Managing bowel control problems

Many bowel control problems can be managed or treated successfully. It’s important to talk to your doctor if you’re having problems. They can assess you and advise you on what may help.

They may suggest making changes to your diet, taking medicines to slow down your bowel or doing exercises that strengthen the muscles used in bowel control. Your emotions can affect your bowel control too. Managing stress and learning to relax may help to settle your bowel.

Some people are taught how to retrain their bowel by resisting the urge to empty it straight away. Your doctor, specialist nurse or continence specialist can give you advice about this.

If your bowel control problems don’t get better with these treatments, your doctor can refer you to a bowel specialist (gastroenterologist). Keeping a daily record of your bowel habits and what you eat can help your specialist to work out what might help you. They may also arrange for you to have tests so that they can give you the treatment that is best for you.

Bowel control problems

There are different ways bowel problems can be treated or managed. What is likely to work best for you depends on your symptoms and what is causing them. So it’s important that you see a doctor to be properly assessed.

Your cancer doctor and their team will probably have helpful suggestions. If your symptoms still don’t improve, you can ask your GP to refer you to a continence specialist or a specialist in stomach and bowel problems (gastroenterologist).

Treatments for bowel function problems are often based on one or more of the following:

  • slowing the time it takes for stools to pass through the large bowel (bowel transit time)
  • emptying the bowel more effectively
  • strengthening the muscles used for bowel control
  • retraining the bowel.


Slowing down the bowel

Slowing the rate at which bowel movements (stools) pass through your bowel helps reduce the number of stools you have. It will also mean your stools are less liquid. Firmer stools are easier to control and make it easier for you to empty your bowel completely.

Diet, anti-diarrhoea medicines and stress management can all help slow bowel transit time. If these approaches don’t work, ask your GP for a referral to a gastroenterologist. They might suggest other treatments that could be useful.


Diet

It’s important to try to continue to eat a wide range of different food types. If you are very limited in what you can eat, get advice from a doctor or dietitian. If you are losing weight because of bowel problems, it’s important to tell them this.

Your doctor or dietitian may recommend making changes to your diet. They may suggest eating at regular times, or having smaller meals more often.

Skipping meals may make your symptoms worse. It can make your bowel habits unpredictable. Eating at regular times helps to encourage a regular bowel pattern.

You may be shown how to adjust the amount of fibre in your diet. Some people are given fibre supplements to take (see below).

Your doctor may prescribe anti-diarrhoea medicine. This may help you to better manage your bowel symptoms and allow you to eat a wider range of foods.

It’s important to drink at least 1–2 litres of fluids a day. Your dietitian can advise you how much to drink. This depends on your body size. Water is best. Drink smaller amounts through the day rather than large amounts of fluids with meals.

Tell your doctor or dietitian if certain foods make your bowel symptoms worse. A dietitian can advise you if changing your diet may be helpful and how best to do this.

Keeping a daily diary of what you eat and how this affects you helps you to work out if certain foods make your symptoms worse.

Foods affect people differently. You may need to try a few changes to your diet before finding out what works best for you.

You may be able to eat less of the foods that upset your bowel without cutting them out altogether. See our food guide for information on how some foods may affect the bowel.

If you think you may have an intolerance to some types of food, such as dairy products or wheat, it’s best to get advice. Ask your doctor to refer you to a gastroenterologist.


Fibre

Fibre helps to regulate the way your bowel works.

There are two types of fibre:

Insoluble fibre helps manage constipation and can help with other bowel problems. You can get insoluble fibre from bran and seeds, such as ground golden linseeds. It’s also in multigrain, wholemeal and wholegrain foods, such as bread and cereals.

Soluble fibre helps bulk up and slow down bowel movements. It may help improve diarrhoea or soft stools. You can get soluble fibre from oats, porridge, bananas, and apples and pears with their skins removed. It’s important to remove the skins, because they contain insoluble fibre.

Pulses, such as baked beans and lentils, are high in soluble fibre. But they stimulate the bowel, so aren’t recommended if you have diarrhoea or soft stools.

Your specialist nurse, continence adviser or gastroenterologist will advise you on the type of fibre you need. They will explain how much you should have.

Add fibre to your diet slowly and start with small amounts. This gives your body time to adjust. You can slowly increase the amount. Make sure you drink more water while you’re increasing your fibre.

Adding more fibre is not right for everyone. After pelvic radiotherapy, you may not be able to cope with as much fibre as before. So it may not be appropriate to follow the ‘five a day’ plan for fruit and vegetables. Some high-fibre foods make the bowel produce a lot of gas (wind). If wind is a problem for you, you may need to avoid these foods.

Fibre supplements

People who have frequent bowel motions or incontinence may be prescribed soluble fibre supplements, such as Normacol® or Fybogel (soluble fibre). These supplements are also used to prevent constipation. They work by absorbing water and expanding to fill the bowel. This makes stools bulkier and easier to push out.

Some people find that Fybogel can make the bowel produce a lot of gas (wind).

You can buy fibre supplements at the chemist, or your doctor can prescribe them. When you’re taking fibre supplements it’s important to drink plenty of fluids – at least two litres every day.


Medicines

It’s important to speak to your doctor or specialist nurse before taking medicines to treat bowel symptoms.

Anti-diarrhoea drugs

If changes to your diet aren’t enough to control bowel problems, anti-diarrhoea drugs may help. It’s important to speak to your doctor or specialist nurse before taking any medicines.

