If you bowels or sphincters do not work properly, it is likely that you suffer from faecal incontinence or chronic constipation, or even both at the same time. There are many reasons for experiencing bowel problems.
Some of the relatively common but serious conditions that affect the function of the bowel include:
Neurogenic bowel describes a lack of nervous control which prevents the bowel from functioning correctly. Neurogenic bowel may result in faecal incontinence, chronic constipation, or both.
One cause of neurogenic bowel is a spinal cord injury (SCI). The affect of a spinal cord injury on the function of the colon depends on where along the spinal cord the damage occurs. Damage to the lower part of the spinal cord often leads to relaxation or a lack of firmness in the colon (flaccid colon), resulting in slow stool movement, constipation, faecal incontinence, and difficulty emptying. Control of the external anal sphincter may also be disrupted, increasing the risk of incontinence.
An SCI affects the bowel system - the severity of the dysfunction and its symptoms depends on where the injury occurs.
With a high SCI, (a tetraplegic injury) the general symptoms are:
- increased transit time (risk of constipation)
- hyperreflexia – many uncontrolled spasms which lead to frequent evacuations
- low rectal capacity – the nerves react to only a small quantity of stool in the rectum
- reduced or no control of the external sphincter – this is due to ruptured communication between the defecation centre and the brain and may lead to faecal incontinence
A low SCI (a paraplegic injury) often has the following symptoms:increased transit time – this leads to constipation in the left part of the colon
- increased rectal capacity – the nerves react only to a large quantity of stool in the rectum
- loose lower bowels – an increased rectal capacity may over time lead to a loose bowel (flaccid bowel), resulting in faecal incontinence and possibly even mega colon
- reduced rectal contractions, making it difficult to fully empty the bowels
- reduced or no control of the external sphincter
All these symptoms may lead to severe constipation and with time also enlarged bowels and mega colon.
Other possible causes of neurogenic bowel include spina bifida, multiple sclerosis, and diabetes mellitus.
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a collection of conditions characterised by inflammation of the large and/or small intestine.
The two main types of IBD are ulcerative colitis and Crohn's disease. The two diseases are very similar. The main difference is that Crohn’s disease can occur anywhere along the digestive tract, while ulcerative colitis usually only affects the top layer of the colon and rectum. The inflammation usually causes abdominal pain and diarrhoea but may also cause constipation.
Cancer of the colon or rectum
Cancer of the colon or rectum describes the uncontrolled growth of cells that may mean these parts of the body no longer function correctly. Some people have an inherited condition called familial polyposis, where large numbers of projecting, swollen and thickened membrane (polyps) develop on the inner lining of the colon. These polyps can eventually become cancerous.
When pressure in the colon increases, for example due to constipation, pouches called diverticulae can be formed. These pouches are very common in people over the age of 60 and for most, never cause any problems – some people don’t even know they have them. However, sometimes the pouches become inflamed or infected this condition is known as diverticulitis – causing pain, fever, diarrhoea and constipation.