Bowel
CONSTIPATION
About
-
- Having fewer than three bowel movements a week
- Stools are dry and hard
- A bowel movement is painful and stools are difficult to pass
- A feeling that you have not fully emptied your bowels
Causes
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- Older age
- Stress
- Being a woman, especially while you are pregnant and after childbirth
- Hormonal changes
- The baby inside the womb squishes the intestines, slowing down the passage of stool
- Changes in your regular routine ie: traveling
- Not eating enough foods rich in fibre
- Not drinking enough water
- Taking certain medications
- Having certain neurological and digestive disorders
Symptoms
-
- Fewer than three bowel movements/wk
- Stools are dry, hard and/or lumpy
- Stools are difficult/painful to pass
- Stomachache/cramps.
- Bloating
- Nausea
- Incomplete emptying feeling after a bowel movement
Diagnosis
- Medical history and bowel movement history
- Physical exam, including rectal exam
- Lab tests: Blood and urine tests to check for hypothyroidism/anemia/diabetes
- Stool sample: To check for signs of infection/inflammation/cancer
- Imaging tests: Computed tomography (CT), magnetic resonance imaging (MRI) or lower gastrointestinal tract series may be ordered to identify other problems
- Colonoscopy: An internal view of your colon with a scope – may be performed
- Colorectal transit studies: These tests involve consuming a small dose of a radioactive substance, either in pill form or in a meal, and then tracking both the amount of time and how the substance moves through your intestines
- Defecography:
- A small amount of liquid barium is released through a tube into the colon and rectum
- An x-ray video is taken that shows how the rectum is functioning
- Anal manometry:
-
- A short, thin tube is inserted up into the anus and rectum to measure sphincter tightness
- Studies the strength of the anal sphincter muscles
Treatment
-
- Review your medications and supplements (if you take any) with your doctor so they can be modified if they are causing the problem
- Self-Care
- Exercise regularly
- Check how you sit on the toilet
- Raising your feet, leaning back or squatting may make having a bowel movement easier
- Do not read, use your phone or other devices while trying to move your bowels
- Dietary Changes
- Drink 2-4 extra glasses of water a day
- Avoid caffeine-containing drinks and alcohol, which can cause dehydration
- Add fruits, vegetables whole grains and other high-fibre foods to your diet ie: prunes, bran cereal
- Add an over-the-counter supplemental fibre to your diet
- Eat fewer high-fat foods, like meat, eggs and cheese
- Keep a food diary and single out foods that constipate you
- Oral Medication
- There are a few prescription drugs on the market
- A very mild over-the-counter stool softener or laxative, mineral oil enemas and stimulant laxatives are available over the counter
- Ask your pharmacist or doctor for help in making a choice
- Do not use laxatives for more than two weeks without calling your doctor
- Overuse of laxatives can worsen your symptoms
- Surgery
- If there’s a structural problem in the colon
- Examples of these problems: Intestinal obstruction/stricture, tear in the anus or rectal prolapse
INCONTINENCE (BOWEL/FECAL)
About
-
- When bowel movements cannot be controlled
- Stool (feces/waste) leaks out of the rectum at unwanted times with/without awareness
- Happens more often in women than in men, and often amongst older people
Potential Causes
-
- Frequent diarrhea/constipation
- Muscle damage
- Older age
- Nerve damage
- Inability of the rectum to stretch
- Reduced rectal storage capacity
- Rectal prolapse (rectum falls into the anus) or rectocele (rectum pushes into the vagina)
- Chronic constipation
- Laxative abuse
- Radiation treatments
- Certain nervous system/congenital defects
- Inflammatory bowel disease
Symptoms
-
- The feeling of needing to go and not being able to make it to the bathroom in time
- Stool leaks out when passing gas
- Stool leaks out due to physical activity/daily life exertions
- Stool is seen in the underwear after a normal bowel movement
- Complete loss of bowel control
Diagnosis
- Physical exam, including rectal exam
- Anal Manometry: A short, thin tube is inserted up into the anus and rectum to measure sphincter tightness
- Studies the strength of the anal sphincter muscles
- Endoluminal (anal) Ultrasound: A small probe is inserted up into the anus and rectum to take images of the sphincters
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- Helps evaluate the shape and structure of the anal sphincter muscles and surrounding tissue
