Faecal Incontinence

What is faecal incontinence? 

Faecal incontinence (FI) is when there is involuntary passage or inability to control the passage of poo through the anus. Poo may be seen in the underwear or leak out when passing gas or during physical activity or daily life exertions. It is a common problem especially amongst the older population (more often in women than men) and is likely underreported due to embarrassment and associated stigma. 

Causes of faecal incontinence

• Obstetric trauma 

• Iatrogenic injury from surgery 

• Degeneration of the muscles in the anal canal that control continence 

• Neurological / spinal injury 

• Loss of storage capacity (e.g. rectal surgery, Crohn’s disease) 

• Rectal prolapse (protrusion of the rectum into the anal canal or beyond anus) 

Investigations for faecal incontinence 

• Colonoscopy to exclude malignancy 

• Endoanal ultrasound to assess local anorectal anatomy 

• Anal manometry / physiology 

• Defecating proctogram (XR or MR) 

How is faecal incontinence treated?

A consultation with your GP and subsequent referral to a colorectal surgeon will ensure that your symptoms are appropriately assessed and treated 

Conservative measures:

Dietary changes - reduce spicy food, dairy products, caffeine and alcohol 

Bowel training / Biofeedback - setting up a bathroom routine, and learn certain exercise to strengthen the muscles around your anus 

Medication 

• Antidiarrhoeal medication - to change the consistency of your poo

• Regular enema at consistent times - to regulate poo evacuation and reduce episodes of FI. Discuss with your specialist before commencing 

• Moisture barrier cream - to protect the skin around the anus 

Surgical management options: 

Many different techniques are available to treat the difficult problem of FI, failing conservative management. These options should be carefully considered in the context of each patients. 

• Sacral nerve stimulator (SNS) - A temporary trial of wires are initially placed, and if there is >50% improvement, permanent wire and stimulator are then inserted 1-2 weeks later. Its effective up to 90% of cases but access to this is limited in the public setting. 

• Sphincteroplasty - is a technique of sphincter repair where the muscles are overlapped back together. The efficacy reduces over time. 

• Sphincter augmentation - PTQ implantation into the anal sphincter is technically simple and minimally invasive, indicated in patients with weak / disrupted sphincters. Studies have shown significant improvement in incontinence scores, improving patient quality of life. Re-injection is effective

• Colostomy - Often the last resort, where an opening is made in the abdomen, through which the colon is brought to the surface of the skin, with poo emptying into stoma bags.