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Faecal Incontinence

Description

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.

Causes

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

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).

Investigations

  • Only faecal incontinence that is not controlled by simple measures needs investigation by more invasive means
  • A colonoscopy is often recommended to rule out any sinister pathology in the anorectum such as a tumour
  • Endoanal ultrasound is the best way to look at the structural integrity of the anal sphincter and to detect defects.
  • Anorectal physiology can be performed to measure the pressures generated to hold in motion
  • Nerve conduction studies can indicate if there is a problem with the pudendal nerve.

Treatment

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

  • biofeedback – pelvic floor exercises and muscle re-training
  • Sphincter Repair – this is valuable when a large defects are demonstrated on ultrasound
  • Sacral nerve Modulation (SNM) – a small implantable electrode to provide stimulation to a sacral nerve has shown great benefit in the short and medium term
  • Colostomy (bag) – used when all other methods have failed
  • Prince of Wales Private Hospital
  • The Royal Hospital For Women Foundation
  • Colorectal Surgical Society of Australia and New Zealand
Randwick Rooms

Prince of Wales Private
Suite 17, Level 7
Barker Street
Randwick NSW 2031

Phone: 1300 553 347
Fax: (02) 9650 4924

Double Bay

Double Bay Day Hospital Specialist Suites
Suite 3.01, Level 3, commercial
451 New South Head Road
Double Bay

Phone: 0290 863 133
Fax: (02) 9086 3123

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