Faecal Incontinence

What is Faecal Incontinence?

Faecal Incontinence is the inability to control the passage of faeces or flatus from the anus.  This can be severe with major accidents or minor with streaking or smearing of the underwear. Incontinence may occur everyday or at irregular intervals.  There may be difficulty with cleaning and sufferers may routinely have to wear a pad.  Faecal urgency is the inability to wait or 'hang on' to go to the toilet to use the bowels.  A sufferer has to get to the toilet as soon as they feel an urge to go.  Accidents may not happen but faecal urgency is disabling. Faecal incontinence or urgency may lead a sufferer to be house bound or only go to places where they feel safe from or can cope with an accident.  Work, social and sex life can all be affected.

Normal Continence: This is the ability to recognise the need to go to the toilet and to "hang on" until a socially appropriate time to go. It relies on a healthy bowel and healthy anal spincter.  These are the muscles of the anus that we can contract or relax.

What causes Faecal Incontinence?

There are many causes of faecal incontinence:

1. Childbirth injury to the muscles or nerves of the anal sphincter.  This is the commonest cause of faecal incontinence. 
2. Chronic constipation with repeated straining to defaecate may cause injury to the nerves of the anal sphincter muscle.
3. Faecal impaction and rectal prolapse (protrusion of the lower bowel through the anus) may be associated with incontinence.
4. Injury to the anal sphincter from an accident or surgery (fistula, fissure, haemorrhoids).
5. Diseases of the bowel such as irritable bowel syndrome and inflammatory bowel disease.
6. Congenital causes where babies may be born with a problem of the bowel or anal sphincter such as imperforate anus.
7. Miscellaneous causes such as diabetes, multiple sclerosis, spinal injury and dementia.

How common is Faecal Incontinence?

It is estimated that in Australia up to 5% of the population suffer from faecal incontinence.  It is more common in the elderly and people in nursing homes.

Diagnosis: The diagnosis is established by the history of the incontinence and a rectal examination.  Tests on the bowel such as a colonoscopy or barium enema may be performed to exclude diseases of the bowel.  Further tests on the anal sphincters will help establish the cause and how to manage the problem. 1. Anal manometry involves the insertion of a slender catheter into the anus.  This test measures the strength of the anal sphincter muscles. 2. Anal ultrasound involves the insertion of a proble into the anus.  It is simply performed and not painful.  It gives an accurate picture of the anatomy of the anal sphincter muscles.  Injuries that are suitable for repair may be detected. 3. Nerve tests are used to detect if a nerve injury is present.  This may influence management.

Treatment: Symptoms of faecal incontinence are readily improved.  Alteration of diet, thickening of the faeces (medication and bulking agents), pelvic floor exercises and physiotherapy are often helpful in regaining control.  Surgery can be offered to repair or tighten the anal sphincter muscle when this is damaged. For selected conditions causing incontinence, newer procedures are available to enhance sphincter closing by injecting inert materials into the muscle or by implanting a nerve stimulator to facilitate muscle contraction. Where this is not possible, a new anal sphincter can be created.  These procedures are complex and may not be suited for every patient. 

A plastic artificial anus can be used.  Alternatively a muscle from the leg can be shifted to wrap around the anus and recreated the muscle of the anal sphincter. Occasionally, a colostomy will be recommended.  Modern applicances make this an attractive option which may be preferable to continued soiling or accidents. The major reason for not seeking medical attention for continuing faecal incontinence is embarrassment.  If you suffer or know someone who suffers from faecal incontinence talk to your doctor.  A colorectal surgeon can give specific advice on the cause and potential remedies fo the problem.

Faecal incontinence is a difficult and frustrating condition for a patient, and it can have a significant impact on your mood and your ability to carry out your normal daily activities. Please discuss any concerns around this with your surgeon. Treatment outcomes are variable, and there may be the need for several surgeries in complex situations. As a patient, it is important that you receive a clear description of the likelihood of treatment success from your surgeon.