The most commonly used treatment is loperamide (Imodium® or Diareze®). It slows down your bowel, making the stools more solid and less frequent. Taking loperamide regularly, half an hour before meals, works very well for some people. It’s safe to take it for as long as you need it, but discuss this with your doctor.

The dose may need to be adjusted until you find what works best for you. Your doctor may recommend starting with a low dose and increasing this until it’s right for you. Loperamide is also available as syrup. This allows you to take less and adjust the dose as needed.

Sometimes doctors prescribe other anti-diarrhoea tablet, such as codeine phosphate or diphenoxylate (Lomotil®). Your doctor or a continence adviser can advise you about the medicines that may be best for you.

Doctors can also prescribe low doses of anti-depressant drugs to help slow down the bowel.

Medicines that can increase bowel symptoms

Some medicines can make bowel symptoms such as wind or frequent bowel motions worse. These include:

  • non-steroidal anti-inflammatory painkillers (NSAIDs), such as ibuprofen and diclofenac
  • magnesium in antacids (for heartburn)
  • lactulose and Fybogel
  • metformin – a tablet used to treat diabetes
  • beta-blockers – tablets to treat high blood pressure
  • antibiotics
  • some types of antidepressants such as venlafaxine and citalopram.

If you’re taking any of these drugs and think they may be making your symptoms worse, talk to your doctor about whether there are any alternative drugs that might affect you less.


Managing stress

Your emotions can also affect your bowel. Not feeling in control of your bowel can be stressful. Anxiety and stress can make bowel movements looser and more frequent. We have more information about coping with bladder and bowel problems.


Strengthening the muscles used for bowel control

Doing exercises to strengthen the muscles used in bowel control can be very useful. It can help with urgency, leakage of stool and to control wind. These exercises are called pelvic floor muscle exercises or sometimes Kegel exercises. A continence specialist can tell you if they are likely to help and can teach you how to do them.

The exercises work the sphincter muscles around the back passage (anus) and the pelvic floor muscles. The pelvic floor muscles are also important for bladder control and when having sex.

The Bladder and Bowel Foundation has information on how to do pelvic floor muscle exercises. You can order or download it from their website.

It’s important to do pelvic floor muscle exercises correctly and to practise regularly. It can take at least 12 weeks to strengthen the muscles. You need to continue doing the exercises three times a day. Try doing them at the same time every day to get into a routine. Or you can set a reminder on your mobile phone.

Keeping to a healthy weight is also important. Being overweight puts extra stress on your pelvic floor muscles.

Biofeedback training

If you find it difficult to learn pelvic floor muscle exercises, you may be offered biofeedback training to help you. As you squeeze your pelvic floor muscles, sensors measure the pressure. This helps you to know when you’re squeezing in the right way. Biofeedback training is only available in specialist units. If your continence adviser thinks this may help you they can refer you.


Bowel retraining

If you have loose bowels or urgency you may worry you won’t be able to ‘hold on’. Worrying you may not get to the toilet in time can make you anxious. You may try to monitor your bowel for signs that you need to ‘go’. This can make you very aware of any activity in your bowel, including wind.

Continence specialists can help by teaching you to retrain your bowel. The aim is to help you build up the length of time you can ‘hold on’. Bowel retraining is usually used in combination with other approaches. It’s often used with anti-diarrhoea medicines and muscle strengthening exercises (see above).

With bowel retraining you learn to resist the urge to go right away. At first you start by getting to a toilet when you feel the urge. You then wait for a minute or so before actually sitting on the toilet to open your bowels. The aim is to increase the time between feeling the urge to go and emptying your bowel. This will build up your confidence and give you more control of your bowel.


Other treatments

Treating bile acid malabsorption

Bile acid malabsorption can be caused by radiotherapy to the bowel. It causes diarrhoea that’s not helped by anti-diarrhoea medicines.

A bowel specialist can diagnose bile acid malabsorption using a scan called a SeHCAT scan. Your specialist can tell you more about this. The scan will confirm whether you have bile acid malabsorption and how much it will affect you. It is important to get the diagnosis right. If you have bile acid malabsorption, you need to take a drug for the rest of your life to treat it.

You may also be advised to keep to a low-fat diet. Bile acid malabsorption can be treated with a drug called colestyramine (Questran®). It comes as a powder you mix with water or fruit juice.

If your bowel movements (stools) are sometimes pale, smelly and difficult to flush away, Questran may not work. Or it may make things worse. If this happens, your specialist may prescribe a newer medicine, called colesevelam (Cholestagel®). They may also refer you to a dietitian for advice on keeping to a low-fat diet.

Sacral nerve stimulation

Sacral nerve stimulation may be used to treat very troublesome bowel symptoms and help bowel control. It is usually used when other treatments haven’t helped.

Sacral nerve stimulation uses electrical pulses to stimulate the nerves to the bowel. A doctor places electrodes under the skin in the lower back (sacral area). They connect the electrodes to a pulse generator, which produces pulses of electricity. Doctors think these affect the nerves that control the lower part of the bowel and the anal sphincter.

The treatment is in two parts. First, you are tested with temporary electrodes. This is to check if sacral nerve stimulation works for you. If the test is successful, you can have a small permanent implant fitted.

Back to Long-term and late effects

Changes in how your bowel works

Treatment for rectal cancer may lead to changes in how your bowel works. These can usually be managed successfully over time.

Managing bladder problems

There are ways to manage changes in the way your bladder works. It’s important to talk to your doctor if you’re having problems.