Faecal incontinence is the inability to control bowel movements, resulting in the unexpected passage of stools. There are grades of incontinence ranging from mild to severe. Faecal incontinence can mean loss of solid or liquid stool, gas or mucous leakage.
The cause of faecal incontinence is often multi-factorial. It most commonly occurs in middle age and elderly women who have had traumatic vaginal deliveries many decades beforehand. In other cases it can be from damage to muscles or nerves of the pelvic floor or anal sphincters secondary to previous surgery, trauma or degenerative processes. Local conditions of the anorectum such as haemorrhoids or rectal prolapse can be associated with incontinence.
Symptoms range in severity from mild occasional leakage of mucous to complete loss of solid stool. There are 2 main types of faecal incontinence. ‘Urge’ incontinence is the type where a person feels an urge to defaecate but is unable to hold on long enough before a toilet is reached. ‘Insensate’ incontinence is the type where the underwear is soiled and a patient had no awareness of the need too defaecate. In general terms, urge incontinence is associated with problems with the external anal sphincter (the one you can control consciously) and insensate incontinence is associated with problems with the internal anal sphincter (the one under autonomic control).
Faecal incontinence can often be fixed by simple measures. Treatment of underlying haemorrhoid or rectal prolapse is undertaken if these are present.
Dietary modifications including either increasing or decreasing fibre can improve things. Stool bulking agents such as benefiber and Metamucil can help. Medications to firm the stool and slow bowel transit such as loperamide are useful. Some people used enemas on a regular basis to keep the rectum empty thus avoiding accidents.
Other treatments include