What Is a Bowel or Fecal Urgency?
Bowel or fecal urgency is a sudden, irresistible need to have a bowel movement. Urge fecal incontinence is inability to hold stool during bowel urgency. Bowel incontinence is complete inability to control bowel movements. Tenesmus (Greek tens = strain) is a repeating painful urge to defecate without excreting any stool.
Causes of Bowel Urgency
1. Occasional Bowel Urgency in Healthy People
A large, especially fiber-rich fruit or vegetable meal, can produce a lot of stool, which can be, for some people, difficult to hold in. A quick change from mixed to vegetarian diet can also irritate the bowel.
Irritant Foods and Drinks
Certain spices or sauces, salad dressings, caffeine in coffee, tea, cola or energy drinks, alcohol, and foods or drinks sweetened by high fructose corn syrup (HFCS) can irritate the bowel and cause bowel urgency.
Psychological stress, like anxiety before an exam, or fear, can trigger bowel movement.
Premenstrual Syndrome (PMS)
Sensitive women can experience bowel urges, painful abdominal cramps, headache, swelling or other symptoms of premenstrual syndrome in days before and during their period. Learning to cope with stress, diet low in animal fats and dairy, and, in serious cases, anti-inflammatory drugs, like ibuprofen can help.
Weak Pelvic Floor Muscles
Pregnancy, childbirth, stress or obesity can result in weakness of pelvic muscles, which can cause both bowel and urinary urge incontinence. In absence of neurological damage, Kegel exercises to strengthen pelvic muscles can help.
2. Food Intolerances and Allergies
Irritable Bowel Syndrome (IBS)
People with IBS typically experience an urge to defecate within few minutes after a meal. Alternating diarrhea and constipation, abdominal cramps or pain are other symptoms of IBS, triggered by stress or certain foods, like fruits, milk, sweets or legumes. Low-FODMAP diet can help. Often you will need to identify problematic foods by eliminating diet trial.
Individuals with fructose malabsorption may experience bowel urgency and diarrhea within few hours to two days after eating foods rich in fructose, sorbitol or high fructose corn syrup (HFCS). Low-fructose diet helps.
People with lactose intolerance may have diarrhea with bowel urgency few to several hours after eating dairy products. Lactose-free diet helps.
Cow’s milk, eggs, soy, wheat, nuts and peanuts in children, and nuts, peanuts, fish and shellfish in adults are common causes of food allergies. Itchy lips and throat, swollen face, itchy rash and diarrhea, appearing within minutes (or several hours) after food ingestion are main symptoms. Avoiding triggering foods helps.
3. Acute Bowel Infections
Food poisoning with bacteria, like salmonella, can cause urge to defecate and diarrhea several times a day and last for few days. Nausea, vomiting, fever and blood in the stool may appear. Read about traveler’s diarrhea.
Sexually Transmitted Diseases (STDs)
Rectal infection with Herpes simplex virus (HSV2), common in homosexual men, may be a cause of painful, urgent defecation. Small, red, painful or itchy blisters around the anus, and bloody or mucous stool are common symptoms. In women, Chlamydia can cause pelvic inflammatory disease (PID) with bowel and urinary urgency and urethral or vaginal discharge.
Diverticulitis, infection (usually bacterial) of abnormal pouches (diverticules) in the last part of the colon, can cause bowel urgency. Suddenly appearing high fever, left side abdominal pain and diarrhea are other possible symptoms.
4. Chronic Bowel Diseases
- Ulcers developed in Crohn’s disease, ulcerative colitis and parasitic infections, like severe amebiasis irritate the rectum and can cause bowel urgency.
- Rectal tumors can affect normal closure of the anus and cause urge bowel incontinence.
- In a rare carcinoid syndrome, carcinoid tumor in the gut secretes serotonin, which can cause explosive diarrhea.
- Rectal candidiasis, infection with a yeast Candida albicans, mostly affecting AIDS patients and other people with low immunity, can trigger urgent bowel movements.
- Laxative abuse can result in chronic diarrhea with bowel urgency.
5. Neurological Disease or Injury
Bowel or urinary urgency (or retention) may be a problem in multiple sclerosis, Parkinson’s disease, spinal cord injury, peripheral neuropathy (in chronic diabetes or alcoholism) and other neurological disorders.
6. Other Disorders
Endometriosis, abdominal or pelvic adhesions and abdominal or pelvic tumors can all cause bowel urgency.
7. Surgery and Cancer Treatment
A patient may experience bowel urgency for few months after surgical removal of prostate cancer, or other major pelvic surgery (1).
Chemotherapy or radiation therapy of abdominal or pelvic cancers can damage the bowel and cause urge bowel incontinence.
After gallbladder removal, bile is constantly delivered into the duodenum, and, if not absorbed in the small intestine sufficiently, it reaches the colon and can irritate it. Read more about green diarrhea triggered by bile salts.
After partial or complete surgical removal of the stomach, food may rapidly enter the small intestine and trigger diarrhea. After removal of a large part of the small intestine, especially in small children, the remaining intestine might not be able to digest all ingested food, which may therefore be excreted with the stool. Read more about dumping syndrome and short bowel syndrome.
How To Deal With Bowel Urgency?
Here is what you can do to get rid of bowel urgency:
- Have regular meals, small portions, avoid irritant foods; fruits, legumes, wheat and dairy products are often problematic. See low-FODMAP diet.
- Try to have a bowel movement in the morning, after breakfast.
- Accept challenges at work and in relationships in peace. You can not avoid all stress, but maybe you can avoid unnecessary stress.
- If necessary, lose some weigth and make Kegel exercises to strenghten your pelvic floor muscles.
- Ask your doctor about eliminating diet trials or tests to find a cause of diarrhea.
- Loperamide, an over the counter (OTC) drug, available without prescription, can postpone a bowel movement for few hours.
Treatment of Urge Bowel Incontinence
To find a cause of urge bowel incontinence you might need to have colonoscopy, defecography or other investigations. Treatment of an underlying disease, diet changes, medications to slow down peristalsis, anal plugs and surgery are available treatment options.
- Bowel urgency after surgical removal of prostatic cancer (seattlecryo.com)
Article reviewed by Dr. Greg. Last updated on September 3, 2011