Some people who have had the horrible experience of a bowel accident in public understandably become very sensitive to anything arriving in the rectum. It is a natural reaction to try and prevent an accident by immediately finding a toilet. However, with time this can develop into a bad habit. As soon as you have the slightest feeling that you might need the toilet you drop everything and rush to the nearest toilet.
Most people find that their emotions have an influence on their bowels. If they are worried or anxious it leads to more frequent, more urgent, and looser bowel actions. We know that worry stimulates the bowels to work more often and with greater urgency. If you panic when your bowel is full, this can cause the sense of urgency to become even stronger the more you panic the more you need to go.
It is easy to see how this can develop into a vicious circle. The more you worry, the worse it gets. The worse it gets, the more you worry. In the end it can almost be a self-fulfilling prophecy you do not make it to the toilet because you are convinced that you cannot do so.
There is also a tendency, in the attempt to hold on, to tense all your muscles and to hold your breath. If you squeeze with your tummy muscles you will actually be raising the pressure in your abdomen and encouraging your bowel to empty rather than to hold on. You will help to force the stool down and out, rather relaxing and breathing normally and holding it in.
While you are rushing to the toilet, it is very difficult to concentrate on hanging on. When the rectum fills, the internal sphincter opens. You need to be able to contract the external sphincter hard enough and for long enough to allow this to close off again and to prevent an accident. If you are running upstairs or trying to get your clothes out of the way, this makes it difficult to squeeze your external sphincter effectively. Rather than rushing to the toilet there and then, you may do better to sit or stand still, breathe deeply and contract the anal sphincter, for long enough for that urge to wear off.
You may not be able to do this to start with. If the urge is too strong, start by trying to delaying bowel emptying once you are sat on the toilet if you cannot, there will not be a disaster. Once you are sitting on the toilet with that desperate urge, see how long you can wait until you really have to let go. You may surprise yourself at how much control you really have. See Table for a programme that will gradually help you to resist the urge. This will take a lot of will-power and determination.
If you practice hanging on, and combine this with sphincter exercises, and alterations to diet as necessary, you should find eventually that it gets easier. The longer you can hang on, the more fluid is absorbed from the stools and so the firmer and less urgent they become. If you are having 2 or 3 bowel actions in quick succession in the morning, you may eventually be able to hang on to the first ones, and so just have one larger bowel action all at once. Also, when you have some successes, you become more confident, panic less, and so things do not feel nearly so urgent. The less you panic, the easier it is to make that urge go away.
The Holding On Programme
Currently when you need to have your bowels open you find that you have to rush to the toilet. Your rectum (where you store the stool), your sphincter muscles and your confidence need retraining to help you overcome this problem.
Next time when you need to have your bowels open:
1) Sit on the toilet and hold on for as long as you can before opening your bowels. If you can only manage a few seconds, dont worry, it will gradually get easier. Whatever you can manage now, you are aiming to double it, and then double it again. Gradually increase this to 5 minutes. Dont worry if youre not able to do this for the first few times but keep practising.
2) When you have mastered this, repeat the above but hold on for 10 minutes before opening your bowels. It may be helpful to take something to read with you. This stage is harder but remember youre on the toilet and therefore safe.
3) Once you are able to delay opening your bowels for 10 minutes sitting on the toilet now is the time to begin to move away from the toilet. Therefore the next stage is when you want to open your bowels to sit near the toilet either on the edge of the bath or on a chair inside or just outside the toilet area. Now hold on for 5 minutes. Once you are able to do this, repeat the exercise increasing to 10 minutes.
4) When you are able to delay opening your bowels for 10 minutes whilst off the toilet you should now gradually move further away. Maybe sitting on the bed in your bedroom. As your muscles are now becoming stronger you should be able to hold on for 10 minutes and as you feel more confident, increase the distance between you and the toilet.
Gradually you will find that you can increase the distance and the time away from the toilet. This may take some time to master but obviously the more practise you have at both your sphincter exercises and this programme it will happen sooner rather than later.