The New Diaper Primer

Chapter 12: Bowel (Fecal) Incontinence


Many of us who feel we are only urine incontinent have had accidents involving bowel release. A lot of us know of people who are not incontinent at all who have had an unfortunate accident with bowel release usually related to some short-term problem such as food poisoning which causes urge diarrhea. I'm sure many of us have had that experience, probably more than once, and it's a pretty nasty experience. I know I have been extremely thankful that I am wearing a diaper for urinary incontinence when I get hit with an episode of sudden bowel release.

I will not attempt to cover the subject in depth, since I do not routinely have to contend with bowel incontinence. This section will remain one that "just scratches the surface" until we can collect information from those of you who suffer bowel incontinence and who might care to send us information to share your ideas for coping. Wet-diaper wear vs. dry-diaper wear is not an option in this case. With urinary incontinence, urine is not very noxious to your skin, and for most of us, odor does not represent a problem. So we can wear a wet diaper with no one noticing and with no ill effects to our skin.

Fecal incontinence requires dry (clean) diaper wear; that is, a clean (if not actually dry) diaper is worn until it is soiled and then immediately changed. Fecal matter, unlike urine, contains digestive juices and acids that are harmful to the skin and will attack the skin immediately. For this reason, I highly recommend applying a barrier cream, many of which are available from various sources, but any diaper-rash ointment or even plain Vaseline will suffice for some basic skin protection.

In the day-to-day world, the odor from fecal incontinence is extremely difficult to handle. I have no experience with the tablets such as "Nullo" or any other preparation taken internally to control excrement odor. External deodorants that are highly effective with wet diapers do virtually nothing when a diaper gets soiled. For myself, a bowel release in the diaper marks the abrupt end of whatever I was doing. I make any possible excuse and return home to clean up and change.

Obviously, this segment will need input from those of you who have found ways to deal with clean-up and changing away from home.

Although I strongly favor cloth over disposables for everyday diaper wear, I readily concede that fecal incontinence is best handled with disposables as a matter of convenience. However, I would be remiss if I failed to point out cloth diapers will provide superior containment of fecal matter, and the inconvenience factor in cleaning them can be greatly reduced with the use of a diaper service.

If you have read the preceding parts of this primer, then you have learned about the diaper characteristics we call absorption and wicking. We did not mention "containment", since that feature is more or less "automatic" when only urinary incontinence is considered. Once a diaper becomes wet, the plastic outer surface of the disposable or the plastic pants worn over the cloth diaper provide for the "containment" of the wetness within the diaper. They protect your clothing and the furniture you sit on. Most failures of containment in the case of urinary incontinence can be traced to a lack of absorption or wicking which led to a leak. And that may occur notwithstanding an obvious tear in the plastic backing that would also result in a containment failure.

With fecal incontinence, absorption and wicking mean nothing, and containment now means everything. The fecal matter that pushes its way into your diaper will not be absorbed and safely tied up by "diaper particles". The job of the diaper in this case is to contain the fecal matter within the diaper until you can change.

Taping on a (disposable) diaper

I feel that standing cuffs or leak guards (whatever different manufacturers call them) are the single most important consideration in choosing a diaper for fecal incontinence. That feature is followed by fit and your technique in taping on the diaper. Since we are talking dry diaper wear, we want the cheapest diaper possible with cuff guards and which fits well and has dependable tapes!

I mentioned a barrier cream as highly recommended for fecal incontinence, so start this diapering sequence by applying a barrier cream. Cover the anus, buttocks, (and for males) the scrotum and penis. Massage the cream in well, particularly in skin folds. All that skin is super-sensitive. You do not need to coat your hips or your frontal pubic area that is covered with hair. Usually fecal matter does not move that far forward. At this point, you have to thoroughly wash your hands so that you do not contaminate the diaper tapes or taping surface. You would be amazed at how little cream (or oil or powder) it takes to ruin a diaper tape!

Open the new diaper up and stretch it out the long way to pop up the cuff guards; be sure they are not stuck down anyplace along their length. For taping on the diaper, I start with the leg tapes first anyway, but will urge those of you who prefer to tape the waist first to consider trying this technique. Standing with your back to a wall holding the back of the diaper in place by pressing it to the wall with your buttocks, reach down and bring the front up to your front waist. Now make any fit adjustments so that the front and rear waist both fall where you want them to. Smooth the front diaper wing snugly across your thigh and side of hip toward the rear, taking care not to touch the ointment/cream on your skin with your fingers that would transfer to the diaper surface or tape and ruin the diaper tape.

