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Last reviewed: June 2023
Next review date: June 2026
This information is for adults with Crohn’s or Colitis who experience bowel incontinence or urgency. There is very little evidence for managing bowel incontinence and urgency in children with Crohn’s or Colitis. But many of the same things may be helpful for children.
This information can help you understand:
It also provides you with some tips to help you live well with bowel incontinence or urgency.
If you have a stoma and are having a problem with high output, see our information on Living with a stoma.
We need your help to improve our information to better support people with Crohn’s and Colitis. Fill in our short survey to let us know what we're doing well and how we can better meet your needs.
Bowel incontinence is when you pass liquid or solid poo without meaning to. There are two main types of bowel incontinence:
Some people will experience both urge and passive incontinence.
Some people will have incontinence from time to time. For others it might happen every day. It can also happen at night.
People may describe their own bowel incontinence as:
Urgency is the sudden intense feeling of needing to poo and having to rush to get to the toilet.
People may describe urgency as:
Bowel incontinence affects about 1 in 10 people in the general population at some point in their life.
Bowel incontinence is more common in people with Crohn’s or Colitis than in the general population. Studies estimate that it affects up to 7 in every 10 people with Crohn’s or Colitis at some point.
Urgency is also a common symptom of Crohn’s and Colitis. In one study nearly 70% (7 in every 10) people reported having urgency.
It is likely that many people do not report having problems with bowel control. So it could be even more common than studies estimate.
You are more likely to experience bowel incontinence or urgency during a flare-up. But they can also occur during remission (when your symptoms are under control). Bowel incontinence affects at least 10% (1 in 10) people in remission. Urgency affects up to 66% (6 in 10) people in remission. It is more common in people who have proctitis, a perianal fistula or an ileo-anal pouch (a J-pouch).
Bowel control problems in people with Crohn’s or Colitis are also more common:
Urgency and bowel incontinence can be a sensitive issue that can have a real impact on your daily life. People who experience bowel incontinence may:
But there are ways of managing and treating bowel control problems. So, make sure you ask for help from your GP or IBD team. It’s important to remember that:
The bowel is the largest part of your gut. It consists of two sections, the small bowel and the large bowel. You might also hear them called the small intestine and the large intestine. The large bowel consists of the colon and the rectum. The rectum is the part that stores poo.
At the end of your rectum is the anus. This is the opening where poo comes out of your bottom. The anal canal connects the rectum to the anus. The way your body controls when you fart (pass wind) and poo is complicated. It involves:
If any of these systems are not working as well as they should, you may experience urgency or bowel incontinence.
The most common causes of bowel control problems for people with Crohn’s or Colitis are:
Diarrhoea (passing a looser poo more often than is normal for you) is a key symptom of Crohn’s and Colitis. It can be difficult for the rectum to hold in liquid poo, especially when it happens often. So, urgency and bowel incontinence can develop.
In a healthy gut, the muscles in the bowel move poo slowly along the bowel. In people with Crohn’s or Colitis the bowel can become inflamed, which makes it more sensitive. This can make the rectum more active, pushing poo out as soon as it arrives. Inflammatory changes to the muscles and nerves of the gut can persist once inflammation dies down. This can cause problems with bowel control even when disease is not active.
Muscles in your bottom (anus) work to keep poo in until you are ready to pass it. These muscles are known as your anal sphincter. If these muscles are damaged, you may have less control over passing wind, and liquid or solid poo. In people with Crohn’s or Colitis, these muscles can become damaged by:
Damage to the muscles can also be due to other causes not related to Crohn’s or Colitis. These include childbirth, surgery, or piles (haemorrhoids).
This diagram shows the position of the muscles around the anal canal where poo travels. The pelvic floor muscles also help you control when you pass pee, poo, and wind.
Nerves control both the sensations from the bowel, and the anal sphincter muscles. Ongoing inflammation due to Crohn’s or Colitis can affect the nerves in the gut lining. This damage can make the bowel more sensitive and affect control of the anal sphincter.
Some people with Crohn’s or Colitis have constipation. Constipation is when it becomes difficult to poo, and you may not have a poo for several days or even weeks. When you do it may be hard and lumpy. Liquid or solid poo can build up in the large bowel and become packed together. Liquid poo can then sometimes leak around the packed poo. This is sometimes called overflow diarrhoea. You might not be aware of this leakage, as there will be no urge to have a poo.
A fistula is when a narrow tunnel develops that connects an organ to another part of your body. A perianal fistula connects the anal canal or rectum to the surface of the skin near your bottom. Pus, blood, or poo can drain from the fistula opening. A perianal fistula can also cause damage to the anal sphincter. See our information on Fistulas for more details.
Most of the evidence for managing bowel control problems comes from people with bowel incontinence. There is less evidence for the management of urgency, but it is generally managed in the same way as incontinence.
There are several things that you can try to help manage your bowel incontinence. Some of these you may be able to do by yourself. For others you may need help from a healthcare professional. For many people, these initial approaches will help to improve bowel control. If these first steps do not help, you may need more specialised management.
