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Bowel Changes After a Stroke 

People may have problems with their bowels after a stroke. A stroke may have damaged the part of the brain that controls bowel function. A person may have any of these bowel problems after a stroke:

  • Constipation

  • Loss of bowel control (fecal incontinence)

  • Fecal impaction

Each of these problems can cause distress and discomfort.

Constipation

A person is constipated when they have trouble passing their bowel movements or are not having bowel movements as often. Constipation can cause pain. If constipation is severe, stool can become lodged (impacted) in the bowel. You should take steps to avoid it.

Causes

  • Not enough fiber in the diet

  • Eating too fast

  • Eating meals at odd times

  • Not drinking enough fluids

  • Not enough physical activity

  • Pain medicine

  • Antacids that contain aluminum and calcium

  • Antidepressant medicine

  • Depression

  • Drinking too much caffeine and alcohol

  • Ignoring the urge to have a bowel movement

Loss of Bowel Control

People who are having soft or normal stools can lose control over bowel movements. They may feel the urge to have a bowel movement but are not able to hold it until they get to a toilet or commode.

Causes

  • Constipation

  • Fecal impaction

  • Chronic use of laxatives

  • Diarrhea

  • Not able to get to a toilet or commode fast enough when there is the urge to have a bowel movement

  • Loss of strength and tone of the anal sphincter

  • Nerve damage to the anal sphincter or the nerves that sense stool in the rectum

Treatment for Constipation and Loss of Bowel Control

First, tell your doctor if you are having problems with your bowels:

  • Diet: Eat high fiber foods. Fruits, vegetables, whole grain breads, cereals, bran cereals, wheat germ, and beans are some foods that are high in fiber.

  • Fluids: Drink 8 – 10 glasses of fluids every day. Fluids may include water, fruit juice, and vegetable juice.

  • Activity: aim for 10 minutes of activity 4 times a week or 20 minutes twice a week. Doing pelvic floor exercises improves the strength of the anal muscle. Contract the rectal muscles 15 to 20 times, three times each day.

  • Bathroom habits: Use bathroom if you feel the urge to have a bowel movement. Do not ignore the urge. If it is hard for you to move around by yourself, get a commode in your room. Sit upright on the commode or toilet if you are able. Sitting upright makes it easier to have a bowel movement. Incontinence pads may be worn to prevent soiling of clothes.

  • Medicine: Review your medicines with the doctor. Some can cause diarrhea or constipation that can cause loss of bowel control. Stool softeners, laxatives, or medicine to prevent diarrhea may be needed to treat the loss of bowel control. Always talk to your doctor before taking any of these.

Fecal Impaction

This occurs when a large, hard, dry mass of stool stays in the rectum and cannot be passed out of the body. It is often caused by chronic constipation. Watery stool may leak out around the hard stool causing soiling of clothing. A fecal impaction will need medical care. If you have the symptoms described below, you must call the doctor.

Symptoms of Fecal Impaction

  • Watery stool if you have not been able to pass a hard stool

  • Pain or an uneasy feeling in their gut

  • Bloating or swelling

  • Upset stomach

  • Throw up

  • Loss of appetite

  • Weight loss

  • Headaches

  • Constant urge to have a bowel movement.

Treatment of Fecal Impaction

A doctor or nurse may need to remove the stool from the rectum. A bowel program will also be ordered by the doctor to prevent further problems.