Now, when you bring the rear side wing up to tape it to the front of the diaper, lift that leg by bending the knee somewhat. Take care to wrap the diaper wing snugly along the "panty line" of your thigh. After you have taped both bottom tapes, you should have formed snug "leg openings" with your disposable. Feel with a finger at the leg opening below your buttock (cheek). The diaper should be snug to your skin. Again, take care not to get cream on your fingers. I keep repeating this caution because it is a hassle; it's very easy to get cream on your fingers and then you ruin a tape or two!

Now, tape the waist tapes without pulling the back of the diaper up any higher on your waist than where it ended up as you wrapped the wings around your legs. This may (and should) result in a diaper seat that is just a bit "baggy" - that is fine. That gap allows space for the fecal matter to occupy and, hopefully, stay within the confines of the diaper until you can change.

It happens; you have a load of fecal matter in the diaper.

In most cases we have to sit down before we can change.

For men only: If you will have to sit down but can reach a private spot - out of the public eye - before you do sit down, then use your hands to push the fecal mass in the rear of your diaper into your crotch and towards the front of the diaper. Here we are counting on the tight leg taping and the cuff guards to contain the mass as we move some of it forward into unoccupied diaper in front prior to sitting down. Now when we do sit down, the fecal mass will be squeezed to any part of the diaper it can access. Otherwise, in sitting down, most likely the back portion of the diaper will get most of the relocated mass. The weak link for containment is the channel or depression formed by your back bone that leads to the great world outside your diaper... exactly where you don't want a mess!

For women: Pushing the load forward will create a special problem. Rather, one of our female correspondents gives this advice. I find that if I keep my legs tightly closed and sit down, sort of front-to-back, the load gets pushed to the back, and I can avoid some nasty infections at worst and a harder clean-up when changing at best. I have had very little problem with any of my load getting out of my diaper in the back. That problem has happened occasionally, but only after an especially large load. I try not to sit down with a load in my diaper, and I find this way of managing the load works pretty well. I try to keep my legs pretty close together when I walk, too. This helps to keep the load from moving into the crotch of my diaper and helps to push it toward the seat of my diaper. No major problems have occurred for a long time.

Special underwear considerations

Let's accept that a release is going to happen. Containment won't be perfect, and you'll get some of the fecal matter oozing out between your legs and at the top of your rear waist. I recommend mid-thigh underpants for males. Sometimes called boxer briefs, these cotton underpants have legs that reach to your mid thigh and they are much deeper cut than jockey-style. Pull a pair of these on over the disposable. The waist of the mid-thigh cotton underpants should come well above the diaper waist. It is important that it be above the diaper waist in the rear to catch any fecal matter that escapes upwards at the rear waist. Next, pull on an undershirt, leaving the tail outside, or over the mid-thigh briefs and then add a second pair of cotton briefs (jockey style) into which you can tuck the undershirt. Plastic pants are optional, I would lean toward wearing a pair with snug leg bands and then "scrunch up" the legs of the mid-thigh briefs so they are covered by the plastic pants. Now you have the disposable diaper hopefully to contain the fecal matter but you have a bit of "cloth diaper and plastic pants" over the disposable to catch any of the substance leaking out.

Clean-up

Let's move on to the diaper change and clean-up. With urinary incontinence, clean-up between diaper changes is optional. Depending on individual differences, some persons have low-odor or no-odor urine that is mild and does not bother the skin. Taping on a new diaper is quick and easy. Some of the more fastidious will want to utilize an anti-bacterial wipe and possibly some powder between changes. But with fecal incontinence, I urge a full wash-down, in the tub, with the hand-held showerhead. I must leave the tips for changing while "on the road" to others and will add that information as it arrives. Invariably, I head for home when I have that rare bowel release in my diaper. The method below assumes a home situation.

Undress down to the underwear and then set up a basin or diaper pail near the shower. Have a roll of paper towels and a couple of plastic bags (shopping bags are adequate) for disposal purposes. If you have never experienced this, you will not believe how fecal matter will spread over everything. So care is needed, and I recommend being in the bathroom when you start removing the underwear. To be even more cautious, move into the tub or shower stall. Pull off the plastic pants if you were wearing them. They should not be contaminated with mess. Remove the cotton jockey shorts and check for contamination. If none, toss them on the floor for regular laundry. If there is some contamination at the rear waist, be careful with the next step, removing the tee shirt. The tee shirt will be contaminated, and you will want to roll the waist up several inches before pulling the shirt over you head to avoid the mess spreading to the back of your head!

