Behaviour Change Ahead? – Bowel Problems

In last week’s article, I talked about emotions and emotional responses around Urinary Tract Infections (UTI). Today is the turn of constipation and faecal incontinence.

Imagine you cannot sit still for long because you are constipated, are having faecal incontinence or stomach pains.

You get up and start walking around looking for the nearest toilet, you get told to sit down, up and down you go getting more and more frustrated and emotional, you desperately need to find a toilet but again you are told to sit down, maybe you are told you are a nuisance, or they haven’t time to keep telling you to sit down, wouldn’t you have an emotional response.

It’s claimed you keep family awake at night, you are disturbing residents or are non-compliant.

You are likely to be labelled with behaviours and aggression via the medical model of BPSD and sent down the pathway where you will likely be chemically restrained, treating the symptoms not the cause.

Symptoms of constipation can include:

  • back pain due to the mass of poo pressing on the nerves in your lower back (the sacral nerves)
  • a swollen tummy (abdomen)
  • high or low blood pressure
  • a fast heart rate
  • dizziness
  • sweating
  • a high temperature (fever)
  • confusion
  • explosive diarrhoea or diarrhoea that you have no control over
  • feeling and being sick
  • severe abdominal pain
  • dehydration
  • Polypharmacy i.e. Co-Codamol is a common cause of constipation
  • Emotional responses

Symptoms of faecal incontinence can include:

  • People with disorders such as Parkinson’s disease, Multiple Sclerosis, Stroke, Spinal cord injury and Alzheimer’s can sometimes develop faecal incontinence that is associated with their illness
  • Some medications like antibiotics can cause loose stools /diarrhoea which may make symptoms worse
  • People with inflammatory bowel diseases which can cause diarrhoea and an urgent need to go to the toilet.
  • Muscle damage.Injury to the rings of muscle at the end of the rectum (anal sphincter) may make it difficult to hold stool back properly. This kind of damage can occur during childbirth, especially if you have an episiotomy or forceps are used during delivery.
  • Nerve damage.Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to faecal incontinence. The nerve damage can be caused by childbirth, constant straining during bowel movements, spinal cord injury or stroke. Some diseases, such as diabetes and multiple sclerosis, also can affect these nerves and cause damage that leads to faecal incontinence.
  • Chronic constipation may cause a dry, hard mass of stool (impacted stool) to form in the rectum and become too large to pass. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool from farther up the digestive tract to move around the impacted stool and leak out. Chronic constipation may also cause nerve damage that leads to faecal incontinence.
  • Solid stool is easier to retain in the rectum than is loose stool, so the loose stools of diarrhoea can cause or worsen faecal incontinence.
  • When the veins in your rectum swell, causing haemorrhoids, this keeps your anus from closing completely, which can allow stool to leak out.
  • Loss of storage capacity in the rectum.Normally, the rectum stretches to accommodate stool. If your rectum is scarred or your rectal walls have stiffened from surgery, radiation treatment or inflammatory bowel disease, the rectum can’t stretch as much as it needs to, and excess stool can leak out.
  • Surgery to treat enlarged veins in the rectum or anus (haemorrhoids), as well as more-complex operations involving the rectum and anus, can cause muscle and nerve damage that leads to faecal incontinence.
  • Rectal prolapse.Faecal incontinence can be a result of this condition, in which the rectum drops down into the anus.
  • In women, faecal incontinence can occur if the rectum protrudes through the vagina.
  • Polypharmacy
  • Emotional Responses

It must be remembered reader, that Constipation and Faecal Incontinence are not a normal part of ageing.

We can be constipated yet have loose stools, there may be a plug in our anus, known as faecal impaction but we pass loose stools around the plug.

Using the medical model and treating the symptoms we could be treated for faecal incontinence which would compound the situation, leading to an emotional response and ultimately chemical restraint to “make you more compliant”.

The problem is then compounded further, and we may end up in Hospital with a bowel obstruction that may lead to surgery and being labelled as a bed blocker because there is no social care available or as a resident of a home, you may have lost your bed because the home says they can no longer cope with you.

Using the social model, a medical professional would investigate the causes and should therefore determine the true cause of the incontinence and treat the cause not the symptoms..

We all know how embarrassing and uncomfortable being constipated or faecally incontinent can be, is it any surprise that we have emotional responses when we experience these things.

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