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Constipation and Urinary Incontinence

What is a normal bowel habit?

A normal pattern of bowel movement can vary considerably from person to person. Most people will empty their bowels between three times daily and three times per week.

What is constipation?

Constipation is a common problem, resulting in less frequent bowel actions. In most cases, the stool is hard and dry, and small amounts may be passed with difficulty. You may experience cramps, swelling, pain with straining and a feeling of incomplete emptying of the bowel.

What causes constipation?

There are a number of factors which cause or contribute to constipation, including:

• not eating enough fibre;
• not drinking enough fluid;
• not getting enough exercise;
• long term laxative use;
• some medications (check with your doctor);
• debility or frailty;
• pregnancy;
• anxiety, depression and grief;
• disorders of the bowel which may require further investigation; or
• chronic illness e.g. an underactive thyroid, Parkinson's Disease, multiple sclerosis.

Can there be complications?

Constipation may cause faeces to pack the intestine and rectum so tightly that the normal pushing action fails and the colon is not strong enough to expel the stool. This is called faecal impaction.

Accidental loss of faeces, i.e. faecal incontinence can occur in those with constipation when the bowel becomes too full.

Haemorrhoids can be caused by straining to have a bowel movement. Anal fissures (tears in skin around anus) are caused when a hard stool stretches the sphincter muscle.

In extreme cases straining can cause a small amount of intestinal lining to push out from the anal opening causing a rectal prolapse.

How can constipation affect bladder control?

Constipation can contribute to loss of bladder control by:

• Weakening of the pelvic floor muscles due to chronic straining when emptying the bowels.
• A full bowel pressing on the bladder can obstruct the outflow of urine, or affect the capacity of the bladder, making you feel that you need to go to the toilet more frequently than normal.

How to prevent constipation

You may like to try these simple changes to your lifestyle. Consult with your doctor or continence advisor, if you need further assistance.

Drink at least six or eight glasses of fluid per day (approximately 1,500 millilitres), unless advised otherwise by your doctor.

People with bladder control problems often don't drink very much fluid for fear of becoming wet, which often results in them becoming constipated and worsening the problem.

Add fibre to your diet. Fibre comes from the non-digestable part of fruit and vegetables. You need approximately 30 grams of fibre per day. Natural foods rich in fibre include:

• all vegetables;
• all fruits, including dried fruit;
• whole grain and wholemeal cereals and breads; and
• legumes, e.g. baked beans, kidney and soya beans.

If you can only tolerate soft foods, the following foods are a good source of fibre: 
Bananas, rolled oats, fruit juices, pureed vegetables and stewed or canned fruit.

Remember

You must increase your fluid intake when increasing your fibre intake.

Daily exercise, e.g. take a daily walk. Walking encourages the movement of faeces through the bowel and promotes regular bowel habits.

What to do if you become constipated

Start by increasing the fluid and fibre in your diet. Review your medications with your doctor. If these measures do not bring success, only then consider the use of medications, e.g. laxatives.

Remember

Laxatives should normally only be taken for short periods of time.

There are three types of laxatives:

1. Bulking Agents
   These increase the bulk of stool. An adequate fluid intake is essential with these laxatives.

2. Lubricant Laxatives
   These soften the faeces.

3. Stimulant/Irritant Laxatives
   These promote bowel movement by irritating/stimulating the bowel wall.

Consult the doctor or continence advisor regarding which type of laxative is best suited to your needs.

What to do if constipation persists

In severe or chronic cases of constipation the following treatment may be necessary:

A night time dose of stimulant laxative, followed next morning by a suppository or enema; in extreme cases repeated enemas may be required.

If you continue to have problems with constipation or diarrhoea, or are experiencing a change from your usual bowel pattern, with or without pain or blood please see your doctor.

Remember

You are not alone. Incontinence can be cured, treated or more effectively managed.

Where can help be found?

There are many health professionals qualified to assist you with bladder control problems. You may seek assistance from your doctor who may offer treatment directly or refer you to a specialist, or to a qualified continence advisor. You may also seek help and obtain information directly from the following sources:

• National Helpline 1800 330 066
• Continence services and clinics.
• Continence Nurse Advisors.
• Local Community Health Centres.
• Local Doctors.
• Domiciliary Nursing Services.
• Independent Living Centres.
• Continence Foundation of Australia.
• Australian Physiotherapy Association in your state (see telephone book)