Treatments and Medication

Sometimes medicines are used in treating incontinence. They work by solidifying liquid or soft stool or making the bowel squeeze less strongly. Obviously, if diarrhoea is present, treating this should lessen frequency and urgency and make incontinence less likely. If you are opening your bowels more than once each day and have soft or loose stool, your doctor may suggest some medicine to slow down the bowel.

Where the internal anal sphincter is weak, the stool can be made firmer by use of a drug such as loperamide (also called Imodium), codeine phosphate, or Lomotil. These drugs may control the passive seepage of loose stool. The dose needs to be individually decided, as it is difficult to predict a dose that will be effective, but not cause constipation. Some people find one of these drugs does not help but that another works well, or that a low dose combination is best. The only way to tell which may help you is by trial and error.

These drugs are designed to slow down the passage of stool through the colon, so that more water can be absorbed and the stool becomes firmer and so less likely to leak. It is usually best to take these medicines immediately after opening the bowels, and if possible before food rather than after a meal. They usually act quite quickly and last just a few hours, so you need to take the tablets at the time when you need them. There is little point taking a tablet at night if your main problem is in the morning. If the tablets work too well for you and cause constipation, loperamide is also available as a syrup, which can enable you to have half or even a quarter of the usual dose.


Treatments Information for patients taking Loperamide (Imodium)

YOU SHOULD NOT TAKE THIS MEDICATION FOR MORE THAN A FEW DAYS WITHOUT MEDICAL ADVICE

This information sheet is for people who have been prescribed loperamide (also sometimes known as Imodium) for a bowel problem. This information sheet is designed to give you some more information about this medication.

What is loperamide?

Loperamide is one of a group of drugs called anti-diarrhoeals. These drugs are designed to thicken your stools and so to reduce diarrhoea. It will also firm up slightly soft stools.

How does it work?

Loperamide works by slowing down the passage of food through the gut and encouraging more uptake by the body of water from the waste in the lower bowel. The longer food takes to pass through the gut the more time there is for water to be absorbed from it though the gut wall. The stools that are then produced are thicker and firmer.

What dose do I take?

The doctor who prescribed loperamide will have discussed with you a suggested starting dose. People vary a lot in their response to loperamide. It sometimes needs some experimentation to find the dose that will control your bowels without constipating you. The more you take the firmer your stools should become. If you take more than you need you may feel constipated. If you do not take enough your stools will remain loose or soft. It is usual to start on a low dose and build it up slowly over a few days so that you can judge how you body is responding.

Loperamide comes in capsules / tablets or as a syrup. As the syrup is often used for children it can only be obtained on prescription in this country.

Amount you take Actual dose of loperamide
1 capsule / tablet
1 teaspoon (5ml)
1 half teaspoon (2.5ml)
2 milligrams
1 milligram
1/2 milligram

It is best to take loperamide half an hour before a meal. This will help to slow down the usual gut activity that is stimulated by eating. Most people find that the bowel is most active in the morning and so loperamide will help most if taken before breakfast. The medicine starts to work within half an hour of taking it and is effective for 8-12 hours. This means that doses taken after lunch are not likely to help much if all your problems are in the morning. However, a dose last thing at night may help with early morning frequency. Loperamide is a very safe drug which is not addictive. It can be taken in doses of up to 8 capsules (16 milligrams) per day over long periods of time. Do not take more than 16 milligrams per day without medical advice.

If you have any further questions please do not hesitate to ask your doctor.


People in whom passive leakage is a major problem may even choose to slow the bowel down so far that there are no bowel actions without the help of suppositories or an enema to empty the bowel once every few days. This is not ideal, but at least it can give you control back.

There is a new cream in development which is designed to raise the muscle pressure in the anus. This seems to be most helpful for people with a small amount of seepage, and should be generally available soon.

If the stools are very loose, especially if there seems to be a lot of mucus, medication such as Fybogel, Movicol or Regulan can help to mop up the excess fluid in the colon and produce more formed stools. Methyl-cellulose tablets also help some people.

Other medicines will be useful to some people with faecal incontinence. Where the underlying problem is constipation with impaction (a blockage of hard stool in the colon), a laxative may be helpful to prevent the problem from coming back once the impaction has been cleared. Some medicines are helpful to some people with irritable bowel syndrome, and some of the diseases that can cause diarrhoea can be kept under control by specific drugs.