Anal or faecal incontinence

Faecal incontinence is a common condition that affects about 2% of the population. It becomes more common with increasing age. Most patients with faecal incontinence do not seek medical attention because of embarrassment and many patients, particularly older patients accept that faecal incontinence is a normal part of aging.

Who gets faecal incontinence?

Faecal incontinence tends to affect older patients. Women are affected more than men. Previous child birth, particularly with tears, prolonged labour, the need for instrumental delivery (e.g. forceps)  increase risk of subsequent faecal incontinence.

However, incontinence can also occur as a result of previous surgery on the anus such as haemorrhoidectomy, surgery for fissure or anal fistula. Radiotherapy, rectal surgery for cancer can also damage the pelvic floor resulting in faecal incontinence. Diarrhoeal states induced by colitis or other conditions can also predispose to faecal incontinence due to difficulty holding onto liquid stools.

Tests for faecal incontinence

Anorectal physiology includes at least three tests which informs your doctor about the function of the anal sphincter muscles. These are:

• Anal manometry: tests pressures generated by the anal sphincter muscles and informs your doctor how well the muscle is working
  
  
• Endorectal ultrasound: ultrasound of the anal sphincter muscles allowing your doctor to see if the anal muscles are intact and allows diagnosis of any sphincter injuries
  
  
• Pudendal nerve terminal motor latency: test of the nerve that keeps the anal muscle working
  
  
• Other tests such as rectal volumes may also be necessary depending on the cause of faecal incontinence.

Treatment for faecal incontinence

Treatment for faecal incontinence varies depending on the cause of the incontinence as well as the severity of the incontinence.

All patients can benefit from biofeedback and pelvic floor strengthening exercises. Constipating medications such as loperamide may also be helpful to improve stool consistency to help patients improve their ability to hold on. Patients who continue to have symptoms may benefit from surgery. Depending on the underlying cause, surgical options include overlapping sphincter repair, injection of bulking agents or insertion of a sacral nerve modulator. Some patients may require the formation of a stoma to relieve the symptoms of incontinence.

Reviewed 2017