily. Wholegrain bread and breakfast cereals, brown rice and pasta are good examples.

Soluble fibre which dissolves in water. Soluble fibre tends to slow the movement of food through the system. Oats and pulses are a good example. This means that a low fibre diet will reduce the amount of undigested material that passes through the bowel.

Sources of insoluble fibre include:

• Whole grain foods

• Wheat and corn bran

• Legumes such as beans and peas

• Nuts and seeds

• Potato skins

• Vegetables such as green beans, cauliflower, courgette, celery

• Some fruits including avocado and unripe bananas

• The skins of some fruits, including kiwi, grapes and tomatoes.

Soluble fibre is found in varying quantities in all plant foods, including:

• Legumes (peas, soybeans and other beans)

• Oats, rye, chia and barley

• Some fruits (including avocados, plums, prunes, berries, ripe bananas and the skins of apples, pears)

• Certain vegetables such as broccoli, carrots and Jerusalem artichokes

• Root tubers and root vegetables such as sweet potatoes and onions (skins of these are sources of insoluble fibre also)

• Psyllium seed husks and flax seeds, nuts, almonds being the highest in dietary fibre

• Fibre supplements such as Fybogel®

Balancing the amounts of each type of fibre and increasing soluble fibre over insoluble may result in a firmer stool and less urgency.

Low fibre and low residue diets

Low fibre and low residue diets

You can eat

You should avoid

White bread and pasta Refined cereals, rice krispies® Ready Brek® White rice Milk, smooth yoghurt, ice cream Rice pudding, semolina, tapioca Soups and sauces strained, clear soups and stocks Cheese Tender, lean meat, poultry, fish Eggs Oil, margarine, butter and mayonnaise Fruit juices (except prune juice) Vegetable juices Smooth peanut butter, up to 2 tablespoons a day Fats, oils, dressings without seeds Desserts with no seeds or nuts Smooth jam, honey, marmite Raw avocado, lettuce, cucumber and courgettes with no skin or seeds Vegetables well cooked and with no skin or seeds - Carrots, tomatoes, potatoes, asparagus tips, pureed spinach, aubergine, green beans

Wholegrain bread and pasta Brown or wild rice Wholegrain cereals – porridge, muesli, Weetabix®, bran flakes Yoghurt, pudding and ice cream with nuts or pieces of fruit Soups with pieces of vegetable Tough or course meat with gristle Fatty foods Chunky peanut butter Coconut Marmalade with shreds Dried fruits Dried beans or peas (pulses) Baked beans Seeds and nuts Popcorn Pickles Horseradish Broccoli, cauliflower, Brussel sprouts, cabbage, peas, squashes, pulses and legumes, sweetcorn. Pineapple, figs, berries, coconut, dried fruit, prunes.

After 6 weeks you can gradually start to introduce small amounts of soluble fibre foods back into the diet, ensuring that you are drinking plenty of fluids as you do so. You may wish to start with peeled apples, pears and oats.

Wind

Most wind is due to the production of gases from the bacteria that live in the large bowel and break down of undigested food. Some is due to what is swallowed while eating or talking. It is normal to produce some each day and the amount varies from person to person, depending on the diet and type of bacteria that live in the bowel. Some people pass small amounts of wind often, whereas other’s pass larger amounts less often. If the anal sphincter muscles are weak or damaged, there may be problems controlling wind from the back passage.

If you pass wind more often than the usual range of 7-25 times per day, it may simply mean that you are consuming food or drink that disagrees with you, even though someone else eating the same food has no problem.

Some habits that can lead to increased wind include talking while eating; drinking from a water bottle or fountain; sipping hot drinks; sighing deeply; smoking and chewing gum.

Foods that cause flatus/wind

Cabbage family vegetables (cabbage, Brussel sprouts, broccoli and cauliflower).

