Faecal incontinence (leakage of poo) is embarrassing, too many people suffer this in silence.

It may not, on first inspection, be the sort of topic discussed in polite, or other, company. The more we understand about how common it is when ageing to have faecal incontinence (leakage of poo) and in most instances how easy it is to prevent this happening the healthier and happier we can be as individuals and within our society. 

The fact you can ‘mail’ your poo for inspection and testing shows that the subject has become top of mind…pun intended. Case in point The NZ Bowel Cancer Screening Programme provides the kit for those in the age-group to mail a poo sample to the laboratory for testing.  

Faecal (or poo or bowel) incontinence is the involuntary passing of faeces and /or flatus (wind, fart) at an inappropriate time or place. It affects approximately 1 in 3 people. It is a very distressing symptom and can affect a person physically, emotionally, mentally, socially, spiritually, and financially.

Firstly, know that faecal incontinence is NOT normal at any age. While it is more common for older people it is NOT a normal part of ageing. BUT for most older people faecal (poo or bowel) incontinence can be managed by simple changes.   

In the first instance keep your bowel healthy to try an avoid poo problems. To do this you should: 

• Drink 6-8 glasses (1500-2000mls) of non-alcohol fluid per day (if your doctor has instructed a specific daily fluid intake follow those instructions). Preferably make 3-4 of those glasses plain tap water, drink it either cold or hot (sipping a cup of boiled water can be very soothing for our body and mind).  
• Eat dietary fibre every day such as vegetables and fruit (unsweetened dried fruit is ok), 1 fresh green flesh kiwifruit per day is highly recommended, nuts, legumes (e.g. baked beans, soya beans, lentils, etc), whole meal breads and unsweetened cereals – if your body reacts to these foods ask your Doctor to refer you to a Dietician so you can get qualified advice to meet your individual needs.
• As much as possible only eat whole foods instead of processed food (frozen vegetables and fruit with no additives are as good as fresh options), and limit takeaways to one meal per week.   
• Exercise regularly - preferably walking 20-30 minutes at least 3-4 times a week.
• Allow sufficient time on the toilet to empty your bowel fully, but do not sit on the toilet for a prolonged time and do not strain to push out bowel motions (poo).

Your bowel is healthy if your bowel motions (faeces, poo) are:

• Regular.
• Soft and well formed.
• Easy to pass.
• Leave you feeling that your bowel has been fully emptied.

Common signs and symptoms of faecal incontinence?

Some people only have issues with leakage when they have diarrhoea (runny poo). For others, faecal incontinence is an ongoing experience. Signs and symptoms include:

• Poo leaking when you pass wind (fart).
• Poo leaking when you are physically active.
• Feeling like you must poop but being unable to make it to the toilet in time.
• Finding more poo than a ‘skid mark’ in your undies after pooping (bowel motion).
• Losing the ability to control your pooping entirely.
• Stomach pain occurring with any of the above (this may or may not happen).

The ‘inside’ story on faecal incontinence.

As noted above faecal incontinence is when you cannot manage or control your bowel movements (pooping), meaning that liquid or solid poop leaks out onto your undies, pyjama pants etc. Faecal (poo) incontinence may range from skid marks on your undies when you pass wind (fart) through to unintentionally passing runny poo (diarrhoea) or solid stools (poo).

Several factors affect your ability to regulate pooping. These include what foods you eat and drink; how your body digests the food and fluids as they move down through your stomach and intestines (this ‘journey’ of the food and fluids can slow down as we age or have illnesses); how well the muscles in our pelvic floor work to hold the poo in, then to push it out when the body signals it is time to poop (pelvic floor muscles hold our bowel and bladder in place, for women they also hold the uterus/womb and vagina in place).  

All along that pathway from eating to pooping nerves work with muscles and our body organs to drive digestion of the food and fluid, turn it into poo, and then tell your body when it’s time to poop.

