What is faecal incontinence?
This is an inability to control bowel movements, which means that stools can leak uncontrollably from the rectum. It can severely affect a person’s quality of life, self-esteem and emotional wellbeing. Faecal incontinence is a symptom or sign rather than a disease and there are often multiple contributory factors.
Who may be affected?
Approximately 2% of the adult population are affected. It can affect people of any age, although the condition is more common in elderly people. It is thought to be slightly more common in women than men.
Possible causes include:
- Faecal impaction with overflow (particularly in elderly and / or immobile patients).
- Obstetric trauma i.e. anal sphincter muscle injury sustained during childbirth, particularly where there has been a history of difficult labour / forceps delivery or where sutures have been required.
- Rectal prolapse.
- Inflammatory bowel disease.
- Neurological disease.
- Acute spinal disc prolapse.
- Congenital disorders e.g. spina bifida.
- Behavioural disorders.
- Bowel cancer.
- Damage following anal surgery.
What can be done to treat it?
This depends on the causative factors. A full history and examination are required. Investigations such as a colonoscopy or barium enema are sometimes required. Some patients may need anorectal physiology tests to accurately assess the anal muscles and nerves. For most patients with a weak anal sphincter, anti-diarrhoeal drugs should be prescribed such as Loperamide. This should be introduced at a very low dose and increased as tolerated until desired stool consistency is reached. Subsequent doses can be adjusted according to stool consistency and bowel control. For people with faecal loading and overflow diarrhoea, rectal enemas may be needed to clear the bowel satisfactorily, often with a strong oral laxative. Often treatment will need to be repeated daily for a week or two.
Other interventions may include:
- Specialist dietary assessment and management.
- Rectal irrigation e.g. using the Peristeen® Irrigation System (see video animation below).
- Pelvic floor muscle training.
- Sacral nerve stimulation.
- Anal sphincter bulking injections.
- Surgery e.g. anal sphincter repair, gracilis neosphincter, artificial anal sphincter, colostomy.