Onions                 Spinach               Beans               Corn                Radishes              cucumber

Nuts                    fizzy drinks           Beer

Dairy products     Chewing gum      Pickles          

Spicy foods

Products which some people find helpful for wind

People’s response to these are very individual. Some people find that one or more of the following products reduce wind or reduces the smell from wind:

     Peppermint oil

     Pepto-bismal

     Rennies® and other over the counter indigestion  remedies

     Charcoal tablets

     Mint tea

    Cardamom seeds (chewed)

    Aloe Vera capsules or juice

    Probiotic drink (ie Yacult®, Actimel®)

    Acidophilus (from health food shops)

• Eat and drink slowly, taking time to chew food

• Eat at regular intervals and don’t eat on the move or skip meals

• Drink water, little and often

• Avoid ‘windy’ foods

• Take regular exercise

• Stop smoking

• Don’t expect to get back to normal overnight, it will take time.

The low FODMAP diet

(FODMAP = Fermentable Oligo-Di-Monosaccharides and Polyols)

FODMAPs are carbohydrates (sugars) that are found in foods. Not all carbohydrates are considered FODMAPs.

The FODMAPs that occur in the diet are:

• Fructose (fruits, honey etc)

• Lactose (diary)

• Fructans (wheat, onion, garlic etc)

• Galactans (beans, lentils, legumes such as soy etc)

• Polyols (sweeteners containing sorbitol, mannitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums etc)

FODMAPs are osmotic which means they pull water into the intestinal tract. They may not be digested or absorbed well and can be fermented by bacteria that naturally occur in the intestinal tract when eaten in excess. This causes symptoms of gas, bloating, cramping and diarrhoea. Some people are more sensitive to these effects than others. In these people a low FODMAP diet may help to reduce symptoms.

The Low FODMAP diet was developed for people with irritable bowel syndrome (IBS). If following this diet is suggested, you will be referred to a dietitian for support and guidance as it can be a long and slow process following a low FODMAP diet and then reintroducing foods one by one. In some people a low FODMAP diet may help to reduce symptoms.

Probiotics

Some people find that by taking probiotics it can improve their symptoms of loose stools and flatulence. This can be in the form of live yoghurt drinks such as Yakult® and Actimel® that are available from supermarkets. VSL#3 is available on prescription and may reduce unwanted symptoms. They need to be taken for at least a month to achieve maximum effect.

Psychological support

How your mood can cause diarrhoea

When you get stressed, anxious or nervous, your body produces adrenaline and other chemicals, which speed up the function of your nervous system. This can make some of your muscles work too fast. If the muscles in your intestines speed up, the natural rhythm of your digestion will speed up too.

Faster digestion means your intestines absorb less fluid, making your poo more frequent and watery - what we know as diarrhoea. Just a small reduction in the fluid you absorb can be enough to bring on a bout of diarrhoea.

If you recognise that anxiety, depression or a mental health issue is a concern for you, then you may wish to refer to the following individuals / organisations for support.

• Your GP to discuss the options available.

• Consider Mindfullness techniques such as yoga, medication, tai-chi. There are numerous mindfull apps available.

• See whether your employer has an Occupational Health team and Well-Being team, do they offer any individual support or group activities.

• Become a Healthier You, advice for eating, managing stress and eating well. They also offer a free NHS Health check. One You Plymouth

• 1:1 counselling organised privately 

Mindfullness Apps

Pelvic Floor Exercise

The pelvic floor is a sling of muscles that extend from yoru tail bone (coccyx) to the pubic bone at the front, forming a ‘platform’ between your legs. They support the bladder, bowel and uterus (in women). The pelvic floor muscles help to control when you pass urine and open your bowels. Having strong, effective pelvic floor muscles can improve or stop and leakage from your bowels.

Locating the muscles

1. Sit comfortably with your knees slightly apart. Now imagine that you are trying to stop passing wind from the back passage. You must squeeze these muscles as tightly as possible to feel the muscles move. Now let these muscles go.

2. Ladies only, tighten the back passage, close around the vaginal exit and lift the muscles at the front, as if you are stopping the flow of urine (water) or squeezing tight inside your vagina.

3. Imagine you are sat on the toilet and passing urine. Picture yourself trying to stop the stream of urine mid flow and then try restarting it. Do not try to stop the stream when actually passing water as this may, if repeated, cause problems with correct emptying.

