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Faecal Incontinence

What is faecal incontinence?

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.

What 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 leakage).

Any tests?

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.

Which treatments?

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.



Investigations

Defecating proctogram
Anorectal Physiology tests

Treatments

Biofeedback or Pelvic Floor retraining
NICE guidance SNS (Public)
Trial Wire SNS
Permanent Sacral nerve Stimulation SNS

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SPIRE Hospital, Bristol. 
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Contact: Claire Trenberth - 0117 9804051
claire.TRENBERTH@spirehealthcare.com
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