Introduction
Faecal incontinence is the inability to control bowel movements. There are both mild and severe forms of the condition, although people who have the condition are often very embarrassed and so do not seek medical advice.
Causes
The primary underlying cause of faecal incontinence is damage to the nerves or muscles around the anus. This damage in turn causes weakening of these muscles. The following may be factors:
- Obstetric injury during delivery e.g. large tears / cuts or instrument-assisted whilst giving birth.
- Previous surgery around the anus e.g. anal fistula operations or haemorroid operations.
- Trauma to muscles of the anus.
- Any infection in the anal region, which may in turn damage muscle tissue.
- Rectal prolapse – protrusion of the rectum outside the bottom.
- Ageing – as you age, the muscles of your pelvic floor become progressively weaker.
Symptoms
Faecal incontinence may not occur until later on in life, regardless of the cause. The most obvious symptom is the inability to hold or defer a bowel motion (urge incontinence) or being incontinent without realizing (passive incontinence).
Rectal bleeding may also occur, in which case it is strongly advised to visit your doctor to make sure this does not have another more serious cause, such as ulcerative colitis, colorectal cancer or a prolapse.
Tests & Diagnosis
The first stage of diagnosis is to review medical history, particularly in women who have had children, where specific factors such as having had heavier babies or multiple pregnancies, or having undergone forceps delivery may make the development of faecal incontinence more likely. In some cases, prior illness or particular types of medication may increase the risks of developing the condition.
The next diagnostic step is a physical examination of the anus and anal area to determine if there has been any noticeable damage to the anal muscles.
Specialised tests are also used in combination with the above to help determine how well the muscles around the anus (the sphincter muscles) function. These consist of manometry and ultrasound of the anal canal. Manometry is where a probe is inserted into the anus to measure the pressures as the anal muscles are tightened and relaxed. Anal ultrasound provides important information regarding whether the sphincter muscles are completely intact.
Treatment
Treatment varies depending on whether the condition is mild or severe. In mild cases, a combination of approaches may give considerable relief. These approaches include dietary changes and medication to slow bowel emptying, such as anti-diarrheal medication. Any condition that may be contributing to incontinence is also treated. A specialized physiotherapy program, called biofeedback, may also be used.
Where the condition is more severe, surgery may be the most appropriate treatment. Previously the main treatment for severe faecal incontinence was the fitting of a colostomy, however there are now a range of different surgical options for the condition.