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- Pudendal Nerve Terminal Motor Latency Test: Measures the functions of the pudendal nerves, which are involved in bowel control
- Anal Electromyography (EMG): Determines if nerve damage is the cause and examines the coordination between the rectum and anal muscles
- Flexible Sigmoidoscopy/Proctosigmoidoscopy: Sigmoidoscope is inserted into the rectum so the bowel can be viewed
- Evaluates the end of the large bowel/colon, looking for any abnormalities
- Proctography/Defecography: A small amount of liquid barium is released through a tube into the colon and rectum
- An x-ray video is taken that shows how the rectum is functioning
- Magnetic Resonance Imaging (MRI): To evaluate the pelvic organs
Treatment
- Dietary Changes: Eliminate foods that can cause loose stools from your diet ie: beans, cabbage family vegetables, dairy products, dried fruit, spicy foods, artificial sweeteners
- Bowel Retraining (Biofeedback): Developing a “going-to-the-bathroom” pattern to gain greater control over bowel movements
- Have a trained therapist teach you certain exercises to increase anal muscle strength
- Oral Medication: Anti-diarrheal drugs and bulk laxatives to decrease movement of the stool through the intestine and firm it up
- Surgery
- Sphincteroplasty
- Repairs a damaged or weakened anal sphincter that occurred during childbirth
- Doctors identify an injured area of muscle and free its edges from the surrounding tissue
- They then bring the muscle edges back together and sew them in an overlapping fashion, strengthening the muscle and tightening the sphincter
- Rectocele or rectal prolapse correction
- Can be done surgically to reduce or eliminate fecal incontinence
- Sphincter replacement
- A damaged anal sphincter can be replaced with an artificial anal sphincter
- The device is essentially an inflatable cuff, which is implanted around your anal canal
- When inflated, the device keeps your anal sphincter shut tight until you’re ready to defecate
- To go to the toilet, you use a small external pump to deflate the device and allow stool to be released
- The device then reinflates itself
- Sphincter repair (Dynamic Graciloplasty)
- Muscle from the inner thigh is taken and wrapped around the sphincter, restoring muscle tone to the sphincter
- Sacral nerve stimulation
- A small device (a neurotransmitter) is implanted under the skin in the upper buttock area
- The device sends mild electrical impulses through a lead that is positioned close to a nerve located in the lower back (the sacral nerve), which influences the bladder, the sphincter and the pelvic floor muscles
- Colostomy (Bowel Diversion)
- Stool is diverted through an opening in the abdomen and a special bag is attached to this opening to collect the stool
- A last resort treatment
- Sphincteroplasty
IRRITABLE BOWEL SYNDROME (IBS)
About
-
- Colon/lower bowel disorder
Potential Causes
-
- Unknown
- What is known is that the colon muscle in those with IBS contracts more readily than in those without it and those with the condition have a lower pain threshold
- Triggers include
- Certain foods
- Medications
- Stress
Symptoms
-
- Abdominal pain/cramps, usually in the lower half of the abdomen
- Bloating
- Constipation in some, diarrhea in others
- Excess gas
- Harder/looser bowel movements than usual
Diagnosis
- Medical history is evaluated
- Physical exam
- Blood tests and stool samples: To rule out other conditions
- Stool examined for bacteria, parasites or bile acid (if you have chronic diarrhea)
- Flexible sigmoidoscopy: With a flexible lighted tube, the lower part of the colon (the sigmoid) is examined
- Colonoscopy: Entire colon is examined with a colonoscope
- If necessary, small amounts of tissue can be taken for biopsy and polyps can be identified and removed
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- *There is no definitive test to diagnose IBS
Treatment
- Diet
- Avoid trigger foods (ie: high-gas foods, gluten, certain carbs such as fructose, fructans, lactose, FODMAPs)
- Eat fibre
- Drink plenty of fluids
- IBS Diet
- Stress reduction
- Mindfulness
- Yoga
- Psychotherapy
- Regular physical exercise
- Oral Medications
- Fibre supplements/laxatives: For constipation-predominant IBS
- Anti-diarrheals
- Bile acid binders: Cholestyramine, colestipol or colesevelam
- Anticholinergics: To relieve bowel spasms
- Tricyclic antidepressants: Inhibit the activity of neurons that control the intestines to help reduce pain
- Pain medications: Pregabalin/gabapentin for severe pain/bloating
- Medications specifically for IBS: Can help ease diarrhea and relax the colon