Faecal Incontinence

What is faecal incontinence?
Faecal incontinence ranges from lack of control of wind to a complete loss of control of stool. It is a common condition with around 10-15% of people affected in the UK.

What causes faecal incontinence?
The three main causes are damage to the sphincter muscle, damage to the nerves to the sphincter / pelvic floor or a weak pelvic floor with prolapse. These are often related to damage from childbirth. Incontinence may not come to light until many years later, as the muscles get weakened further with ageing.

What symptoms do patients get?
Patients may experience different patterns of incontinence. Some patients suffer from leakage of stool from the anal canal without them being aware that it is happening (passive incontinence). Other patients know that they need to open their bowels but cannot get to the toilet in time (urge incontinence). Others notice leakage after evacuation (post-defaecatory leakage).

Which tests will I need?
A colonoscopy or flexible sigmoidoscopy will exclude a cause higher up the bowel. Anorectal physiology and an endoanal ultrasound examine the structure and function of the anal sphincter. If there is a suspicion that bowel prolapse may be causing the symptoms, then we may suggest a proctogram.

Which treatments might be offered?
Simple measures such as physiotherapy and making the stool consistency firmer with anti-diarrhoeal medications such as loperamide (immodium) help some patients. For patients not significantly improved with these approaches, there are a number of surgical techniques for improving continence, including sacral nerve stimulation, anal sphincter repair and laparoscopic ventral rectopexy. The exact procedure we recommend will depend on your symptoms and the results of your investigations.