Faecal Incontinence

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Dr Chong Choon Seng

MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)

Faecal incontinence refers to the inability to control bowel movements, leading to unintentional leakage of stool. The severity of this condition can range from infrequent minor leaks to complete loss of bowel control. It often affects physical, emotional, and social aspects of life. Identifying the underlying cause is key to managing the condition effectively.

Symptoms of Faecal Incontinence Symptoms of Faecal Incontinence

Symptoms of Faecal Incontinence

Faecal incontinence presents with various symptoms, which can differ in type and severity depending on the underlying cause.

  • Stool Leakage: Uncontrolled release of solid or liquid stool, which can happen during coughing, sneezing, or physical exertion. In severe cases, leakage may occur without any apparent trigger.
  • Urgency to Defecate: A sudden, overwhelming need to pass stool, often accompanied by difficulty in delaying bowel movements. This can result in accidents if access to a toilet is delayed.
  • Incomplete Bowel Emptying: A persistent sensation that the rectum has not been fully emptied, even after passing stool. This may lead to frequent attempts to defecate.
  • Rectal Discomfort or Pain: Pain, irritation, or pressure in the rectal area, which can occur during or between bowel movements. While not present in all cases, it may be associated with certain underlying causes.

Causes and Risk Factors

The causes of faecal incontinence often involve a combination of physical and neurological factors. Certain risk factors can increase its likelihood.

  • Muscle Damage: Tears or injuries to the anal sphincter muscles can reduce the ability to hold stool. This damage is commonly associated with childbirth or surgery.
  • Nerve Damage: Disruption in the nerves that control the anal muscles or rectum, often due to diabetes, stroke, spinal cord injuries, or neurological disorders, can lead to incontinence.
  • Chronic Diarrhoea or Constipation: Repeated episodes of diarrhoea can overwhelm the anal muscles, while chronic constipation may stretch and weaken the rectum, making stool control more difficult.
  • Ageing: Weakening of the pelvic floor and anal sphincter muscles due to ageing can increase the likelihood of incontinence.
  • Rectal Prolapse or Pelvic Floor Disorders: Conditions such as rectal prolapse, where part of the rectum protrudes from the anus, or pelvic organ prolapse can impair the structural support needed for bowel control.

Diagnosis of Faecal Incontinence

Medical History

The doctor will gather a detailed medical history, focusing on bowel habits, dietary patterns, and any past injuries, surgeries, or medical conditions that may affect bowel function.

Physical Examination

The physical examination includes assessing anal tone, identifying signs of muscle or nerve impairment, and detecting any structural abnormalities or other factors contributing to incontinence.

Anorectal Manometry

This test measures the strength, coordination, and sensitivity of the anal sphincter and rectum. A small, flexible tube is inserted into the rectum, and pressure sensors provide precise data about muscle function during rest, contraction, and simulated bowel movements.

Endoanal Ultrasound

This imaging test uses a probe to create detailed images of the anal sphincter muscles. It is particularly useful in identifying muscle tears, thinning, or scarring, which are common in cases related to childbirth or trauma.

Defaecography

A specialised imaging procedure (X-ray or MRI) is conducted while the patient defecates a soft material. It provides insights into the function of the rectum, pelvic floor, and anal canal, identifying structural problems like rectal prolapse or impaired muscle coordination.

Colonoscopy

A camera-equipped flexible tube is inserted into the colon to examine the lining for abnormalities, including polyps, tumours, or inflammation. This test may be used to rule out diseases that cause incontinence, such as colorectal cancer or inflammatory bowel disease.

Treatment Options

Treatment aims to address the underlying causes and manage symptoms. Options include non-surgical approaches and surgical procedures, depending on the severity and cause.

Non-Surgical Treatment

  • Dietary Adjustments: Adjusting fibre intake can help regulate stool consistency, whether the issue is diarrhoea or constipation. For example, high-fibre foods can bulk up loose stools, while avoiding irritants like caffeine or alcohol can prevent digestive disturbances.
  • Pelvic Floor Exercises (Kegels): These exercises involve contracting and relaxing the pelvic floor muscles to improve strength and control. A physiotherapist can provide guidance on proper technique and routines for optimal results.
  • Medications: Anti-diarrhoeal drugs such as loperamide can reduce the frequency of bowel movements, while stool softeners or laxatives may be recommended for those with chronic constipation.
  • Biofeedback Therapy: This treatment uses sensors to monitor muscle activity and help patients learn how to improve coordination and control of the anal sphincter. Sessions are typically guided by a specialist.
  • Bowel Training: Establishing a regular toileting schedule can help retrain the body to have predictable bowel movements. This method works best when combined with dietary changes and other treatments.

Surgical Treatment

  • Sphincteroplasty: This procedure repairs a damaged anal sphincter, often due to childbirth or trauma. It involves suturing the torn muscle edges together to restore control. Recovery typically involves physiotherapy to enhance long-term outcomes.
  • Sacral Nerve Stimulation (SNS): A small device is implanted under the skin near the sacral nerves, which control bowel movements. Electrical pulses from the device stimulate the nerves, improving coordination and muscle function. This is minimally invasive and reversible.
  • Colostomy: A colostomy may be performed in severe cases where other treatments are ineffective. This surgery diverts stool through an opening in the abdomen, allowing it to be collected in an external bag.
  • Injectable Bulking Agents: Materials are injected into the walls of the anal canal to increase bulk and improve closure of the sphincter. This can be an option for patients with mild to moderate incontinence.

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Prevention and Management

Preventing faecal incontinence focuses on maintaining healthy bowel habits and addressing contributing factors. A diet rich in fibre and fluids can regulate bowel movements, while regular physical activity helps maintain pelvic floor strength. For those at risk, avoiding chronic constipation or diarrhoea by managing conditions like irritable bowel syndrome or following medical advice can reduce the chances of developing incontinence. In ongoing cases, adopting a consistent bowel routine and following prescribed treatments can help manage symptoms effectively.

Frequently Asked Questions

How is faecal incontinence related to childbirth?

Childbirth can lead to faecal incontinence, especially in cases involving perineal trauma, the use of forceps, or difficult deliveries. These factors may cause damage to the anal sphincter muscles or surrounding nerves, potentially increasing the risk of incontinence. Symptoms may develop immediately or appear later in life.

Can faecal incontinence occur with certain medical conditions?

Yes, medical conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or rectal cancer can increase the risk of faecal incontinence. These conditions may lead to chronic bowel irregularities or cause structural damage to the rectum and surrounding tissues.

Is faecal incontinence linked to urinary incontinence?

Yes, faecal incontinence and urinary incontinence are often linked, as both can result from weakened pelvic floor muscles. This connection is particularly common in women, especially after childbirth or with age-related muscle weakening.

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Dr Chong Choon Seng

MBBS (NUS)

MRCS (Edinburgh)

Masters in Medicine (Surgery)(NUS)

FRCS (Edinburgh)

Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.

As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.

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