How can bowel problems affect my lifestyle?

Bowel leakage and constipation can be very uncomfortable, and they also have a significant impact on our quality of life. Apart from the frequent physical discomfort and bloating, you may worry about having an accident in public.

This makes it important to find a way to manage your bowel issues.

What can I do to manage my bowel problems?

Bowel issues can often be improved by changing diet; there are also several types of medication that can help. Transanal irrigation can be used to help prevent constipation and bowel leakage. 

What is transanal irrigation?

Transanal irrigation is where water is introduced into the bowel using a rectal catheter. The water stimulates the bowel and flushes out the stool, leaving the lower half of the bowel empty. It’s important to do it regularly to prevent constipation and the risk of bowel accidents.

How often should I irrigate?

For most people, every 1–2 days works well. It’s important to do it regularly to prevent constipation and the risk of bowel accidents. It’s also best to get into a regular routine, rather than changing too much. With time and practice you’ll find out what works best for you. If you’re not sure, ask your doctor or nurse for advice.

What time of the day is best for irrigating?

Try to get into a routine where you irrigate around the same time of the day. Eating and drinking helps the bowel’s natural movement, so about 30 minutes after a meal is a good time. But don’t be afraid to change the routine slightly to suit your day-to-day routine.

Can I travel with the irrigation equipment?

Yes – remember to bring your irrigation system along with lots of disposable catheters as they may not sell them everywhere. If you’re going to use the system abroad, use bottled or cooled boiled water in places where the tap water is not safe to drink. Remember in different time zones your body may take a while to get used to a new routine. You may also be eating different types of food, which can affect the bowels.

Does anal irrigation hurt?

No, transanal irrigation does not normally hurt and is perfectly safe. However it may feel a little strange at first. If it is uncomfortable when the water is pumped in, stop for a while and then continue. If you are in pain, stop irrigating immediately, deflate the balloon and remove the catheter. If the pain persists, contact your nurse or doctor for help.

Are there any risks or complications of irrigating?

Some people experience minor problems such as discomfort or a little bleeding. If the catheter is not inserted correctly, it can cause a hole or tear in the bowel, however this risk is very small if you follow the instructions you get from your doctor or nurse.

What should I do if I leak between irrigations?

If you experience bowel leakage between irrigations, the cause may be insufficient emptying of your bowel due to constipation or hard stool. Alternatively, you may be using too much water during irrigation. Contact your doctor or nurse to help you adapt to your bowel plan. 

The most common bowel issues people experience are:

• Bowel leakage – when you cannot control when your bowels open, resulting in bowel accidents
• Constipation – when stool in the bowel stays there for too long and becomes too hard to pass, resulting in the inability to have a bowel movement
• A combination of the two. You can be constipated but still experience loose stool that leaks past the hard stool

Some of the signs of bowel leakage include:

• Feeling the urge to have bowel movement but not being able to control when your bowels open, resulting in a bowel accident (urge incontinence)
• Leaking stools (passive incontinence)
• Soiling of underwear
• Being unable to control when you pass air (flatus)

Some of the signs of constipation include:

• Inability to have a bowel movement
• Bloating
• Discomfort
• Severe stomach ache

Causes of bowel issues

It is important to understand that having bowel issues is not a disease in itself. There is usually an underlying cause as to why your bowels aren’t functioning properly.

Some of the common causes of bowel issues are:

• Neurological disorders such as Spinal Cord Injury, Spina Bifida or Multiple Sclerosis. If you have a neurological disorder, it’s likely the nerves in your spinal cord – which control how the bowel functions – are damaged
• Complications after rectal surgery, such as after childbirth, where the sphincter muscles have been damaged leading to the inability to control when you go to the toilet
• Anorectal malformations from birth – even with surgical correction, you can still experience bowel incontinence episodes
• Reduced tissue elasticity due to old age, leading to frequent soiling

It’s important for anyone who experiences bowel issues to find a bowel routine that allows regular emptying of the bowel, as this helps to prevent both bowel leakage and constipation. Read more about the products Coloplast has to offer. 

Small changes you can make include: 

• Eating healthier – a balanced diet that is high in fibre and water will help to reduce constipation. Eating lots of fresh fruit and vegetables and less red meat may help to protect against certain types of cancer
• Stopping smoking – smoking can make the symptoms of inflammatory bowel conditions worse
• Reducing your intake of alcohol
• Reducing the use of certain medicines – a number of common medicines, such as those used to treat heartburn and indigestion, can cause diarrhoea or constipation. It may also be possible to change the dosage of many prescription medicines
• Exercising gently – gentle exercise helps to squeeze food along the digestive tract and reduces the risk of constipation

The importance of a bowel routine

One of the most effective changes you can make is having a reliable bowel routine when it comes to emptying your bowels.

This is to ensure:

• Regular emptying of the bowel to prevent bowel leakage and chronic constipation.
• Physical and mental well-being, so that you can get on with the daily activities that are important to you, whether it’s socialising, working, taking part in sport or travelling.

Essentially, neurogenic bowel describes a lack of nervous control which prevents the bowel from functioning correctly. It is caused by damage to the central nervous system and may result in bowel leakage, chronic constipation, or both.

Some causes

The most common cause of neurogenic bowel is a Spinal Cord Injury, though it may also result from other neurogenic disorders such as Spina Bifida, Multiple Sclerosis, Parkinson’s disease or diabetes mellitus. The effect on bowel function depends on where the spinal cord is damaged.

There are two types of neurogenic bowel dysfunction – reflex and flaccid bowel.

Reflex bowel

Reflex bowel is where the bowel opens on a reflex basis when the rectum becomes full. The bowel can empty at any given time because the person may have lost the ability to feel when the bowel is full. This can lead to bowel accidents and leakage.

Flaccid bowel

Flaccid bowel is when the anal sphincter muscle – the muscle that normally keeps the anus closed – becomes relaxed and remains open. This often leads to accidental emptying of the bowel.

Neurogenic bowel also leads to a slow stool transit time, meaning people with neurogenic bowel also are at high risk of suffering from constipation.

If you have neurogenic bowel, then it’s important to find a reliable bowel management routine to avoid accidental emptying, constipation and impaction.