This is the second of a two-part series – Managing bowel incontinence. Read the first one on Managing urinary incontinence.
It is not uncommon for HSPers to have trouble with bowel function. Everyone’s a bit embarrassed about their poo, but faeces are normally about 75 per cent water.
Problems of bowel irregularity (faecal incontinence) include constipation and loss of control. Constipation can also lead to anal fissures and haemorrhoids.
These problems can come from lack of normal nerve and muscle function in the bowel, progressive lower extremity weakness and spasticity, inadequate activity or exercise or immobility, inadequate water intake, inadequate fibre in diet, increased body weight, stress, medicines and depression. Too, constipation is more common in older people. This is due to a number of factors, including reduced intestinal muscle contractions and reliance on regular medications.
With our physical conditions and lifestyle issues as HSPers, we need to be very particular – more so than the average person – about what and how much we eat and drink. The following lifestyle options can be helpful to improve bowel control:
- Eat more fruits, vegetables and fibre.
- Drink more water.
- Get some exercise.
- Toilet routine
- Pelvic floor exercises
Eat more fruits, vegetables and fibre
Dietary fibre http://en.wikipedia.org/wiki/Dietary_fibre is found in food from plants. There are two broad types of fibre – soluble and insoluble.
Soluble fibre helps to soften the faeces. Good sources of soluble fibre include legumes (beans, peas, lentils), oat bran, fruits and vegetables. It helps:
- lower total and LDL (bad) cholesterol
- regulate blood sugar
- reduce risk of cardiovascular disease, diabetes and onset for some types of cancer.
Insoluble fibre absorbs water as it moves through the digestive system, adding bulk to the faeces, helping it to move more quickly through the bowel. Good sources of insoluble fibre are wheat bran, wholegrain breads and cereals. Because insoluble fibre absorbs water, increasing intake of this fibre without drinking enough water can contribute to constipation!!!
The intake of foods such as milk, cheese, white rice, white flour and red meat should be restricted because they tend to contribute to constipation.
Fibre supplements may be helpful if a person is reluctant or unable to include more wholegrain foods, fresh fruits or vegetables in their daily diet. Psyllium husk is the fibre used in many of these supplements (see Over the Counter Products below for more). Because fibre supplements can aggravate or cause constipation, check with your doctor or dietitian when using them for more than occasional use. And be clear, constipation can occur if you don’t drink enough water with a high-fibre diet, so just changing your diet may not be enough by itself.
Look to see how much fibre you should be getting daily using this online fibre calculator.
Here is more information about dietary fibre including the fibre content of common foods.
Drink more water
Liquids help to plump out faeces, making them softer and less dense, and so easier to pass. 6-8 glasses are recommended daily. This can be difficult for HSPers with urinary incontinence, as you tend to drink less and less, but adequate water intake is very important. It could be helpful to plan your water drinking for the time of day when a toilet is more convenient, but not too close to bed time, so sleep isn’t interrupted. Keep in mind that the recommended 6-8 glasses per day don’t include caffeinated drinks such as tea, coffee, energy drinks, soft drink, or alcohol. These are all known as diuretics, they make you urinate more, and all are dehydrating.
Get some exercise
Physical activity is very important for many reasons, including heart and lung fitness, strength, flexibility, body weight control, stress control, mental health, and promoting bowel regularity. Find an enjoyable physical activity that you will happily commit to doing regularly. Even if you’re not able or inclined to go to a gym or buy substantial exercise gear, there are exercises most people can do in their homes with minimal equipment or instruction. Variety is good too.
Establish a regular time for emptying the bowels:
- for constipation, attempt a bowel movement in the morning, soon after waking, or about 30 minutes after a meal. This helps take advantage of the body’s natural gastrocolic reflex.
- respond immediately to the urge to defaecate and not to put off going to the toilet.
- don’t strain down while attempting to defaecate as this won’t empty the bowel effectively, and will place excessive strain on to the muscles that support the pelvic floor.
