Key facts about managing bowel incontinence - Helpful techniques

What are the best techniques to assist with bowel emptying?
There are many techniques and methods for emptying bowels ranging from normal toileting to sophisticated surgical techniques. Most of you will have had extensive toileting experience.

Establishing a bowel emptying routine
Effective bowel management involves a system for bowel emptying at regular intervals, at least every 24 hours. For example, you could associate the timing of bowel emptying with meals, baths, and physical activities. A particular time of day can help establish predictable continence patterns.

Anal/rectal stimulation
Sometimes anal/rectal stimulation to promote bowel emptying can be achieved by wiping the anus firmly with toilet paper as soon as you sit. If the stool is not being expelled, slight pressure can be applied with the fingers to each side of the anus.
Digital stimulation involves inserting a gloved finger into the anus and massaging to stimulate a contraction to eliminate a stool.

Suppositories and microenemas
Most enemas and suppositories are special fluids squirted or placed into the anus. They assist to irrigate the bowel and wash out the stools. They assist particularly where you have reduced ability to push out the stools.

Large volume wash outs
If other methods do not work, large volume enemas also called ‘colonic washouts’ may be required to wash out the bowel. The amount and type of fluid is determined by the specialist clinic, and may include solutions of salty water; soap and water; or other solutions. The enema is administered by using a bowel washout kit. Make sure you get assistance from your continence nurse, and regularly review your technique at regular check-up visits.

A large volume washout will clear the bowel for up to three days. The main problem is that you will probably need help to administer it. This of course means you are not as independent as you would like to be.

Are there any other procedures that may help with bowel incontinence?
Yes. Buttock strapping is a possibility. This provides a bit of extra assistance to your anus to hold in stools. However, this technique will not work when the stools are soft, or when there is diarrhoea. Strapping can be used when swimming, on special outings or even most of the time.
Try different types of tapes to ensure that they are waterproof or that no adverse reactions will occur. Typically used tapes include elastic adhesive tapes, nonallergenic tapes, waterproof adhesive and even electrician’s tape.

Buttock strapping procedure

• The tape is applied low on the buttocks so that it is under you when you sit down.
• Cut the appropriate length of tape.
• Look for the position of the anus.
• Attach tape to one buttock. While holding buttocks together, attach the other end of the tape to the other buttock, ensuring that the tape passes over the anus.
• If the skin is sensitive, place some nonallergenic tape on each buttock. Stronger tape can then be applied on top of this.
• If the anus is very lax, a small piece of paper, such as half a piece of toilet paper, can be folded and placed over the anus. Females should check that the tape has not slipped down into the vagina.

What is an anal plug?
Anal plugs are an important continence management tool, and can offer real independence for some. The anal plug, made from foam, is lubricated with Vaseline and inserted into the anus. After coming into contact with the moisture of the bowel, the plug expands in about 30 seconds to form a bowl-like shape that prevents leakage. The anal plug is made from slightly porous material so that air can pass though it. The plug is removed with an attached string and is changed after each toilet visit.
The anal plug can be worn safely for up to 12 hours. Combined with diet and bowel emptying procedures, anal plugs have significantly changed the lives of many.