Finally, you must be physically able to reach the toilet in time. Ageing, arthritis, and other illnesses can make moving quickly and sitting on the toilet difficult, and then wrist/arm/shoulder/back/hip/knee/etc problems can make it difficult to wipe your bottom/butt after pooping.

In addition to the above there are many other reasons for temporary or permanent problems with pooping, common reasons are:

• Severe constipation (difficulty pooping) which can result in runny poo (diarrhoea) leaking around the sides of the hard poo that is moving slowly down through the bowel.
• Constipation is common for older people.
• Some medications can cause diarrhoea and/or constipation.
• Infections (e.g. food poisoning) can cause diarrhoea and/or constipation.
• Bowel conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), etc.
• Some other conditions can cause diarrhoea and/or constipation (e.g. Dementia of which Alzheimer’s is one type of dementia, Type 2 Diabetes, Multiple Sclerosis, Stroke, Spinal Cord Injuries, etc).
• Childbirth can impact on the pelvic floor and affect control of pooping. As women age, the former childbirth impact on their pelvic floor combined with the changes of ageing can cause diarrhoea and/or constipation.
• Some bowel surgery can result in diarrhoea and/or constipation.
• Radiotherapy – a side effect can be diarrhoea and/or constipation.
• Etc.

A deeper understanding of faecal incontinence.

Faecal (poo) incontinence includes the following:

• ‘Skid mark’ incontinence: this can happen when you cannot wipe your bottom/butt properly after a poop and shows as skid marks on your undies/pyjama pants/etc - this is not strictly incontinence. However, for some people as they bend over and move around during the day or in bed at night-time, small amounts of poo are pushed out of their butt and show as skid marks on undies/pyjama pants/etc – this is ‘skid mark’ incontinence.  Many older people who have difficulty wiping their butt after a poop, have their plumber install a bidet under the toilet seat. It is connected to the toilet water system and has a small ‘heater,’ thus, after pooping and while still sitting on the toilet you push a button, and your bottom/butt is washed clean with warm water and dried – there is no need to try and twist your body to use toilet paper. For more information google ‘toilet seat bidet in NZ’ – there are lots of options, with the price ranging from around $150 - $1,000, plus plumber costs. Financial assistance may be available for some conditions, discuss with your GP or other health professionals involved with your health conditions – they can as appropriate refer you for NASC (Needs Assessment Service Coordination) to determine what personal assistance and subsidies you may be eligible to receive to assist with installing a toilet seat bidet, for more information: https://www.govt.nz/browse/health/help-in-your-home/needs-assessment
• Urge incontinence: You feel the urge to poop but cannot make it to the toilet fast enough to prevent soiling yourself (a ‘poo accident’). This is the most common type for older adults. It usually involves either constipation with diarrhoea leakage and/or issues with the muscles that control your bowel movements. The solution may be as simple as making sure you have a solid bowel motion (poop) everyday – to achieve this requires drinking more non-alcohol fluids every day see volume noted above; and eating less processed food and take-aways; and eating a fresh green kiwifruit daily; and taking Metamucil or a similar product (available from supermarkets and pharmacies, it comes in tablets or a powder to put in drinks or sprinkle on food). Before starting Metamucil or a similar product discuss this with your pharmacist to check if there are any precautions with other medications you take. If after a few weeks of following these suggestions your faecal (poo) incontinence has not improved, discuss it with a health professional experienced with this subject (e.g. a Pharmacist, GP, Gerontology Nurse Specialist, or Nurse Practitioner).
• Passive incontinence: Your rectum (which holds your poop) has stretched as much as it can to contain your poo, but your body is not registering that you need to poop. In this situation, you will usually pass the formed poo without realising it. This type may involve issues with how the nerves communicate with the muscles. If this type of pooping is happening discuss this with your GP, Gerontology Nurse Specialist, or Nurse Practitioner.