A key part of managing urgency and bowel incontinence in people with Crohn’s or Colitis is getting your condition as well controlled as possible. Reducing inflammation in the bowel and reducing diarrhoea or constipation can help improve these symptoms.
Changing what you eat and drink can help to reduce diarrhoea or constipation in some people. This in turn can help reduce urgency and bowel incontinence. You could try using a food diary or app to find out if any foods affect your symptoms.
It is still important to eat a healthy, varied diet that gives you all the nutrients you need to stay well. Find out more about healthy eating in our Food information.
Some types of food or drink stimulate the muscles in the large bowel. This increase in muscle activity pushes poo through more quickly, which can cause diarrhoea. Foods or drinks that might make diarrhoea worse in people with or without Crohn’s or Colitis include:
If you’re constipated, you could try:
For more details about this, see our information on Diarrhoea and constipation. You can find out more about eating and drinking to help with symptoms in our Food information.
Making sure that you have easy access to a toilet is an important part of managing urgency and bowel incontinence. For example, you might ask your employer to move your workstation closer to a toilet. Or you might discuss toilet access with your child’s school to ensure swift access when needed.
See Tips for living well with bowel incontinence for suggestions about toilet access when you are out and about.
To help you empty your bowel completely and at a predictable time, you could try:
If other approaches do not work, your GP or IBD team may suggest trying anti-diarrhoeal medicine. These slow down your bowel. This means that food takes longer to pass through your gut and your body absorbs more fluid from the bowel. So your poo becomes firmer and you need to poo less often. Loperamide is a commonly used anti-diarrhoeal medicine.
Always check with your IBD team before taking anti-diarrhoeal medicine.
Read more about the medicines that can be used to relieve diarrhoea and constipation.
Some NHS continence clinics offer services for people with bowel incontinence. You may be able to refer yourself to your nearest service, or your GP or IBD team may need to refer you. Depending on the service, they can provide access to free advice, teach you pelvic floor exercises and bowel retraining. They can also arrange supply of free continence pads and give you additional support.
Your GP or a member of your IBD team may refer you for specialised tests to see why you are having difficulty controlling your bowel. These might include:
A continence specialist may recommend the following treatments.
Bowel retraining is a treatment programme that involves:
Your pelvic floor muscles help support your bowel, bladder, and the womb in people who have one. These muscles run from your pubic bone at the front to the base of your spine at the back. They help you control when you pass pee, poo, and wind. These muscles can become weaker with age or after childbirth. Pelvic floor exercises can help strengthen the muscles around your bottom that you use to open and close your bowels. There is some evidence that this can help with managing bowel incontinence.
A physiotherapist or specialist nurse will show you how to do the exercises. It is important to learn to do pelvic floor exercises in the right way. And to check from time to time that you are still doing them correctly.
Biofeedback therapy is a type of bowel retraining. It may sometimes be used with pelvic floor exercises. Biofeedback involves placing a small sensor device in your bottom while you are doing the exercises. The device provides information about how well the muscles are working while you’re doing the exercises. Biofeedback therapy is not yet widely available. Ask your IBD team or continence specialist if they provide this service. Or they may be able to refer you to another hospital or centre where it is available.
Sacral nerve stimulation is a type of electrical stimulation. It can be used for people with weak sphincter muscles. Electrodes are inserted under the skin in the lower back and connected to a pulse generator. The generator releases pulses of electricity that stimulate the sacral nerves. The sacral nerves are in your lower back. This causes the muscles of the anal sphincter and pelvic floor to work more effectively. At first, the pulse generator is located outside your body. If the treatment works, it will be implanted under the skin in your back.
A review of six clinical trials found that sacral nerve stimulation can improve continence in some people. But it does not work for everyone. These trials did not specifically include people with Crohn’s or Colitis. Very small studies suggest that sacral nerve stimulation works well for people with Crohn’s or Colitis. We need more studies to confirm this.
Side effects of sacral nerve stimulation can include pain and infection at the site of the implants.
Tibial nerve stimulation is another type of electrical stimulation therapy. A fine needle is inserted near a nerve just above the ankle and an electrode is placed on the foot. A mild electric current is passed through the needle to stimulate the nerves that control bowel function. It is a new treatment for bowel incontinence and we are not sure how well it works in people with Crohn’s or Colitis.
Surgery is usually only considered if other treatments have not helped. But it is a treatment option for people with Crohn’s or Colitis, depending which part of the bowel is affected. See our information on Surgery for Crohn’s or Colitis for more details.
If you are experiencing bowel incontinence or urgency, speak to your GP or a member of your IBD team.
People can be reluctant to talk about problems controlling their bowels. Some people find it very upsetting or embarrassing. It is important to get medical advice if you experience urgency or bowel incontinence. Often it can be managed so that it does not interfere with your everyday life.
In one study, only 4 out of 10 people who experienced bowel incontinence reported asking for help. Reasons people gave for not seeking help included:
Continence products can be useful as a short-term measure. But they do not deal with the underlying problem. They are not a long-term solution on their own.
