Bowel incontinence or faecal incontinence is defined as an inability to control the passing of faeces (stools), resulting in involuntary soiling. Bowel incontinence can vary from person to person but may include:

• a sudden urge to go to the toilet with an inability to control this
• an inability to reach the lavatory in time
• the inability to recognise the need to pass a stool.

Epidemiology

The exact prevalence of bowel incontinence is difficult to establish, due to the embarrassing stigma of the condition. However, current statistical data shows between one and 10 per cent of adults are affected with bowel incontinence. So be assured, you are not alone, and remember in many cases it can be treated with specific medication.

What is a normal bowel motion?

A normal stool is brown in colour, although this can vary depending on the foods you have eaten. Normal frequency is between three times a day and three times a week, but most people open their bowels once a day. The normal consistency of stool should be soft and formed – type three of four on the Bristol stool chart.

Medication

Loperamide works by slowing down the activity of the bowel. This means the bowel’s content moves slower and remains in the intestine for longer, allowing more water to be absorbed back into the body resulting in firmer stools that are passed less often.

Indications for use

Loperamide is sugar-free, and acts quickly. It can be used to treat:

• acute diarrhoea, in adults and children 12 years and over
• acute exacerbations of chronic diarrhoea for periods of up to five days
• the symptomatic treatment of chronic diarrhoea in adults.

Preparations

• Imodium 1 mg/5 ml oral solution.
• Loperamide 2mg hard capsules (contains lactose).

Imodium oral solution is used when lower doses are required. This is prescribed by your doctor or pharmacist. Loperamide 2mg hard capsules can be obtained over the counter at a pharmacy.

Dosages

Individual needs vary and so does the dose required to achieve a formed stool. Under a doctor’s advice, lower or higher doses may be used with the aim of achieving a Bristol stool type three or four, while avoiding constipation. It is usual to start on a low dose and increase it slowly over several days to judge how your body is responding.

The total daily dose should not normally exceed 16 mg (8 x 2mg tables) for adults.

Your doctor or nurse will provide information on the dose required and when the medication should be taken.

Some medications can be used off-label. This means the medication is used in way that is different from the product licence. After discussion, your doctor will consider your medical information when prescribing an off-label dose of loperamide, ensuring that the medicine prescribed is appropriate for you.

Side effects

All medicine can have reported side effects. In the UK, all manufacturers are obliged to include a patient information leaflet with their medical product. This leaflet offers information about the medication, including the reported side effects of the medicine. If the medicine you are given is off-label, you may find that the leaflet may not quite relate to you or your health condition.

The table below contains some of the most common side-effects associated with Loperamide. You will find a full list in the manufacturer's information leaflet supplied with your medicine.

Contra-indications

To make sure this is the right treatment for you, before you start taking Loperamide it is important that you speak with your doctor, pharmacist or nurse if you:

• are pregnant or breast-feeding
• have liver problems
• are constipated
• have a long-term bowel condition, such as ulcerative colitis
• are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines
• have ever had an allergic reaction to a medicine.

References and useful recourses

• https://bnf.nice.org.uk/drugs/loperamide-hydrochloride/#indications-and-dose
• https://www.bladderandbowel.org/bowel/bowel-treatments/faecal-incontinence-treatments/
• https://www.nice.org.uk/guidance/cg49/chapter/Key-priorities-for-implementation
• https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/bowel-incontinence

Bristol stool type record

The chart below can be used to record the dose of Loperamide taken each day and the resulting Bristol stool type, in order to track the effects of different doses and find the best dose for you.