First steps: managing faecal incontinence

Your healthcare professional should explain that you may need to try several different strategies to help manage your incontinence.

Your bowel habit

Management of your faecal incontinence can be helped by ensuring that you have bowel movements at specific times during the day. Your healthcare professional should:

  • encourage you to use the toilet after a meal

  • make sure you have access to private, comfortable and safe toilet facilities that you can use for as long as you need

  • encourage you to sit or squat where possible when emptying your bowel

  • teach you how to empty your bowel without straining.

Your diet

You should be given advice about changing your diet, because the type of food you eat and the amount of fluid you drink can help with regular bowel movements and the firmness of your stools. You may be asked to keep a diary of your food and fluid intake so that any changes can take into account your current diet. Any changes should also consider particular dietary needs that you may have. You may be checked for signs of malnutrition.

Questions about diet

  • Are there foods that could be making my incontinence worse?

  • Are there foods I could try that would help avoid constipation?

  • How much fluid should I drink?

Access to the toilet

A very important way of helping you manage your incontinence is to make sure you can use the toilet as easily as possible. A healthcare professional may assess your home and your mobility to see what extra help you might need. You should be given advice about clothing that is easy to remove so that you can use the toilet more quickly.

Any equipment needed to help you get to the toilet should be provided. If you are in a hospital or a care home, toilets should be easy to find.

Help to use the toilet should always be available if you need it. Your privacy and dignity should always be respected.

Your existing medicines

If you are taking any medicines your healthcare professional should consider whether this is making your incontinence worse, and if so offer a different treatment if possible.

Medicines for faecal incontinence

If you have faecal incontinence with loose stools, you should usually be offered a drug that stops diarrhoea, as long as the problem isn't caused by your diet or by laxatives. In most cases (see below) the first drug you should be offered is loperamide, which you can take for as long as you need. You can change the dose, and stop and start taking loperamide as needed, depending on the consistency of your stools and on your lifestyle. If you are taking a low dose of loperamide, you may be offered loperamide syrup instead of tablets. However, you should not be offered loperamide if you have hard or infrequent stools, acute diarrhoea without a diagnosed cause, or an acute flare-up of ulcerative colitis.

Questions about medicines

  • How long will I have to take the medicine for?

  • What benefits should I expect?

  • Is it important to take the medicine regularly, or can I take it as and when I need it?

  • Are there any serious side effects associated with this medicine?

Review and long-term management

After each stage of your treatment, your healthcare professional should ask whether it has helped you. If it hasn't helped, you should be able to discuss other options.

If you decide not to have any more treatment for your incontinence, or if it doesn't improve, you should be given practical and emotional help as described in this information. You should also be offered 6-monthly check-ups and given advice about how to maintain your dignity and independence. Your healthcare professional may suggest that you see a therapist or counsellor if this might help you to cope with your condition better. You should receive continuing advice about other treatment options, including referral to a specialist.