Bladder and Bowel

Many conditions can affect your bladder and bowel. For example:

• Stroke can damage the nervous pathways that control your bladder and/or bowel
• Long Covid can be accompanied by irritable bowel disease, which usually passes with time
• Some respiratory conditions may make incontinence worse

This can cause incontinence (an inability to control when you go to the toilet), or it may cause other issues like diarrhoea (loose, liquid poo) or constipation (difficulty pooing).

Bladder and bowel issues can be difficult to talk about, and may be embarrassing, but you shouldn’t be afraid to tell a doctor or other health professional if you have problems with going to the toilet. These issues can have a big impact on your wellbeing, and they can often be treated or managed if you speak to a health professional about them.

Urinary incontinence

Urinary incontinence is when you have trouble controlling when you pee. You may find that you need to pee more often, or that pee comes out when you laugh, cough, or exert yourself. In some cases, you may have no control at all over when you pee.

There are a range of pads, underwear inserts, and specially designed underwear which can absorb incontinence if you are unable to control when you pee. These have come a long way in recent years – many easily-available incontinence pads are slim, unobtrusive, and comfortable, and you can even buy incontinence underwear which looks just like regular underwear. Most pharmacies stock pads for urinary incontinence next to or near the feminine hygiene products.

You may also be advised to do exercises which can strengthen your bladder muscles, or strengthen the pelvic floor – the muscles which surround your urethra, rectum, and reproductive organs.

If you need to pee more often than usual, but can hold it for at least a short time, it may be helpful to reduce your fluid intake and to make sure that you are close to a toilet when possible. You may also find it helpful to avoid tea and coffee, which are diuretics (i.e. make you pee more), and to reduce alcohol consumption.

Faecal incontinence

Faecal incontinence is when you have trouble with controlling when you poo, usually because there is a problem with the muscle or nerves of the sphincters.

The sphincters (there are two – inner and outer) are rings of muscle around the rectum which tighten and relax to either hold poo inside the body, or to push it out. Following damage to either the muscles or the nerves that control them, you may find that the sphincters no longer do this job properly. This can lead to passing gas (farting) without being able to control it, or to liquid or solid poo leaking from the anus.

You can buy incontinence pads designed specifically for faecal incontinence, which may be scented or treated to reduce the impact of smells. These insert into your underwear and will catch small leakages.

You may find that diet affects your incontinence. Too much fibre, caffeine, alcohol, or artificial sweeteners may loosen your stool, making leakage more likely.

There are exercises which can strengthen the muscles of the sphincters and the surrounding pelvic muscles. This can reduce incontinence very effectively.

As with urinary incontinence, simply being sure that you can get to the toilet quickly often makes life much easier.

Constipation

Constipation is when you struggle to poo. This can be because your poo is too hard and doesn’t contain enough liquid, but it is more often because your gut isn’t moving the way it should. This is common after stroke, and is also associated with Long Covid in some people.

Constipation can be very painful, as pressure builds up in the gut. It can also lead to issues with straining when you go to the toilet, which puts your heart under pressure and may damage the muscles of your rectum and anus. However, there are many effective treatments for constipation.

• A high-fibre diet – one containing a lot of bran, cereal, and fruit – can loosen your poo, making it easier to pass.
• Making sure you are well-hydrated (drinking 2-3 litres a day) can also help to loosen your poo.
• Laxatives, such as senna or stool softeners, can help to relieve constipation
• Avoiding processed foods like white bread and sugary sweets

Things to watch for

Bladder and bowel problems can have knock-on effects on the rest of your body. If you notice any of the following, speak to a doctor or health professional:

• Blood in your poo or pee
• Serious pain when you go to the toilet
• Bleeding from the anus or rectum
• Serious stomach or belly pain
• Signs of dehydration – dizziness, confusion, very dark-coloured pee, or a dry mouth and eyes