- use a footstool. A knees-above-hips position places the pelvic floor muscles in the correct position to assist defaecation.
- keep legs apart, with feet flat.
- keep lower back straight, and lean forwards.
- bulge your tummy and widen at the waist – but don’t strain.
- hold this posture while your bowel opens in as many ways as possible.
Pelvic floor muscle training
This can also help with urinary incontinence.
Men and women both have “pelvic floors”, though the anatomy and the methods to keep these muscles strong differ. Your pelvic floor muscles help you to control your bladder and bowel. They also help sexual function.
How to build a strong pelvic floor – for men:
fact sheet: http://www.bladderbowel.gov.au/assets/doc/brochures/05PelvicFloorMen.pdf
How to build a strong pelvic floor – for women:
fact sheet: http://www.bladderbowel.gov.au/assets/doc/Factsheets/English/06PelvicFloorWomenEnglish.pdf
Over the Counter Products
If the above lifestyle approaches are not enough to help with bowel control, there is a range of products available over the counter.
As a fibre supplement, psyllium seed husk, a soluble fibre, is ground and used in food products to add fibre or as a thickener. Health food stores love to sell the stuff, however a study has shown that prunes are superior for treating chronic constipation. Eat prunes!
There are numerous brands and types of stool softeners including enemas, suppositories, bulking agents and laxatives. With laxatives there are two main types: bowel stimulants and agents that increase the water content of the stool. But ongoing use of laxatives can contribute to the development of constipation. These products should be used only in moderation to facilitate a bowel movement. Bulking agents can work adversely with certain prescription drugs. Continuous or regular use of these products is generally not recommended unless under the advice of a doctor or pharmacist for longer term care.
More specifics on treatment options including specific brands can be seen here: http://www.mydr.com.au/gastrointestinal-health/constipation-treatment-options
If lifestyle modification and over the counter products aren’t helpful enough…
Doctors sometimes prescribe Bentyl which relieves spasms of the gastrointestinal tract (stomach and intestines) by blocking the actions of spasm-inducing chemicals in the body. It is used to treat functional bowel or irritable bowel syndrome (IBS).
Sacral nerve stimulator implants are being used in patients with severe constipation. The brain controls our body’s muscles and movements through electrical impulses carried by nerves. Sensations such as fullness in the bladder or rectum, are also relayed to the brain via these nerve routes. Sacral neuromodulation helps to correct inappropriate, unwanted or even erroneous messages sent along these nerve pathways.
Continence Nurses and Physiotherapists all can be located either through the Continence Foundation of Australia helpline or through your Area Health Service. You can ring the National Continence Helpline on 1 800 330 066.
South Australian Government website (http://www.sa.gov.au/government/entity/1646/About+us+-+Disability+Services/News%2C+events+and+resources/A-Z+of+disability+information+sheets+and+publications). Click on the letter C for Continence and scroll down to “Continence: key points” and “Continence Resource Center” to learn about free services provided including a phone number for enquiries and appointments with the Registered Nurse at the Continence Resource Centre.
MS Australia – Bowel Dysfunction: http://www.msaustralia.org.au/symptoms-bowel.asp
Better Health Channel, Victorian Government Department of Health: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Constipation
Bladder and Bowel Website, Australian Government Department of Health and Aging: http://www.bladderbowel.gov.au/
My Doctor for a healthy Australia from MIMS:
Spastic Paraplegia Foundation (USA):http://www.sp-foundation.org/treatment.html
Descriptions of sacral nerve treatment:
Prune (dried plum) vs. psyllium therapy trial: http://www.ncbi.nlm.nih.gov/pubmed/21323688
Wow – if poo is 75% water and I drink less than I should, no wonder I have problems. I plan to keep track of how much water I drink for a few days and intentionally drink more, at convenient times… and eat more healthful fibre (for a lot of very important reasons). Good article, Thanks, MJ