New Help for Those With Accidental Bowel Leakage (ABL)

ABL can have a serious effect on a persons quality of life

Definition of Accidental Bowel Leakage (ABL) or Fecal Incontinence (FI)

Accidental bowel leakage (ABL) is the accidental passing of solid or liquid stool or mucus from the rectum. In medical literature, ABL has been referred to as fecal incontinence, yet for many people, there has been no term to describe this condition and they have simply referred to it as anal leakage, bowel incontinence or simply having a leaky bowel.

Background
Fecal incontinence is a vastly under reported but fairly common problem. It is often associated with considerable costs due to the high frequency of changing and the resources needed for cleaning up after episodes of fecal loss. For the user, embarrassing situations caused by leakage have a negative impact on their quality of life and often leads to social isolation.

You might not guess it, but as many as one in ten adult women have experienced accidental loss of stool in the past year. It’s a common problem, even if it’s not a common topic of conversation. Accidental loss of stool is sometimes associated with an intense urge to rush to the bathroom, or it can happen with no warning. Bowel control problems particularly affect women who have experienced pregnancy, childbirth, or nerve or muscle damage in the pelvic region. As there are multiple causes for bowel control problems, effective treatment is particularly difficult and many times invasive.

There are over 20 million women of all ages in the U.S that suffer from some sort of bowel control problems, over 8 million of them experiencing accidents on a monthly or more frequent basis. Because this is a condition that can be embarrassing and debilitating, women often withdraw from social and professional activities, which have a dramatic effect on their quality of life. The majority of women suffer in silence and do not seek treatment for their condition.

A study published in the 2012 International Journal of Clinical Practice showed that over 70% of women over 40 preferred the term accidental bowel leakage (or ABL) to describe this condition. This overwhelming preference for the term ABL is not surprising. For many people, accidental bowel leakage is a term that best describes how they experience their little bowel leaks—often unexpectedly and accidentally.

Accidental bowel leakage (ABL) is the inability to control bowel movements and is a common problem, especially among older adults. The most common cause is damage to the muscles around the anus (anal sphincters). Vaginal childbirth can damage the anal sphincters or their nerves, which is why FI impacts women about twice as often as men.

Risk factors. ABL doesn’t just happen as a result of childbirth. In fact, recent studies show the greatest risk factors for ABL include having common disturbances like chronic diarrhea and IBS (Irritable Bowel Syndrome).

Those with ABL manage it with absorbent products, drugs, dietary changes, exercise, and surgery.

Who Experiences ABL?
ABL affects both men and women. Studies show that 1 in 5 women over the age of 40 and a similar number of men experience ABL. Nine out of 10 have small to moderate amounts of leakage.

Following are four products that can help.

Body liners for both women and men.

Butterfly Body Liners  The first and only secure protection for Accidental Bowel Leakage (ABL) that adheres comfortably and discreetly in between the buttocks. The absorbent core and odor shield provide 2x the absorbency of any other anal leakage pad. They also have wings for hygienic removal and a gentle adhesive that stays in place for comfortable protection.

 
B-Sure Liners  B-Sure pads are small shaped absorbent pads for mild anal leakage associated with hemorrhoids, surgery, diarrhea, childbirth, and more. They are convenient and easy to use and do not have any adhesive. They fit comfortably between your buttocks and can be used to apply topical ointments.

 
Specially designed to contain fecal incontinence
Abena Abri-San Special  This is a specially designed pad, the only one like it in the world… just for bowel incontinence. It is imported from Denmark. Leakage barriers on the sides have built in pockets to contain BM even when released under pressure. The unique groves down the center of the pad better contain runny BM.

The backing is breathable to reduce the risk of skin soreness caused by repeated contact with feces. The pad is designed to allow frequent changes. Abri-San Special is based on the cost effective two piece system, minimizing product costs, even when changed frequently. We recommend using products from our Abri-Fix range when fitting Abri-San Special.



A.  inserted, not inflated  B. Inflated
Eclipse System Insert  A company in Sunnyvale California, Pelvalon founded in 2010 at Stanford University’s Biodesign program is a collaboration between the schools of medicine and engineering.

