Far more people than you might think have trouble with anal incontinence, meaning they are unable to control their bowel movements, leading to unexpected leaks of wind or stool. A great many of these people find their symptoms too embarrassing to tell anyone about, perhaps feeling afraid of how other people might react. They can go for years without asking for help. This is unfortunate, because there is plenty of help available.
‘ostomates face many similar issues’
Anal incontinence usually comes about because of difficulties with the pelvic floor muscles. It is especially common among women.1 This is because women’s pelvic floor muscles are typically a little weaker to start with, and then they are put under a lot of strain during childbirth. Although childbirth is now far safer than ever before, more than one in ten new mothers have trouble with continence three months after giving birth.
Ways to help
Ensure toilets access when out and about
Use the RADAR key, Just Can’t Wait card, Need a Loo website and ToiletFinder app
Protect and soothe sensitive skin
Applying barrier cream or moisturiser; showering with a bidet; using moist toilet tissue; taking a warm, shallow sitz bath
Eat the right foods
Eat probiotics and soluble fibres, and avoid insoluble fibres, FODMAPs and wind
Get active to strengthen pelvic muscles
Pelvic floor exercises, bowel training, urge control, gentle exercise to keep fit
Get the right kit
Rectal irrigation, glycerine suppositories, anal plugs, enemas and silicone inserts
Take care
Support garments and no heavy lifting
Studies have shown that incontinence can have a hugely negative effect on new mothers’ body image, which can lead to feelings of isolation and anxiety.2,3 This often has a ripple effect on to other people. On a family level, mothers can become less comfortable making physical contact and may find it harder to bond with partners and children. Meanwhile, women with particularly unpredictable bowel function may be unable to return to work, which is a problem for her as well as wider society.
The MASIC foundation (Mothers with Anal Sphincter Injuries in Childbirth) was established at the beginning of 2017 to provide support for mothers experiencing difficulties from pelvic floor injuries during childbirth. The charity aims to increase awareness and educate people about this problem and what can be done to help. MASIC is working on:
Campaigning to drive change in health policy to avoid these injuries and improve their detection
• Promoting awareness among doctors and nurses
• Advancing awareness among the general public
• Promoting research into what causes anal sphincter injuries and how they can be prevented, detected and treated
• Supporting mothers who have sustained these injuries and their families.
MASIC has put together a website for women and health visitors who need information about sphincter injuries. It uses the latest research on anal sphincter injury to provide practical advice and recommendations for how professionals can work together to improve care for women who suffer damage during childbirth. MASIC is also providing regional education days for medical and nursing staff to improve care and raise awareness of the problems these women face.
Other useful contacts
Bladder and Bowel Foundation
Helpline: 01926 357220
www.bladderandbowelfoundation.org
Core
Tel: 0207 486 0341
www.corecharity.org.uk
MASIC’s campaigns hope to change the way the NHS works to reduce birth injuries and improve their detection and rates of repair after birth. Other projects in the works include advice about employment and work life for people with incontinence, as well as where to access help for any residual symptoms. There are also plans to set up regional self-help groups, where women can access support to help them reduce the impact of incontinence.
References
1 Brown S, Gartland D, Perlen S . Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study. Br J Obstetric Gynaecol. 2015; 122(7):954–62
2 Keighley MRB, Perston Y, Bradshaw E . The social, psychological, emotional morbidity and adjustment techniques for women with anal incontinence following obstetric anal sphincter injury. BMC Pregnancy Childbirth. 2016; 16(1)
3 Kumar R. Anal incontinence and quality of life following obstetric anal sphincter injury. Arch Gynecol Obstet. 2012; 285(3):591–7
Whether it is sore skin, trouble with body image or the need to keep muscles supported, ostomates face many similar issues to people with incontinence. At MASIC, we hope there will be many opportunities for shared support and mutual understanding between people living with these two conditions.
Yvette Perston is a colorectal nurse specialist team at University Hospital Birmingham
Contact MASIC
Telephone: +44 (0) 7721 618 078
Post: The MASIC Foundation
Oxford Science Park
John Eccles House
Robert Robinson Avenue
Oxford, OX4 4GP
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