4. Now hold for a few seconds and be aware of these muscles as they relax.

When locating these muscles, try not to:

• Squeeze your buttocks together

• Bring your knees together

• Cross your legs

• Hold your breath

• Lift your eyebrows, shoulders, toes upwards. If you do any of these, you are not tightening the pelvic floor muscles correctly.

To check you are tightening the correct muscles:

For Men: Place your fingertips against the skin just behind the scrotum; when you perform this exercise you will feel the muscles tighten and lift away your fingers, your scrotum should lift slightly and the base of the penis should move towards your abdomen.

For Women: Insert 1 or 2 fingers into your vagina, when you perform this exercise you will feel the muscles tighten around your finger.

There are 2 types of exercise, slow pull-ups and fast pull-ups.

Slow Pull-Ups

1. Tighten and draw up the muscles around the back passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles when you are doing this.

2.  Tighten and draw up the muscles at the front, as if you are trying to stop the flow of urine.

3. Hold for a count of 10. Try not to hold your breath, breathe normally.

4. Then slowly relax and let go.

5. Repeat 5 times in total.

Fast Pull-Ups

1. Tighten up the pelvic floor muscles as before

2. Hold for 1 second then relax

3. Repeat 5 times or until your muscles feel tired.

Build up doing 5 slow and 5 fast pull-up exercises 5 times a day. The pelvic floor muscles tire easily and you may notice that it takes a lot of concentration to begin with to do these exercises correctly. When you start, you may not be able to hold for the full 10 seconds, hold for as long as you can and try to increase the time holding as your muscles get stronger, this will show your progress.

Pilates is an exercise that improves flexibility and strengthens muscle tone, it may help to improve pelvic floor strength when used with pelvic floor exercises.

There are also pelvic floor stimulator machines available to buy from pharmacies and online. Your specialist physiotherapist will be able to give you further information on this.

If you have had this problem for some years, it is unlikely that it will be solved overnight, so keep trying. These exercises take time and practice and usually up to 6 months commitment.

NHS Squeezy App

Bowel habit training

For people experiencing urgency it can be helpful to try a progressive programme of urge resistance. This consists of waiting slightly longer each time you have the urge to have your bowels open. To start with this can be done by sitting in the bathroom but resisting the urge for minutes. The length of time for resisting can slowly be increased until a reasonable time can be achieved and so reduce the urgency feeling. This training can be coupled with Pelvic Floor exercise as contraction of the muscles will help to reduce the urge.

Physical Activity

Many people notice that leakage is made worse by heavy lifting, squatting and strenuous physical activity. If possible these activities should be avoided wherever possible, especially when bowel motions are particularly soft. If they can’t be avoided, it is best to do them in the morning when pelvic floor muscles are generally stronger.

It is important to remain active and everyone should try to do some gentle exercise such as walking for at least 30 minutes most days of the week. Daily exercise helps to promote regular bowel activity and benefits overall health.

EVB Sports shorts: These are available via the internet and are designed to help support pelvic floor especially during exercise. They are a triple layer moisture wicking material and have a feature designed to hold a pad if required. They also provide support for the lower back and abdominal muscles particularly after stretching during pregnancy and childbirth.

https://evbsport.com/products/shorts

Bowel emptying

For individuals with control issues, it is ideal for them to be able to predict when they have their bowel action so that they have the confidence to continue with their normal day to day life. As bowels are unpredictable it may be helpful to initiate a bowel action by using suppositories, enemas or washouts, thus emptying the bowel and so avoiding accidents later in the day.

Glycerine suppositories

Glycerine suppositories are used to empty the back passage of poo. As they are very efficient in emptying the back passage they can be used in the treatment of faecal leakage. This is effective because when the back passage is empty, there is nothing there to leak out and so cause an accident.

When used for people with leakage problems this emptying of the lower bowel prevents leakage of poo for the rest of the day and so helps with confidence. They can be used with Loperamide in this situation as the Loperamide slows the bowel movement down and the suppositories help in emptying the back passage completely.

They should be inserted into the back passage and retained for 10 minutes; they will then produce a bowel action. They can be used on a daily basis or when required and are available on prescription or over the counter.