Pelvalon has created a new product and new approach for better controlling accidental bowel leakage (ABL). It is intended to treat ABL in women 18 to 75 years old who have had four or more fecal episodes in a two-week period. The product is an inflatable balloon, which is placed in the vagina. Upon inflation, the balloon exerts pressure through the vaginal wall onto the rectal area, thereby reducing the number of ABL episodes. The device is initially fitted and inflated by a clinician (with the use of a pump) and after proper fitting, the person wearing it can inflate and deflate the device at home as needed. The device should be removed periodically for cleaning.

The device consists of a silicone base and a posteriorly directed balloon. The patient controls the inflation pump, inflating the balloon to add pressure and interrupt stool passage, and deflating it to allow bowel movements.

Treating bowel control problems through the vagina is a new concept. There is another product in clinical trials to control stress urinary incontinence (SUI) that is a balloon which is vaginally inserted. Its called the Solace Bladder Control Procedure. Learn more about the trial being conducted in 15 cites.

The Eclipse System Insert, which is not yet approved by the FDA and is still investigational, is placed in the same location as a tampon. The user inflates a balloon on the Insert, which puts pressure on the rectum and is designed to protect against unwanted stool passage. Women can remove the insert at any time. The Eclipse System is a non-invasive treatment option that does not require surgery.

Does It Actually Work?  It has been clinically tested with 61 women. Following are the findings:
  • The trial showed that after one month almost 80 percent of women in the study experienced a 50 percent decrease in the number of episodes while using the device, as compared to baseline from 5.9 per week to 1.1. 
  • 85% of study participants considered their bowel symptoms 'very much better' or 'much better' after one month. 
  • There was significant improvement across all fecal quality of life measures.
  •  About 40% of women became totally continent. 
  • Study participants had a mean age of 61 years. Thirty percent were obese. Nearly 50% had prior hysterectomy, 8% had prior pelvic prolapse surgery, and 15% had prior urinary incontinence surgery. 
In women successfully fit with a vaginal bowel-control device for nonsurgical treatment for fecal incontinence, there was significant improvement in fecal incontinence by objective and subjective measures.

Adverse events associated with the device included pelvic cramping and discomfort; pelvic pain; vaginal abrasion, redness, or discharge; and urinary incontinence. All device-related adverse events were mild or moderate, and none required any significant intervention (i.e., no surgeries were needed).

How Its Used. The product will begin placement in localized urogynecologists offices and will expand over time to ob/gyns. A woman will visit her doctor who will fit her for the most appropriate size (three base sizes and two balloon sizes). The patient will check for comfort by standing, sitting, etc. before leaving the office. A return visit is expected in a week and following that the product can be used until the next exam (yearly). A woman can remove it to clean it or for any other purpose at any time.

The device isn’t a good option for everyone, however. After being fitted with the device, approximately 40 women who were screened and fitted did not continue. This rate of discomfort or nonacceptance is similar to that associated with pessaries. Also see Poise Impressa.

The initial fitting procedure for the new bowel control device requires a little more provider and patient training, beyond what is needed for use of a traditional vaginal pessary. Patients in the study could put the device in and take it out as they wished. Most patients used it all day long, and some took it out at night. Patients were instructed to take it out once or twice a week to wash it. The cost is expected to be in the range of $1200 to $1400 when it becomes available later this year.


Further Reading & Resources

ABL conversation starter

ABL - See who has it

The Mayo Clinic Fecal Incontinence

Muscle Damage Was Leading to My ABL

The Cleveland Clinic - Colorectal Center for Functional Bowel Disorders

The Underlying Causes of ABL

National Association for Continence

When Neurological Disorders Cause ABL

Your Guide to Constipation Related ABL

The International Foundation of Functional Gastrointestinal Disorders

How Pelvic Floor Dysfunction Leads to ABL, and What You Can Do About It

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About The CareGiver Partnership. The CareGiver Partnership helps caregivers and their loved ones with answers to their caregiving questions, including information about home health care products and supplies, from our Wisconsin-based team of Product Specialists who are all current or former caregivers. The company’s Web site provides the largest online library of resources on subjects most important to caregivers — from arthritis to assisted living, and Parkinson’s to prostate cancer — as well as access to more than 3,000 home care products for incontinence, skin care, mobility, home safety and daily living aids. The CareGiver Partnership was founded in 2004 by Lynn Wilson of Neenah, Wisc. Visit www.caregiverpartnership.com to learn more or call 1-800-985-1353.
 



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