Faecal Incontinence
What is faecal incontinence?
It is a condition characterised by inability to control bowel movements, leading to involuntary passage of stool. The loss of control can range from occasional leakage of small amounts of stool to complete inability to hold bowel movements.
What are the causes of incontinence?
Faecal incontinence can result from various factors, including muscle or nerve damage in the rectum or anus, chronic constipation, diarrhoea, rectal prolapse, change of bowel function following bowel surgery, surgical complications or certain medical conditions affecting nerves or muscles of the pelvic floor.
How is the cause investigated?
In addition to a detailed medical history to determine the cause of faecal incontinence, it is important to characterise the severity of faecal incontinence and its impact on a person’s quality of life.
A physical examination is often conducted, including a rectal examination, to assess the condition of the muscles and tissues in the anal and rectal area. A digital rectal examination involves insertion of a lubricated, gloved finger into the rectum to assess muscle tone, detect abnormalities and check for any signs of rectal prolapse.
Anal manometry measures the pressure and function of muscles in the rectum and anus. It helps evaluate the strength and coordination of the muscles involved in bowel control.
Pelvic floor ultrasound may be used to evaluate pelvic floor muscles and identify any abnormalities contributing to faecal incontinence.
Defaecating proctogram involve imaging the rectum and anus while the patient is simulating a bowel movement. It provides information about the anatomy and function during defaecation.
In some cases, a colonoscopy may be recommended to assess the overall health of the colon and rule out conditions such as colorectal cancer or inflammatory bowel disease.
The specific diagnostic approach may vary depending on the individual case and the suspected causes of faecal incontinence.
What is the treatment?
Treatment of faecal incontinence varies depending on the underlying cause and severity of symptoms. It may involve lifestyle and dietary changes, medications, pelvic floor exercises, biofeedback therapy, or, in some cases, surgical interventions, particularly when other conservative measures have failed.
The choice of surgical intervention depends on the specific factors contributing to faecal incontinence such as muscle or nerve damage, anatomical abnormalities, or other underlying conditions.
Sacral nerve stimulation (SNS) involves the implantation of a device that stimulates the sacral nerves which control bowel function. This can help improve muscle function and reduce symptoms of faecal incontinence.
In some cases, when all treatment has failed, a surgical procedure to divert stool away from the rectum may be considered. This involves creating an opening in the abdomen (colostomy or ileostomy), through which stool is eliminated into a bag. This bypasses the rectum and can be a last resort for many cases.