Incontinence of Stool

General Information
Constipation is the slowing of bowel function. Bowel movements become less frequent. With constipation, people also strain at the time of the bowel movement, pass hard dry stools, and have the sensation of an incomplete bowel movement. Some people also experience an urge to have a bowel movement but are unable to carry it through. Many people will have only one or two of these symptoms.

By itself, constipation is responsible for only a few problems. It may cause the development of fecal impaction and straining at stool. The hard stools sometimes associated with constipation may give rise to fissure or cause hemorrhoids to bleed. The straining associated with constipation may be a cause of prolapse of hemorrhoids.

Constipation receives the blame for many other systemic symptoms. Most of these are nonspecific, such as fatigue, insomnia, fullness, and loss of appetite. It is not likely that the constipation is a direct cause of this sort of symptom.

For most people, bowel function and its frequency are regular in occurrence and timing during the day. The range of normal frequency is wide, from three bowel movements daily to three times a week; both greater and lesser frequency rates occur in normal people.

Far more significant is a change in the customary frequency or regularity, or both. However, such a change is only a clue, not a diagnosis. There are many innocent causes for a change in bowel habit. These include changes in diet, both composition and amount, including the addition or substitution of milk, fiber, fresh fruit, and the like. Abrupt changes in exercise such as caused by illness also can change function. Even gravity seems important, and prolonged bedrest alone can slow bowel function. Less frequent, but much more serious, are changes in bowel habit caused by thyroid disease or complications from diabetes, heart failure, or other problems. Differentiation of simple constipation from more complicated medical problems is the physician’s task.

While relief of symptoms greatly improves comfort, your physician is equally concerned with the cause of the constipation. Tumors and narrowing of the colon may also give rise to constipation-like symptoms. Do not assume that constipation is harmless.

Important Points in Treatment
The best treatment for constipation is treatment of the underlying cause. Laxatives, however effective, remain the second best treatment. Controlling symptoms is never as effective as curing them. Many different classes of cathartics are available without the need for a prescription. These include potent agents that can stimulate bowel action in most individuals despite the mechanism of their constipation. Such therapy provides only temporary relief of symptoms. Selection of a laxative that has a mechanism of action that helps the return to normal bowel habit is a far more appropriate treatment. Your physician remains your best guide to this selection.

Notify Our Office If ...

• You experience a change in bowel habit. The best treatment for constipation is treatment of the underlying cause.

Enemas

General Information
Any injection of fluid into the rectum is an enema. It can be used for the administration of drugs, for the purpose of diagnosis, in preparation for diagnostic procedures, or, most commonly, for the stimulation of a bowel movement.

Properly done, an enema is not harmful to health or the colon (the large intestine). Improperly done or done with toxic or harsh constituents, it can harm the intestine, one’s general health, or both. In certain diseases of the rectum and large intestine, enemas are potentially harmful.

Enemas intended for therapy for diseases should be used only as prescribed by your physician. Many drugs that enter through the lower intestinal tract require careful regulation of dosage. Diagnostic enemas are always used at the discretion of a physician.

Cleansing enemas have been a feature of personal hygiene for centuries. In the middle 1800s and early 1900s, there was a belief that toxic fermentations from the bacteria in the lower intestinal tract were responsible for many different illnesses and for ill health in general. Thus, many people used frequent, even daily, cleansing enemas. There is no evidence that cleansing enemas are necessary or desirable for maintenance of good health and well-being. Generally, such cleansing is not harmful; it is just not necessary. Individuals who have become comfortable with the procedure may safely continue. Initiation of regular cleansing enemas is often not necessary.

Occasionally, enemas can be used to relieve simple constipation. Constipation that recurs and represents a change in bowel habit is a symptom that should be reported to your physician. Effective relief with an enema can mask a serious underlying health problem.

Important Points in Treatment
If you want to or you must use an enema, several points are important. Devices for administration should be cleaned to the point of being sterile. It is possible to introduce infection with improperly cleaned administration devices. Many small-volume enemas and disposable administration kits are available at drug stores.

The volume of an enema should be carefully controlled. Rarely is more than one pint of enema fluid required, and one quart should be the absolute limit.

The fluid constituents should be mild and nontoxic. Tap-water enemas made with potable water involve few complications. Injury of the lining of the lower intestine has occurred from such innocent substances as soapsuds. Salt-containing enemas may be harmful in patients with heart disease. If you have any question about the safety of using an enema, seek the advice of your physician. If you have a rectal abscess, fissure, or serious hemorrhoidal disease, an enema may cause pain or more serious consequences. Enemas may also be contraindicated in certain primary intestinal diseases.

Notify Our Office If

• You have constipation that recurs. This represents a change in bowel habit.

Laxatives

General Information
Normal bowel function is a concern that has captured human attention from time immemorial. Although at one time or another, many signs and symptoms associated with diseases were ascribed to simple constipation, constipation causes relatively few problems.

For most people, bowel function and its frequency are regular in occurrence and timing during the day. The range of normal frequency is wide, from three bowel movements daily to three times per week; both greater and lesser frequency rates occur in normal people.

Far more significant is a change in your customary frequency or regularity, or both. However, such a change is only a clue, not a diagnosis. There are many innocent causes for a change in bowel habit. These include changes in diet, both composition and amount, including the addition or substitution of milk, fiber, fresh fruit, and the like. Abrupt changes in exercise such as caused by illness also can change function. Even gravity seems important, and prolonged bedrest alone can slow bowel function. Less frequent, but much more serious, are changes in bowel habit caused by thyroid disease or complications from diabetes, heart failure, or other problems. Differentiation of simple constipation from more complicated medical problems is the physician’s task.

Important Points in Treatment
Treatment of simple constipation is most effective if it addresses the probable cause of the constipation. Laxative preparations are available in many varieties, including bulk-forming agents, chemical stimulants, contact stimulants (agents that have a direct effect when they contact the lining of the intestine), stool softeners, and saline cathartics (the traditional "dose of salts"). All can be effective in stimulating a bowel movement, but only the careful matching of a laxative with the cause of the constipation can provide a return to your normal bowel habit, after which the use of the laxative should be stopped altogether.

Prolonged use of a laxative, which is often the outcome of selection of an improper laxative, may lead to unwanted side effects and complications. In effect, this is a form of laxative abuse. These complications can include weakness because of a loss of fluids and salts and the development of pigmentation in the lining of the large intestine, the colon.

Powerful cathartics of all classes are regularly available without prescription. Nonetheless, their appropriate use requires the same insight and understanding that are necessary to select from the many prescription-only drugs available for other diseases. Thus, your physician remains your most authoritative guide. Whenever possible, it is best to treat the underlying cause of the constipation and, if necessary, to select the laxative that reinforces the return to normal bowel habit.

Notify Our Office If ...

• You have any change in bowel habit. Far more significant is a change in your customary frequency or regularity, or both. Such a change is only a clue, not a diagnosis.