Faecal Incontinence

Faecal incontinence is the inability to control the passage of faeces or flatus from the anus. It is often underreported due to the stigma associated with the condition. Faecal incontinence affects up to 21% of the population, with variations in prevalence across different age groups. It can result in minor or major accidents when faeces or flatus cannot be controlled.

Many individuals experiencing this condition resort to wearing pads or nappies to maintain hygiene. Unfortunately, due to the associated taboo, a significant number of people suffer in silence. This can lead to a profound impairment in quality of life, as patients may feel embarrassed by recurrent ‘accidents’ and become socially isolated, avoiding public environments. Intimacy with partners may also be affected. Despite its debilitating nature, effective treatment options are available for sufferers.

Continence

Normal continence depends on the body’s ability to recognize the need to go to the toilet and the ability to hold on until it is appropriate to do so. This process is regulated by the rectum, the sphincter muscles (internal and external anal sphincters), and the nerves that coordinate these structures.

When the rectum distends with flatus (wind)or faeces, signals are sent to the brain. The initial response is for the internal anal sphincter to relax while the external anal sphincter contracts. If you are in an appropriate setting to open your bowels or pass flatus, the external anal sphincter relaxes. If not, the external anal sphincter contracts along with the pelvic floor, pushing the contents back into the sigmoid colon or upper rectum. Over time, further peristalsis pushes the contents back into the rectum. This process is called the recto anal inhibitory reflex (RAIR).

When the nerves or sphincter muscles are damaged or impaired, normal continence is affected.

What Causes Faecal Incontinence?

• Trauma to the sphincter complex or nerves of the anal sphincter:
   
  • Childbirth
   
  • Iatrogenic trauma
   
  • Rectal surgery
   
  • Fistula or haemorrhoid surgery
 
• Chronic constipation: Leading to     abnormal distension of the rectum.
• Diseases affecting the bowel: Such     as inflammatory bowel disease (IBD).
• Systemic conditions: Including     diabetes and spinal cord injuries.
• Congenital conditions: Present from     birth.

Diagnosis

A thorough history provides valuable insight into a patient’s journey with faecal incontinence. Additional diagnostic tests may include:

• Colonoscopy: To exclude inflammatory or malignant causes of faecal incontinence.
• Anal manometry studies: To test the functionality of the sphincter muscles and evaluate nerve contributions to the condition.
• Ultrasound: To assess the anatomical structure of the sphincters and the mucosal lining within the anal canal.

Treatment

Treatment is tailored based on a comprehensive evaluation, including the results of anal manometry studies.

1. Pelvic Floor Physiotherapy and Biofeedback:

• Targeted exercises can strengthen or relax the sphincter muscles, as appropriate.
• A specialist pelvic floor physiotherapist can guide these exercises.
• Certain conditions, such as dyssynergic defecation, may require retraining of the sphincter muscles to improve bowel movements, a process known as biofeedback.

2. Dietary Modifications:

• Adjusting fibre intake can help manage symptoms.
• Adequate water consumption is essential to prevent constipation.

3. Advanced Interventions:

• Sacral Nerve Modulation: A proven method to stimulate the nerves within the pelvis, helping to regain control of continence when other measures are ineffective.