If you have bowel incontinence, continence products can help stop you soiling your clothes. You may be able to get them free on the NHS from a continence clinic or your District Nurse. Or ask your GP surgery for more information about continence products available. You can also buy them online or from a pharmacy.
Bladder and Bowel UK have more information on continence products and services.
The Continence Product Advisor gives independent and evidence-based advice on how to choose and use continence products.
Continence products such as disposable pads are often used in people with faecal incontinence. Disposable pads can help to contain and soak up liquid poo and prevent your skin from getting sore. They can be useful for mild bowel incontinence. Disposable pull-on pads and washable underwear are also options.
Using an anal plug is another option for managing incontinence. An anal plug is a foam plug that you insert into your bottom to prevent leaks. You can keep it in for up to 12 hours. Many people find that it is uncomfortable or irritating. You must take the plug out before you have a poo, so it is not suitable if you need to go to the toilet often. Speak to your IBD team if you are thinking of using an anal plug, as they are not suitable for everyone.
Bowel incontinence can cause sore skin around your bottom. Frequent washing and wiping of your bottom can also irritate the skin. Keeping the skin clean and dry is the most effective way to reduce sore skin. The following tips may help prevent sore skin:
If your skin continues to feel sore or it is broken, talk to your doctor or IBD team.
If you are worried about smells, you may wish to try odour neutralisers. These help to get rid of smells rather than just mask them. Products available include room sprays and toilet deodorisers.
Bowel incontinence or the fear of it happening can cause embarrassment, stress, anxiety, and concern. This can lead to a vicious circle where the more you worry the worse it feels. Talking about how you are feeling can help. You might try talking to your GP, IBD team or to a close friend or family member. Your medical team will want to know about the effect that any problems with bowel control may be having on your wellbeing. So, it's important to let them know if you’re struggling with stress, anxiety, or depression.
Struggling with your mental health can make it more difficult to manage your Crohn’s or Colitis. Learn more about what you can do to improve your mental wellbeing and how to get the help you need in our information on Mental health and wellbeing.
Planning ahead can give you more confidence to be away from home. The following are suggestions that may help you manage bowel incontinence when you are out and about.
Some people find it useful to carry a supply of:
You may also wish to keep a change of clothes at work or in your car, just in case of any accidents.
Wear trousers or skirts that are easy to undo, perhaps with an elasticated waist or a zip or Velcro instead of buttons. Darker colours may disguise leaks more easily. The Continence Product Advisor has more information on clothing and adjustments that can help with managing incontinence.
Members of Crohn’s & Colitis UK get a ‘Can’t Wait’ Card’. This explains that, due to your condition, you need toilet facilities urgently. It may be helpful to show this if there is a long queue for the toilet, or if you want to use a shop’s facilities. See Become a member for further details.
A Radar Key is a key for accessible public toilets. A Radar Key is available from Crohn’s & Colitis UK if you become a member. You can also buy one from Disability Rights UK.
Many people who experience incontinence plan their journeys by toilet stops. This is sometimes called toilet mapping. There are many toilet map apps available that can help you plan your journey. Or you could use online resources such as the Great British Toilet Map to help you find the nearest public toilet when out and about.
Using public transport can be a challenge if you need easy access to a toilet. For long-distance travel, most coaches now have an on-board toilet. And you can check the location of facilities at train stations in the UK via the National Rail website.
If possible, request in advance an aisle seat near the toilet. Take a small supply of everything you need in your hand luggage. An ‘Emergency kit’ can be useful, but check with the airline if they allow neutraliser spray on the plane.
If you are going to stay away overnight you might like to think about bedding and laundry arrangements. You could take a towel or light-weight waterproof mattress protector to put under you in bed if bowel leakage at night might be a problem. You can buy disposable bed protection sheets online. Check laundry arrangements before you travel. A tube of detergent, a folding coat hanger and a portable washing line with pegs can be useful if you need to do your own washing.
We follow strict processes to make sure our information is based on up-to-date evidence and easy to understand.
Please email us at evidence@crohnsandcolitis.org.uk if:
You can also write to us at Crohn’s & Colitis UK, 1 Bishop Square, Hatfield, AL10 9NE, or contact us through our Helpline: 0300 222 5700
We know it can be difficult to live with, or support someone living with these conditions. But you’re not alone. We provide up-to-date, evidence-based information and can support you to live well with Crohn’s or Colitis.
Our helpline team can help by:
Providing information about Crohn’s and Colitis.
Listening and talking through your situation.
Helping you to find support from others in the Crohn’s and Colitis community.
Providing details of other specialist organisations.
Please be aware we’re not medically or legally trained. We cannot provide detailed financial or benefits advice or specialist emotional support.
Please contact us via telephone, email or LiveChat - 9am to 5pm, Monday to Friday (except English bank holidays).
If you need specific medical advice about your condition, your GP or IBD team will be best placed to help.
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