Bowel Dysfunction

Overview

Bowel dysfunction is a broad term for problems with how the bowels move and how well a person can control them. Normal bowel function depends on coordinated muscle activity, healthy nerves, and intact reflexes that move waste through the intestine and allow it to be passed at a convenient time. When any part of this system is disrupted, the result can be difficulty passing stool (constipation), an inability to control bowel movements (incontinence), or a combination of both.

Bowel dysfunction can result from nerve or spinal injury, neurological diseases, pelvic floor problems, or damage from surgery or childbirth. The term "neurogenic bowel" is used when the cause is a problem with the nerves controlling the bowel. While these problems can be distressing and have a real impact on daily life and dignity, many can be improved with a structured management plan.

Symptoms

Symptoms vary depending on the cause and whether the main problem is sluggish movement, loss of control, or both.

• Constipation, hard stools, or difficulty and straining when passing stool
• A feeling of incomplete emptying or blockage
• Loss of control over bowel movements (fecal incontinence), including leakage or accidents
• Urgent, hard-to-control urges to pass stool
• Loss of the normal sensation of needing to go
• Abdominal discomfort, bloating, or cramping
• Long, unpredictable gaps between bowel movements

For some people the main difficulty is being unable to go, while for others it is being unable to hold on; many experience a mix at different times.

Causes

Bowel dysfunction has many possible causes, often involving the nerves or muscles that control the bowel.

• Nerve and spinal injury: Spinal cord injury or nerve damage can disrupt the signals that control bowel movement and sensation.
• Neurological diseases: Conditions such as multiple sclerosis, stroke, and Parkinson disease.
• Pelvic floor problems: Weak or poorly coordinated pelvic muscles, sometimes after childbirth or surgery.
• Damage to the anal sphincter: From childbirth, surgery, or injury.
• Chronic constipation that stretches and weakens the bowel over time.
• Other factors: Diabetes affecting the nerves, some medications, and certain bowel diseases.

Risk Factors

• Spinal cord injury or neurological disease
• Diabetes with nerve damage
• Difficult or assisted childbirth
• Previous pelvic, bowel, or anal surgery
• Long-standing chronic constipation
• Older age and reduced mobility

Diagnosis

Diagnosis focuses on understanding the pattern of symptoms and finding the underlying cause.

• History and bowel diary: Detailed questions about frequency, consistency, control, and triggers.
• Physical examination: Including assessment of the abdomen, pelvic floor, and anal muscles.
• Specialized tests: Such as tests of anal muscle strength and reflexes, imaging of the bowel, or studies of how quickly stool moves through the gut.
• Tests for underlying conditions: To check for nerve, spinal, or bowel disease contributing to the problem.

Identifying whether the problem is mainly with movement, control, or sensation helps tailor treatment.

Treatment

Treatment is individualized and often combines several approaches to establish a regular, predictable, and manageable bowel pattern.

• Diet and fluids: Adequate fiber and fluids, adjusted to the type of problem.
• Bowel routine: Establishing a regular time and routine for emptying the bowel.
• Medications: Laxatives or stool softeners for constipation, or medicines to firm stool and reduce urgency for incontinence.
• Pelvic floor therapy and biofeedback: To strengthen and coordinate the muscles that control the bowel.
• Bowel programs: Structured techniques, including for people with neurological causes, to empty the bowel reliably.
• Treating the underlying condition: Such as managing diabetes, repairing sphincter damage, or addressing spinal problems.

With a consistent plan, many people gain better control and confidence, even when the underlying cause is long-term.

Prevention

• Eat enough fiber and drink adequate fluids to keep stools regular
• Stay physically active, which helps bowel function
• Respond promptly to the urge to have a bowel movement and avoid long-term straining
• Do pelvic floor exercises if advised, especially after childbirth
• Manage conditions such as diabetes that can affect the nerves
• Follow a recommended bowel routine if you have a neurological condition

When to See a Doctor

See a doctor if you have ongoing constipation, loss of bowel control, or a change in your usual bowel habits. Seek urgent or emergency care if you have:

• Sudden loss of bowel control along with leg weakness or numbness in the groin or saddle area, which can signal serious nerve or spinal compression
• Severe abdominal pain, swelling, vomiting, and inability to pass stool or gas, which may indicate a blockage
• Bleeding from the bowel, especially if heavy
• Unexplained weight loss or persistent change in bowel habits

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Bowel problems.
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Bowel Control Problems.
3. Mayo Clinic. Fecal incontinence and constipation — Symptoms and causes.
4. National Institute of Neurological Disorders and Stroke (NINDS). Spinal cord injury information.