Bowel incontinence may occur as a side effect of medications, especially those which can inhibit intestinal muscle contraction.
Medications that are known sometimes to cause bowel incontinence include:
Phenothiazines (Thorazine) and related antipsychotic drugs have been found to decrease intestinal muscle tone in some individuals.
High-dose antidepressants (e.g., amitriptyline) are thought to cause or worsen constipation, and in some cases, this can lead to faecal leakage.
Typical doses of antidepressants do not usually induce bowel incontinence; it is only with higher doses that there is a risk for this side effect.
Other medications, such as erythromycin, iron salts, and bismuth subsalicylate preparations (e.g., Pepto-Bismol), have been known to cause constipation with an increased risk of faecal incontinence.
Opioids (e.g., heroin) and their derivatives (e.g., methadone) can also lead to constipation that may worsen into faecal incontinence.
It is unclear whether constipation itself is the cause or the worsening of symptoms associated with opioid withdrawal may cause this side effect.
Anticholinergics (e.g., atropine, scopolamine, and diphenhydramine) and some antiparkinsonian drugs (e.g., levodopa and its derivatives) can cause constipation may worsen into faecal incontinence.
Procainamide is a medication that produces bowel incontinence in up to 33% of people who have taken it for many years at a dose of more than 1,200 mg per day once a day.
Procainamide has also worsened constipation with an increased risk of faecal incontinence in some people taking this medication.
Belladonna alkaloids, e.g., atropine, scopolamine) may cause constipation that may worsen into faecal incontinence.
Laxatives themselves can also cause bowel incontinence, especially in those with underlying disorders that affect intestinal motility and tone or when taken outside of medical supervision.
Sometimes the addition of other medications, for example, bulk-forming laxatives (Metamucil, consul) with stimulant laxatives (senna), can worsen diarrhoea and lead to faecal incontinence if large amounts are used.
Many medical conditions can cause bowel incontinence, the most common of these being scleroderma (a chronic autoimmune disease that hardens various soft tissues in the body).
Alternative medicine has claimed that certain herbs, for example, linseed and slippery elm (which is not a herb but a tree bark), can treat or prevent constipation and faecal incontinence.
There is no scientific evidence to support these claims.
There is no cure for bowel incontinence, but several medications may help with the symptoms, and there are some lifestyle changes that may also help.
Although there is no definitive cause for faecal incontinence associated with constipation, it appears to have a hormonal or neuromuscular basis.
The following are general guidelines as to what can be done:
When possible, lifestyle adjustments that increase the amount of water in the stool (such as increased water intake and increased fluid consumption) and lessening stool frequency or increasing stool size should be considered.
Bowel incontinence is usually managed with a combination of medications.
One study found that an attempt at bowel retraining using behavioural therapy and laxatives was helpful for patients with chronic constipation.
Cranberry extract can also treat constipation, but it can also cause faecal incontinence when large amounts are taken, so it should only be taken under medical supervision.
Other products that have been used in the past with some success include capsaicin ointment (used in transcutaneous electrical nerve stimulation) and topical niacinamide (which appears to stop diarrhoea and increase stool softening).
Certain medications may also be helpful:
Anticholinergics (e.g., atropine, scopolamine, and diphenhydramine) can be used to treat constipation if taken first thing in the morning when food is likely to be moving through the digestive system.
Procainamide can be used if it does not produce bowel incontinence or if it is not causing constipation.
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