Faecal Incontinence
Understanding Faecal Incontinence
Faecal continence is characterised by the involuntary loss of faecal matter (gas, solid or liquid) from the back passage. Faecal incontinence may be associated with a sudden urgency to defecate; occur post defecation or occur passively with no awareness.
Signs and Symptoms of Faecal Incontinence
- Unwanted and uncontrolled leakage from the back passage
- Increased urgency to defecate
- Soiling after emptying the bowels, which may be associated with a sense of incomplete evacuation
Causes and Risk Factors for Faecal Incontinence
The cause of faecal incontinence is often multifactorial and may include
- Chronic constipation or diarrhea
- Advancing age
- Pelvic floor muscle weakness
- Previous surgery to the anorectum
- Obstetric anal sphincter injury
- Neurological disorders
- Medication side effects
- Stress and anxiety
Diagnosis of Faecal Incontinence
The first step in diagnosis of faecal incontinence is a though history and physical examination. Further evaluation to confirm diagnosis includes
- Colonoscopy
- Functional assessment of the muscles in the anorectum via digital rectal examination and/or anorectal manometry
Treatment Options for Faecal Incontinence
Treatment of faecal incontinence often includes input from a multidisciplinary team. Common treatment options may include;
- Pelvic floor muscle (PFM) strengthening
- Optimising defecation technique including your toileting position, use of abdominal and pelvic floor muscles, and passive support/splinting if prolapse is relevant for you
- Adjunctive therapies utilising electrical stimulation to strengthen the pelvic floor muscles and dampen the signally between the rectum and the brain
- Stool manipulation through changes to dietary fibre, fluid intake, and laxatives.
- Lifestyle modifications including physical activity, weight loss, sleep hygiene, and overall relaxation
- Surgical procedures may be considered where conservative approaches have failed. This includes sacral neuromodulation (a pacemaker connected to the nerves controlling continence control, sphincter bulking injection, prolapse repair surgery, sphincter repair)