Faecal incontinence ranges from lack of control of
wind to a complete loss of control of stool. It is a common condition with
around 10-15% of people affected in the UK.
normally maintains continence?
Two rings of muscle circled around the anus
maintain continence. However, only one of these muscles (internal anal
sphincter) can be contracted at will. The muscles only work
when the nerves operating them are intact and working
normally. Continence is also dependant on how thick the
patient’s stools are – loose motions causing more problems.
Continence may also depend on the ability of the rectum to expand and store
stool. If this storage capability is reduced, then patients may have
problems. This occurs when the rectum is inflamed or has been
reduced in capacity by surgery.
What are the common causes?
The three main causes are damage to the anal
sphincter muscle, damage to the nerves that supply the sphincter and pelvic
floor or a weak pelvic floor with prolapse. These are often related to damage
sustained during childbirth (usually the first pregnancy) or possible following
surgery e.g., a haemorrhoidectomy, surgery for fistula or internal fistulotomy
for fissure. Incontinence may not come to light until many years later after
the menopause, as the muscles get weakened further with ageing.
What are the symptoms?
Patients may experience different patterns of
incontinence. Some suffer from leakage of stool from the anal canal without
them being aware of it happening (passive incontinence). Others know that they
need to open their bowels but cannot get to the toilet in time (urge
incontinence). Others notice leakage after evacuation (post-defaecatory
A colonoscopy or flexible sigmoidoscopy will exclude a cause higher up the bowel. Anorectal physiology and an endoanal
ultrasound (see left) are used to examine the structure and function of the anal sphincter. If there
is any suspicion that a prolapse may be causing the symptoms, then we will arrange for you to have a proctogram.
Faecal incontinence occurs in varying degrees and
what may be acceptable for one patient, may not necessarily be acceptable for
another. This to an extent determines treatment.
Simple measures such as physiotherapy and making
the stool consistency firmer with anti-diarrhoeal medications e.g., loperamide
help some individuals. For patients not significantly improved with these
approaches, there are a number of surgical techniques for improving continence,
including sacral nerve stimuation, anal sphincter repair and laparoscopic
ventral mesh rectopexy. The exact procedure we recommend will depend on your
symptoms and the results of your investigations.