Introduction

Chronic constipation and faecal incontinence, two common symptoms of bowel disorders, are known to have a profound effect on quality of life.²⁻³ Many people living with bowel disorders also experience loss of independence and control, feelings of embarrassment, anxiety and depression, and social isolation.¹ And the prevalence, especially among women, is higher than you might expect.⁴

Up to 50% of people who survived pelvic organ cancers experience bowel disorders.⁵
And up to 19% of women who gave birth vaginally experience faecal incontinence more than a year after delivery.⁶

Many patients find it hard to talk about bowel disorders, even with their healthcare providers, so they are unaware of their treatment options.⁷ We know that bowel disorders have a negative effect on people's lives and that the pathway to treatment is long.¹

By identifying patients at risk of developing bowel disorders, or who may be suffering in silence, we can shorten their time to treatment and improve their quality of life.

Talking about bowel disorders is difficult but essential

Talking about bowel disorders is difficult but essential

Many patients find it difficult to overcome the stigma of talking about bowel disorders because it can be such a sensitive subject.
They are not alone.

In a study of 172 women at a urogynaecology clinic with
symptoms of pelvic organ prolapse or urinary incontinence, none
of them initially reported any symptoms of bowel disorders.
However, during the study 55% admitted they had also been
experiencing symptoms of bowel disorders. Of these, 67% had
constipation, 41% faecal incontinence and 34% faecal urgency.⁸

Patients often fail to report their bowel disorders because they are
unaware that they could be related to their urinary symptoms, and
this can negatively impact their quality of life.⁸

Pelvic floor disorders and the impact of faecal incontinence

Pelvic floor disorders and the impact of faecal incontinence

The term ‘pelvic floor disorders’ (PFDs) refers to a group of conditions
including stress urinary incontinence, overactive bladder syndrome,
pelvic organ prolapse, and faecal incontinence.⁹ Faecal incontinence is
highly stigmatised and is more prevalent in women than men.¹⁰ 19% of
women who give birth vaginally experience faecal incontinence over a
year later.⁶

Carina, a mother of two, first experienced bowel disorders including
faecal incontinence in 2012, years after giving birth. It took her 11 more
years to find solutions that worked, and she now passionately
advocates for open communication about bowel issues to shorten time
to treatment and alleviate unnecessary pain and suffering.

“It took 11 years, included lots of wrong turns, but now, with the right
combination of treatments, my life has changed.”


Carina | Living with pelvic floor disorders

 

Risk factors for pelvic floor disorders

Risk factors for pelvic floor disorders

Pelvic floor disorders (PFDs) are highly prevalent among women, and
there is a significant association with age and vaginal birth. Other risk
factors for pelvic floor disorders include menopause, smoking, chronic
diseases and obesity. PFDs are also associated with diabetes, connective
tissue disorders, and neurological diseases.⁹

It is important to identify these risk factors in patients who may be
suffering in silence with bowel disorders, so we can help shorten time to
treatment and improve their quality of life.

Cancer survivors and bowel disorders

Cancer survivors and bowel disorders

Dorte, a dental technician from Copenhagen, has Low Anterior Resection
Syndrome (LARS) following rectal cancer. After developing symptoms of
faecal incontinence, it took her years to find an effective treatment. And
now she can once again do what she loves: spending time at the nearby
stables with her horse, Zydney.

“I was diagnosed with rectal cancer. So, I had a stoma surgery and then
I had it reversed. After that, my life turned into a nightmare with
somewhere between 30 and 40 toilet visits a day.”

Dorte | Cancer survivor

Bowel disorders following pelvic organ cancer

Up to 50% of pelvic organ cancer patients suffer from bowel disorders following surgery, radiotherapy, and/or chemotherapy. During their treatment, they can experience symptoms such as faecal incontinence, faecal urgency, emptying difficulties and frequent bowel movements.⁵

Learn more about bowel disorders following pelvic organ cancer

Chronic constipation can be a side effect of using strong opioids for pain management

Chronic constipation can be a side effect of using strong opioids for pain management

Between 23-87% of cancer patient who take opioids for pain, experience
chronic constipation. Even if they are also prescribed laxatives, they are
very frequently constipated which significantly impairs quality of life.¹¹

Treatment options for bowel disorders

Treatment options for bowel disorders

Treatment of bowel disorders can be challenging, and the degree of evidence supporting the different treatment options varies. Learn more about treatment options such as standard bowel management and Transanal Irrigation (TAI) in the updated and
simplified treatment pyramid by clicking on below link.

The simplified version of the existing treatment pyramid is proposed, consisting of only 3 steps, while exploratory and experimental treatments are placed in a separate box to
better mirror the actual clinical practice.¹²