It's Time to Talk About Accidental Bowel Leakage

Madison, Wisconsin - It's a problem that affects as many as 20 percent of adults in the U.S., but you probably haven't heard much about it.


That's why doctors and researchers at the University of Wisconsin School of Medicine and Public Health are working to change perceptions and encourage conversation about accidental bowel leakage (ABL), the accidental loss of liquid or solid stool from the rectum.


Video: Tackling the Taboo View Dr. Brown's webinar presentation: Tackling the Taboo: Let's Talk About Accidental Bowel Leakage


You're Not Alone


In recent studies about accidental bowel leakage, researchers have found that nearly one in 5 women over the age of 40 has reported an episode of ABL, and the condition appears to affect men at similar levels.


But while those who suffer from ABL certainly aren't alone, the silence is loud and clear.


That's why health care professionals are championing the relatively new term of "accidental bowel leakage" to describe and discuss the condition, rather than the more widely used medical term of "fecal incontinence."


"Having this new terminology to talk about this condition is going to really make it easier for us to start the conversation," says Heidi Brown, MD, a UW Health urogynecologist who specializes in female pelvic medicine and reconstructive surgery. 


"When you say 'accidental bowel leakage,' people will say, 'Oh, that happens to me – I have that,'" Brown says. "People may not be as comfortable saying that when you use other words."


Brown and other researchers published a key study about ABL in the November 2012 International Journal of Clinical Practice which highlighted the crux of the problem: Nobody's talking about it, and too few people are seeking care when accidental bowel leakage happens to them.


Clearing up misconceptions about ABL is one way to encourage conversation and ultimately point ABL sufferers to solutions and resources, Brown says.


"This doesn't just happen to 'old people' – that's a myth," Brown says, noting that approximately 70 percent of those affected by ABL are younger than 60. "ABL affects all different kinds of people."


Accidental Bowel Leakage Risk Factors


While age is one factor, a variety of conditions and factors can lead to ABL, including:

  • Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), Crohn's disease, ulcerative colitis and other digestive disorders, such as chronic constipation and chronic diarrhea (especially after gallbladder removal)
  • Diabetes
  • Obesity
  • Stroke
  • Neurologic conditions
  • Radiation to the pelvic floor from cancer treatment
  • Surgery in the pelvis (such as prostate, cervical, uterine and colorectal cancer)
  • Trauma due to either an accident or a vaginal birth

Treatment for Accidental Bowel Leakage


Regardless of the cause of ABL, good solutions exist.


"Anybody can have ABL, and there are things that anybody with ABL can do to make it better," Brown says.


Mild problems may be addressed with constipating medications or dietary adjustments to increase fiber and avoid ABL triggers, which include:

  • Caffeine
  • Spicy foods
  • Milk products
  • Chocolate
  • Olestra
  • Artificial sweeteners

Strengthening the pelvic floor through Kegel squeezes can also improve symptoms. Some people will benefit from biofeedback training to learn to sense the stool and strengthen the muscles to control the problem. In biofeedback training, an EMG sensor connected to a computer provides a visual display of the patient's efforts to control pelvic floor muscles. Over the course of the biofeedback training sessions, the patient then learns to isolate the appropriate muscles, typically resulting in an improvement in incontinent episodes.


Physicians who specialize in the treatment of ABL may also offer an office-based procedure called Solesta to bulk the anal canal, or an outpatient surgery to place a pacemaker for the pelvic floor called sacral neuromodulation, or Interstim.


Skin irritation from ABL can be avoided through the use of butterfly-shaped body liners made for bowel leakage, alcohol-free moist wipes and barrier creams like zinc oxide. If these options are not enough, your primary care doctor can refer you to a specialist.


"If you are experiencing ABL, having a conversation with a health care provider can be a helpful start," Brown says.


Start the Conversation with Your Doctor


Learn more about questions to discuss with your doctor from


Your ABL Conversation Starter


Accidental Bowel Leakage Study


The University of Wisconsin-Madison School of Medicine and Public Health is participating in the LIBERATE Study, a national, multi-center clinical trial evaluating the long-term safety and effectiveness of an updated device for the treatment of fecal incontinence. Dr. Heidi Brown is the principal investigator for UW-Madison, which is one of 14 sites around the nation. Learn more 

Date Published: 05/02/2017

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