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Penn ABL Clinic Brings Attention and Relief to an Underrecognized Condition


Physician discussing with patient

Sometimes our bodies betray us in embarrassing ways; accidental bowel leakage (ABL) is a perfect example.

ABL is the loss of stool — liquid or solid — unintentionally. It’s more common in women, affecting 1 in 13 women under the age of 60 and 1 out of 7 women over the age of 60, and, as Penn Medicine urogynocologist, Uduak Andy, MD, affirms, it’s something that often hits people out of left field.

“People don’t realize that this can happen because no one is talking about it,” she says. “In many cases, the person will bounce from doctor to doctor without ever getting a proper workup, let alone a diagnosis or relief. I want women with this condition to know that Penn Medicine’s ABL Clinic is here for them.”

Penn Medicine’s ABL Clinic is a service of the Penn Urogynecology Program. It’s overseen by Dr. Andy who, along with her team, provides these women with the care, treatment and education that they need to manage their ABL. According to Dr. Andy, the whole process begins with a thorough evaluation.

Causes of ABL

“ABL can be tricky to treat because it can be caused by several different things including childbirth, a physiological problem with the anal rector muscles, diet or gastrointestinal issues,” she explains. “We start with the simplest thing, diet. To evaluate this, we ask our patients to keep a food and bowel diary for a period of time to see if non-invasive modifications, such as adding more fiber to the diet, will help them develop a good bowel regimen.”

She adds that she may also use tests, such as anorectal manometry, to measure the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal bowel movements.

“We want to make sure that she’s not having accidents because her anal muscles aren’t strong enough or aren’t sensing things early enough,” says Dr. Andy.

Treatment Options

While a good number of her patients respond well to diet modification, Dr. Andy explains that there are some women who require more invasive approaches. In these cases, the ABL Clinic offers the full range of available options, including neuromodulation and surgery.

The program is part of the National Institutes of Health’s Pelvic Floor Disorders Network, which encourages collaborative research on pelvic floor disorders in an effort to improve patient care. This affiliation, says Dr. Andy, means that patients seen in the ABL Clinic can be offered alternative treatment approaches for this condition that may not be available to other providers in the region. One example is a study evaluating the use of percutaneous tibial nerve stimulation, a common treatment for urinary incontinence, that may help with ABL.

When it comes to the preventing this condition, Dr. Andy offers some advice. “Women should always strive to maintain good stool habits and have bowel movements every day; increase your fiber if you’re having trouble,” she says. “I’d also suggest Kegel exercises — which are good things to do anyway — to strengthen the pelvic floor.

“And, if they develop ABL,” Dr. Andy continues, “know that our clinic is a place where they can come to be seen and evaluated and leave with a plan of treatment that will ideally provide them with relief and a better quality of life.”

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