Managing bowel incontinence (leakage)

Bowel incontinence (leakage) is when your bowels can't hold in your poo. First line treatments for it are the ones used first and that work for most people. Second line treatments are ones you try if first line ones don't work. And third line treatments are the ones only used when all other options have failed. There are also experimental treatments you might try but evidence for these isn't strong.

First line treatments 

You’re likely to need a mix of treatments to get in control of bowel (faecal) incontinence.

Drugs to help with incontinence (leakage)  

There’s not much evidence about which drugs, if any, have a big impact on bowel incontinence. But if your poo is loose or soft, the first step is usually to make it firmer.      

The drug loperamide (brand name is Imodium) is the first drug to try. It slows your gut down, so that runny poo stays in it longer. More water gets absorbed from it by your gut, making your poo more solid. You take this drug as a tablet or a syrup.     

Sometimes using laxatives too often, and too much fibre in your diet, can make your poo loose. If that’s behind your problem, cut down or avoid these.     

Firming up your poo might make it too hard and trigger constipation. So when you start an anti-diarrhoea drug (like loperamide), begin with small doses. Then take bigger ones if you need to.      

Drugs that can actually cause runny poo    

Drugs that many people with MS use can cause diarrhoea and lead to leakage:    

• muscle spasms and stiffness drugs, like baclofen (brand name Lioresal). Your dose may need checking  
• the following disease modifying therapies (DMTs): teriflunomide (Aubagio), dimethyl fumarate (Tecfidera) and fingolimod (Gilenya)
• laxatives      
• blood pressure drugs like beta-blockers and calcium channel blockers      
• metformin, a diabetes drug      
• antibiotics like penicillin and erythromycin      
• some anti-depressants (tricyclics and SSRIs)
• the sedative benzodiazepine      

Your doctor or MS nurse can advise you if you get diarrhoea from these drugs. Don’t stop taking a drug without talking to your doctor. You can ask for a Medicines Use Review with the pharmacist who gives you your prescriptions. They’ll check if taking these drugs, especially several together, might give you bowel problems.  

In Scotland ask for a Medicines Care Review instead. You may need to ask at several pharmacies until you find one that offers this service. 

Second line treatments 

There's only one second line treatment for bowel incontinence (poo leakage) caused by MS. It’s called transanal irrigation (TAI). You try this if gentler first line treatments don't work. 

Third line treatments

The third line treatment for MS bowel problems, including incontinence (and constipation), is surgery. Few people need this. But it's worth thinking about if all other treatments don't work. A number of surgeries are possible. 

Experimental treatments

Pelvic floor muscle training   

Pelvic floor exercises strengthen muscles around your bowels and rectum (back passage),  including your external anal sphincter. Both men and women can do these exercises. Evidence that these exercises make much of a difference isn’t that strong. You might get better results by combining them with biofeedback.    

Imagine you’re clenching the muscles around your back passage (rectum) to stop some wind escaping. The muscles you feel tightening are the ones to work on.     

You can do the exercises sitting down. Squeeze the muscles 10-15 times in a row without holding your breath. Don’t tighten your stomach, buttock or thigh muscles.    

Hold each squeeze for a few seconds. Add more squeezes each week (resting between each set of squeezes). Try to do the exercises three times a day. A continence physiotherapist or continence nurse can teach you a good technique.    

It takes a few months before you feel it’s working. If you start feeling a difference, don’t stop. You need to keep exercising these muscles.

We have a video that talks you through pelvic floor exercises. 

There's also a leaflet from London’s St Mark’s Hospital that shows exercises to help with bowel leakage.

Electrical stimulation of the nerves  

Electrical stimulation of the nerves involves sending a low-level electric current along nerves that connect with your bowels. This can change how the muscles there behave. That can help with incontinence (and constipation). This is called neuro-modulation. 

Anal inserts for poo leakage    

You put one of these inserts up your rectum (back passage) to stop leakage. They're made of silicone and come in different sizes. Once the insert is in place, the silicon moulds to make a seal. This stops it slipping out and plugs your bottom so that nothing can leak out.      

You can keep an insert inside you for 12 hours (although the makers of Navina anal inserts say up to 24 hours for their product). You take it out if you want to poo. Some people find them uncomfortable to wear, especially over many hours. To take it out, pull the insert at the end.    

You can get anal inserts on prescription after you’ve been assessed by a health worker.