Microlax Enemas

Microlax enemas are used to empty the back passage of poo which can help in the management of faecal leakage. This is effective because when the back passage is empty there is nothing to leak out and so cause an accident. They can also be used to treat symptoms of a rectocoele, which is a bulge in the wall of the rectum into the vagina.

When used for people with leakage problems this emptying of the lower bowel prevents leakage of stool for the rest of the day and so helps with confidence. They can be used with Loperamide in this situation as the Loperamide slows the bowel movement down and the enema helps in emptying the back passage completely.

Medication

The rectum is designed to hold solid/formed poo; watery stools are more likely to leak and cause faecal incontinence. Loperamide (Imodium®) is an anti-diarrhoeal medication. It is a safe drug to take and does not inter-react with other medication and is safe to take long term to help control symptoms. It is designed to thicken the poo and reduce diarrhoea.

Loperamide comes as capsules or liquid and works by slowing the passage of food through the colon, allowing more water to be absorbed and creating a formed poo. Different people need varying doses to achieve a formed poo, so please follow the advice given to you with the aim of achieving a Bristol Stool type 3-4, but to avoid becoming constipated. It is usual to start on a low dose and increase slowly over several days to judge how your body is responding. Most people take Loperamide on a daily basis but it is equally as useful taken when required if your poo is loose, or 30mins before going out.

Loperamide can be used with glycerine suppositories to help prevent leakage of poo. The Loperamide makes the stool firmer and the glycerine suppositories empty out the back passage so that there is no stool present to cause leakage. Most people need to use the Loperamide and suppositories daily to achieve this. Experimentation with dosage and timing can lead to more controlled bowel actions.

Fybogel® and Normacol® are bulking agents which can be useful to try and bulk up loose poo, particularly if you are having frequency of small amounts of poo. We may use this in conjunction with Loperamide.

You will be advised by your Medical team if you are prescribed medication or your pharmacist will be able to advise you further.

Anal inserts

There are several different types of anal inserts. They are made of a soft silicone or foam. They work better with a formed stool and may not work for those with very loose stools or urgency. There are 2 sizes available to ensure the best fit. They are available on prescription but should only be used following medical advice.

Renew Anal Inserts -

https://renew-medical.uk/

Coloplast Anal Insert

https://products.coloplast.co.uk/coloplast/continence-care/peristeen/peristeen-anal-plug/

Rectal irrigation

Your nurse specialist may suggest rectal irrigation as a treatment option. It is a method of emptying the back passage and lower bowel, using warm water. It is done while sitting on the toilet and can help with bowel leakage as it empties the bowel so preventing accidental soiling.

These systems need to be recommended and taught by trained health care staff and are available on prescription if it is felt to be appropriate for you.

Undertaking irrigation takes time and motivation and can take up to 3 months before establishing a good routine. You will be well supported during this period until you feel confident with what you are doing.

Rectal Irrigation – Coloplast Peristeen Plus & MacGregors Irresido klick.

For further information about rectal irrigation, please visit

https://goldcare.healthcare/an-introduction-to-transanal-rectal-irrigation/

Skin Care

Anyone who has frequent bowel motions, diarrhoea or accidental leakage (faecal incontinence) may get sore skin around the back passage. This can be very uncomfortable and distressing. Occasionally the skin may become so inflamed that it breaks into open sores. These sores can be difficult to heal.

Taking good care of the skin around your back passage can help to prevent these problems developing.

Tips to prevent soreness:

• After a bowel action, wipe gently with soft toilet paper

• Whenever possible, wash around the anus after a bowel action

• Use warm water only, disinfectants and antiseptics can sting if you have open sores

• Avoid using products with a strong perfume such as scented soap, talcum powder or deodorants on your bottom. Many baby wipes contain alcohol, so should be avoided.

• Moist toilet tissue can be useful. Available in both home and travel size they are widely available from most supermarkets and have the advantage over wet wipes for being flushable.