Age and gender factors

Anyone can experience faecal incontinence, but some common causes are:

• Age: Faecal incontinence is more common if you are over age 65. Muscles naturally weaken with age. However, faecal incontinence is NOT a ‘normal’ part of ageing. Talk to a health professional experienced with this subject (e.g. a Pharmacist, GP, Gerontology Nurse Specialist, Nurse Practitioner, or Physiotherapist).
• Gender: Women and people assigned female at birth (AFAB) are at greater risk. Experiences unique to women and people AFAB are also associated with greater risk, including older women who had vaginal childbirths and/or received hormone therapy during menopause. Solutions are available, discuss with a GP, Nurse Practitioner, Gynaecologist, or Geriatrician.

What are the complications of faecal incontinence?

One of risks that many overlook is every episode of diarrhoea takes fluids and nutrients away from what our brain and body need for their normal daily functions. If we have regular episodes of diarrhoea, we probably won’t be drinking enough fluids or eating enough healthy food for our brain and body to function as well as it can. Our brain and vital organs will ‘hog’ the reducing levels of fluids and nutrients. This may cause us to be tired, or thirsty, our skin can feel dry and itchy (especially our hands), intermittent brain fog can occur, and we can feel less motivated to do ‘things’ such as household chores, cooking, and socialising.

For older people when the fluid and food balance is day after day in deficit (i.e. more going out in the diarrhoea than they are eating and drinking) muscles rapidly weaken, this increases the risk of falls, this increases the risk of injuries and in turn can reduce independence. This is why older people should not ignore diarrhoea, especially they should not ignore increasing numbers of skid marks per day and/or increasing volumes of poo in the skid marks, urge incontinence or passive incontinence (all described above).

The diarrhoea leakage can take a toll on the skin around your butthole (anus), causing it to feel irritated. This can include the feeling of burning, itching, and throbbing pain. Eventually, you may develop sores (ulcers). Treating the ‘skid mark’ incontinence, urge incontinence and passive incontinence, as described above, can prevent these skin problems from happening.

But not all complications are physical. A major concern for people with faecal incontinence is the toll it can take on their mental and emotional well-being. It is common to feel embarrassed, anxious, or stressed over the leakage; they may refuse to talk to anyone about it. It can cause people to reduce their social activities, they may stop attending regular outings they previously enjoyed.

People make excuses why they can’t attend, when the real reason is the embarrassment about smelling of poo or having a poo (incontinence) ‘accident’ while away from home. It is essential to address faecal incontinence as soon as possible, in the ways described above, so the condition does not reduce outings and socialisation with other older people. Becoming disconnected from your friends and the activities / groups you enjoyed can increase feelings of loneliness and longing.     

In summary

Firstly, know that faecal incontinence is NOT normal at any age. While it is more common for older people it is NOT a normal part of ageing. As described above there are many reasons for faecal incontinence.

You will have read above that stopping the faecal incontinence for older people may be as simple as starting a daily pattern of: drinking more fluids, especially hot or cold water; and eating a fresh green flesh kiwifruit; and taking Metamucil or a similar product to gently push the food and fluids down through your stomach and intestines, turning it into formed poo which stimulates the bowel to empty properly. This daily regime works to stop there being ‘rock like’ poo moving slowly down the bowel and causing diarrhoea to escape around the sides, which is a common reason for urge incontinence, especially for older people (all described above).

Discuss your faecal incontinence with a health professional experienced with this subject (e.g. a Pharmacist, GP, Gerontology Nurse Specialist, or Nurse Practitioner). If after trying the above daily regime for a few weeks you are still having faecal incontinence they can suggest other options, and if none of that works they may refer you to a Geriatrician or Bowel Specialist for their assessment.

The main message is DO NOT be embarrassed to talk about your faecal (poo) incontinence to a health professional experienced with this subject. They can offer you solutions that are not expensive, and which can greatly improve your health, energy levels, everyday experiences, and thus improve the quality of your life.

A potted history of the toilet.

It is unclear who first invented the flush toilet. Although archaeological excavations in northwest India have revealed 4000-year-old drainage systems which might have been toilets, it is not clear whether this is genuinely the case.

