Urgency and Incontinence

Accidental bowel leakage can be a devastating symptom of inflammatory bowel disease (IBD). It is a source of considerable embarrassment for some people. It may cause them to withdraw from social situations.¹

Fecal and anal incontinence

Fecal incontinence is the unintentional loss of solid or liquid stool. Anal incontinence is the unintentional loss of stool or gas.² Just before an accident, you may feel intense cramps and urgency. The feeling of urgency is unpredictable. For some people, it is as distressing as incontinence.² Accidental bowel leakage can happen even during remission.³

Anal sphincters are muscles that allow you to control bowel movements. You have an internal and external sphincter. Your rectum is the lower part of your large intestine. If everything is working normally, your rectum holds stool. As the rectums stretches, it causes a contraction. You will have a feeling of urgency. The internal sphincter relaxes. When you get to the bathroom, your pelvic floor muscles relax. Waste can passes out of the body.²

Incontinence can be due to problems with the sphincters or stool. Diarrhea is one of the most important risk factors for accidental bowel leakage.² Watery, loose stool moves through the digestive tract quickly. It can be difficult to control. Fistula repair can damage the sphincter muscles and cause incontinence.⁴ Accidental bowel leakage is also a risk of colorectal surgery.

How common are urgency and incontinence?

In the general population, about 7% to 15% of individuals experience accidental bowel leakage.² It is much more common among people in the hospital (18% to 33%) and nursing homes (50% to 70%).

In a survey of people with IBD, 74% reported having had accidental bowel leakage. Nine percent had it regularly.³ The authors speculated that this figure might be high because people with incontinence were more likely to respond to the survey. They did another calculation that assumed that all the people who did not respond were always continent. Based on this, they concluded that at least 24% of people with IBD had accidental bowel leakage.

What other conditions can cause urgency and incontinence?

Accidental bowel leakage can happen because of weakness to the anal sphincter or damage to the muscles in the pelvic floor. This can result from trauma during childbirth or surgery, among other causes. Problems with feeling the sensation of rectal fullness causes some cases of incontinence. Bowel disturbances can cause accidental bowel leakage. One example is when chronic constipation leads to overflow diarrhea.

How is fecal incontinence evaluated?

Less than one-third of people with accidental bowel leakage tell their health care provider.² The people who do talk to their provider about it tend to have more frequent and severe symptoms, diarrhea, or pain. It can be easier to talk about accidental bowel leakage with a provider that you see regularly.

Your provider may bring it up by asking you about feelings of urgency or rectal fullness.¹ It may come up as part of a discussion of your medical or surgical history. Your provider may do a rectal examination to determine the reason for incontinence.

How are urgency and incontinence treated?

Treating the underlying IBD will treat diarrhea. Hopefully, this will improve continence.⁵ Certain fiber supplements, called bulking agents, also may be helpful. The fiber binds to some of the water. This makes the stool a little firmer and easier to control.⁵ Your provider might recommend using antidiarrheal medications, which may improve sphincter tone.⁵ It is important to note that these over-the-counter medications are meant for people without a severe digestive disorder, such as Crohn's disease or ulcerative colitis, the two main forms of IBD. Using non-prescription to manage symptoms of IBD could mask the true cause of urgency or incontinence. Talk to your provider before using over-the-counter medications.

If one of the anal sphincters has been damaged, your health care provider may refer you to a surgeon.¹ Some types of sphincter damage can be repaired.

How can I be sure to have access to a bathroom?

Access to bathrooms is a significant issue for people with bowel control problems. You may be reluctant to go somewhere new if you do not know exactly where the bathroom is—or if you are uncertain that you will be allowed to use it.

Fourteen states have passed a Restroom Access Act (Table).⁶ This law is also known as Ally’s Law. It is named after a teenager with Crohn’s disease who championed this Act.^7,8 The Restroom Access Act requires businesses to allow people with bowel or bladder control problems to access employee-only restrooms.⁶ This law helps people with Crohn’s disease, ulcerative colitis, irritable bowel syndrome, an ostomy, or a bladder disorder.

Table. States that have passed the Restroom Access Act

Source: CCFA Advocacy Toolkit, pg 13

If you live it a state without a Restroom Access Act, you could consider working with lawmakers to get this law passed. The Crohn’s and Colitis Foundation of America has an advocacy toolkit to help you organize support for this law and contact lawmakers who might champion your cause.

School accomodations

Urgency and accidental bowel leakage can be a significant issue for children in school. The Crohn’s and Colitis Foundation of America has an information sheet for school personnel.⁹ The Guide offers ideas for accommodating a child with IBD. One suggestion is to make it possible for a child to use the bathroom quickly and discretely.

Students with IBD may qualify for accommodations under 2 federal laws, Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act.⁹ For example, a 504 plan could include provisions allowing your child to leave class to use the bathroom without asking, eat or drink in any classroom, and take tests in a different room without a penalty for leaving to use the restroom.