• Pat your bottom dry gently with soft paper or a soft towel. Do not rub

• Wear cotton underwear to allow the skin to breathe. Avoid tight jeans and other clothes which may rub the area

• Use non-biological washing powder for underwear and towels

• Avoid using any creams or lotions on the area, unless advised to do so. A barrier cream may be helpful and are available over the counter or on prescription.

• If you need to wear a pad because of incontinence, use a pad with a soft surface.

Sitz Bath                                                                                                                                    

A sitz bath is a warm, shallow bath that cleanses the perineum (the space between the rectum and vulva or scrotum). A sitz bath can be used for everyday personal hygiene. It can also provide relief from pain or itching in the genital area.

A Bidet Shower

A bidet shower (bidet spray, bidet sprayer or health faucet) is a hand-held triggered nozzle, similar to that on a kitchen sink sprayer that delivers a spray of water to assist in anal cleansing and cleaning of the genitals after defecation and urination. The bidet shower is very common in parts of Asia where water is considered essential for anal cleansing. Many plumbers are able to fit these for use with Western-style (sitting) toilet installations.

Toilet Access

This is obviously very important for people with bowel control problems and the fear of not being able to find a toilet can lead to social isolation. The following can help give confidence and reassurance when out. Disabled toilets are available for men and women with bowel control problems and are not just for use for people in wheelchairs.

RADAR Key

The RADAR National Key Scheme (NKS) offers key holders access to around 8,000 locked accessible public toilets around the country. RADAR publish the national key scheme guide with listings of all RADAR key scheme toilets around the UK. RADAR keys can be obtained from the local council and are even available to buy from http://Amazon.co.uk or speak with a member of your Pelvic Floor team

Toilet Map

Toilet Map is available as a web site and an app, locating toilets.

https://www.toiletmap.org.uk/

Just Can’t Wait toilet card

Several companies have produced the Just Can’t Wait toilet card. This card can be shown when out shopping or socialising and it may help you gain access to a toilet.

The card states that the card holder has a medical condition which requires the urgent need to a toilet. Although the card does not guarantee you access to a toilet many places will be willing to help.

They can usually be obtained from some companies, the local continence team or your Pelvic Floor Nurse.

Surgical Options

Surgery may be considered if conservative measures have been exhausted. Your Pelvic Floor Team will discuss treatment options with you.

If a significant bowel prolapse has been identified, it may be necessary to have it repaired and this will be discussed with you. In many cases having a prolapse does not result in surgery being needed.

In some cases we will consider Sacral Nerve Stimulation (Interstim Therapy), which can help to restore normal nerve activity. A small implanted medical device is inserted to send mild electrical pulses to pelvic floor nerves located just above the tailbone. www.medtronic.eu or www.axonics.com

Anal Sphincter repair, an operation performed on the back passage to repair the gap in the damaged anal sphincter muscle.

Bowel surgery and formation of a stoma, this is when the bowel is bought out to the skin to discharge bowel contents into a bag. This would only be considered if other treatments are unsuccessful.

Acknowledgement & Resources

Nurse Led Coping Advice, Yvette Perston, CNS, University Hospital Birmingham

Faecal Incontinence. Patient advice and information leaflet on the management of faecal incontinence. Oxford Pelvic Floor Service Oxford University Hospitals.

Eating Well. Beating Bowel cancer

www.beatingbowelcancer.org

http://www.nhs.uk/Conditions/Incontinence-bowel/Pages/Treatment.aspx

Better Health, Healthier Families

https://www.nhs.uk/healthier-families/recipes/

Notes:

Please write down any notes you wish to make e.g. questions to ask the doctor or nurse, or lists of medicines and when to take them, or how you have been feeling etc.

Daily Diary

You may be asked to complete a diary of your eating and bowel habits.

• Record your food & drink details for one week.

• You need to record your daily bowel habit e.g. how often you go, whether in the toilet, amount etc. and your stool consistency. You may wish to refer to the Bristol stool chart on page 4.

• Record any remarks e.g. blood, mucous, urgency (having to rush to the toilet), straining, pain, feeling of incomplete emptying, amount of leakage, what you had to change etc.

• Record the use of any relevant medications e.g. laxatives, enemas, suppositories, constipating agents or other self-help remedies