However, the honour of producing the first toilet goes either to the Scots (in a Neolithic settlement dating back to 3000 BC) or to the Greeks who constructed the Palace of Knossos (in 1700 BC) with large earthenware pans connected to a flushing water supply.

By 315 AD, Rome had 144 public toilets. The Romans treated going to the toilet as a social event. They met friends, exchanged views, caught up on the news and wiped themselves with a piece of sponge fixed to a short wooden handle.

This was then rinsed in a water channel which ran in front of the toilet and reused. It has been suggested that this practice spawned the phrase "getting hold of the wrong end of the stick".

In Medieval England, people used "potties" and would simply throw their contents through a door or window into the street. The more affluent would use a "garderobe", a protruding room with an opening for waste, suspended over a moat. The name probably comes from the practice of storing robes in the toilet area so that the smell would discourage fleas and other parasites. Peasants and serfs, however, relieved themselves in communal privies at the end of streets. A huge public garderobe was constructed in London and emptied directly into the River Thames, causing stench and disease for the entire population.

Garderobes and public toilets were eventually replaced by the "commode", a box with a seat and a lid covering a porcelain or copper pot to catch the waste.

France's Louis XI hid his commode behind curtains while Elizabeth I, covered hers in crimson velvet and lace, using sprigs of herbs to disguise the odours.

It is a widely held belief that Thomas Crapper designed the first flush toilet in the 1860s. It was 300 years earlier, during the 16th century, that Europe discovered modern sanitation.

The credit for inventing the flush toilet goes to Sir John Harrington, godson of Elizabeth I, who invented a water closet with a raised cistern and a small downpipe through which water ran to flush the waste in 1592. He built one for himself and one for his godmother; sadly, his invention was ignored for almost 200 years: it was not until 1775 that Alexander Cummings, a watchmaker, developed the S-shaped pipe under the toilet basin to keep out the foul odours.

As the population of Britain increased during the 19th century, the number of toilets did not match this expansion. In overcrowded cities, such as London and Manchester, up to 100 people might share a single toilet. Sewage, therefore, spilled into the streets and the rivers.

This found its way back into the drinking water supply (which was brown when it came out of the pipes) and was further polluted by chemicals, horse manure and dead animals; as a result, tens of thousands died of water-borne disease, especially during the cholera outbreaks of the 1830s and 1850s.

In 1848, the government decreed that every new house should have a water-closet (WC) or ash-pit privy. "Night soil men" were engaged to empty the ash pits. However, after a particularly sizzling summer in 1858, when rotting sewage resulted in "the great stink (pictured). The government commissioned the building of a system of sewers in London; construction was completed in 1865. At last, deaths from cholera, typhoid and other waterborne diseases dropped spectacularly.

In 1861, Thomas Crapper was hired by Prince Edward (later King Edward VII) to construct lavatories in several royal palaces.

He patented several toilet-related inventions but did not actually invent the modern toilet, although he was the first to display his wares in a showroom. He and his contemporaries, George Jennings, Thomas Twyford, Edward Johns & Henry Doulton, began producing toilets much as we know them today.

Bathroom technology really arrived in the 20th century with flushable valves, water tanks resting on the bowl itself and toilet paper rolls (first marketed only in 1902). In 1992, The US Energy Policy Act was passed, requiring flush toilets to use only 1.6 gallons of water. As a result, companies all over the world moved to develop better, low-flush toilets to prevent clogging.

Many toilets now have automatic flushes and the sealed "vacuum water closet", as seen on planes or boats, is already being introduced in some countries, most notably Japan. Some of these toilets also compost the waste produced so it can be used as a garden fertiliser

(Source:  British Association of Urological Surgeons).

 

 

 

 

Feedback welcomed.

We would like to hear your thoughts on this Article.

Click here to submit your feedback.

 

 

 

Published:  November 2024

To be reviewed: October 2027