The contaminated underwear goes in the basin or diaper pail for soaking. The mid-thigh underpants most likely will be contaminated, if not at the rear waist, then at the legs. They will go in the basin for soaking. For removing the diaper, I slide it right down to the tub and step out. I find less mess and bother than with trying to rip the tapes the open. The soiled diaper gets put in the plastic bag and set down on the tub or shower stall bottom while you wipe yourself with paper towels, adding the soiled paper towels to the plastic bag. When you have wiped as much as possible, the top is tied, and that bag is put in a second plastic bag, which is also tied and then placed on a safe (cleanable) surface, such as the bathroom floor, while you shower.

I highly recommend the "personal" or hand-held showerhead that attaches in place of the ordinary fixed showerhead. Being able to direct a stream of water close to the soiled areas is a big advantage. Soap needs to be the liquid variety in a pump dispenser (now available in anti-bacterial variety) so that you can keep accessing soap one-handed while the other hand is holding and directing the stream of water. Moreover, bar soap would itself become contaminated and represent one extra thing to clean up!

Hopefully, you don't have a problem touching feces, but if you do, you had better get over it. Remember, it's your waste, and you handled the substance once when it was ingested as food. Now the waste merely represents rejected food that body is done with. (Hope that helps!).

After hosing off with the hand-held shower head, start washing with the liquid soap and your other hand. As soon as the wash water starts to run clean, I will pause to wash down any splatter on the shower walls and hose away any bits on the tub bottom. I then put down the shower head and begin two-handed soaping and washing. The "Lather-rinse-repeat" formula is what all our shampoo directions tell us. That is ideal advice for clean up following a fecal release in a diaper. After you dry off and put on a clean diaper, you can move the bag of soiled diaper materials out of the house (because it has an odor), then attend to the laundry items and finish any necessary clean-up to the tub. As a safety matter, I strongly recommend a rubber bath mat, especially the ones with suction cups that grip the tub bottom. If you feel the need to get that mat really clean for the next family member, you can run a couple of inches of water in the tub and add a half cup of bleach and a little laundry detergent. This cleaning solution can be swished all around the tub and the walls can be wiped down as well. Drain the solution and rinse the walls, tub and rubber mat with the hand-held shower head and you can feel as though you did a reasonable job of cleaning up the tub after essentially using it as the toilet!

If fecal incontinence has become more than an occasional problem for you, you will find below some advice from other contributors: (TO BE ADDED AS RECEIVED)

FOODS THAT DIRECTLY EFFECT FECAL INCONTINENCE

Stimulates the internal anal sphincter to relax:

Coffee, Chocolate, Tea, Any caffeinated beverages.

Irritant:

Spicy foods

Gas-producing:

Beer, Carbonated beverages.

Laxative:

Fruits

EFFECTS OF FOOD ON THE GASTORINTESTIONAL TRACT

Foods that thicken stool:

Bananas, Rice, Bread, Potatoes, Creamy peanut butter Applesauce, Cheese, Tapioca, Yogurt, Pasta, Pretzels, Oatmeal, Oat Bran, Grits, Boiled milk

Foods that stimulate stool production:

Dried or string beans, Chocolate Raw fruits, Raw vegetables, Highly spiced foods, Fried foods, Greasy foods, Prune juice, Grape juice, Highly seasoned foods, Cabbage, Leafy green vegetables (lettuce, broccoli, spinach), Sweet foods and beverages, Alcohol, Wheat bran

Foods that cause odor:

Fish, Eggs, Asparagus, Garlic, Cabbage-family vegetables (onions, cabbage, Brussels sprouts, broccoli, and cauliflower), Beans, Turnips

Foods that cause gas:

Dried and string beans, Beer, Carbonated beverages, Cucumbers, Radishes, Cabbage-family vegetables (onions, Brussels sprouts, cabbage broccoli, and cauliflower), Dairy products, Spinach, Corn

Foods that color stools:

Beets, Red Jell-O, Chlorophyll-based preparations (Nullo)

Return to Chapter Index


Disclaimer

©2005 Incontinence Support Center