Fecal incontinence (FI), also known as anal incontinence is a lack of control over defecation, leading to involuntary loss of bowel contents - including flatus (gas), liquid stool elements and mucus, or solid faeces.
Incontinence can result from different causes and might occur with either constipation or diarrhoea.
Continence is maintained by several inter-related factors, including the anal sampling mechanism, and usually there is more than one deficiency of these mechanisms for incontinence to develop.
Faecal incontinence can occur at any age with one in ten people being affected. Some people experience incontinence on a daily basis, whereas for others it only happens from time to time.
What are the common causes of FI
The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery (especially involving the anal sphincters or hemorrhoidal vascular cushions) and altered bowel habits (e.g., caused by irritable bowel syndrome, Crohn's disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence).
FI is one of the most psychologically and socially debilitating conditions in an otherwise healthy individual, but it is generally treatable.
A history will be taken and advice given on areas such as diet, lifestyle and medications. Simple changes to diet and bowel habit can be useful for controlling symptoms whilst eliminating or adding certain medications can help decrease movement in the bowel and, in turn, make stool more formed and help reduce leakage.
Treatment options include:
- Advice on pelvic floor muscle exercises to strengthen the muscles that control the bowel.
- Guidance on diet and lifestyle to help relieve constipation and diarrhoea.
- Medication to control constipation and diarrhoea.
- Bowel retraining – treatment for people with reduced sensation in the rectum or constipation.
- Biofeedback therapy —exercise designed to check how well you are performing pelvic muscle exercises and improve your bowel function.
- Surgery including Sacral Nerve Stimulation.
How is FI diagnosed?
Tests are available to help diagnose pelvic floor disorders. You will require an internal digital rectal examination (DRE) to manually assess muscle strength and pelvic floor muscle strength and tone. This will also assess the skin condition around the anus and inside the rectum.
A fibre optic camera on a flexible tube. This examines the inside of the bowel to rule out abnormalities that may be causing these symptoms such as inflammatory bowel disease, bowel cancer or other abnormalities.
A test to work out the muscles strength and nerve function using a pressure measuring device. This is a safe and low risk procedure which usually takes approx. 30mins.
This involves a scan of both sphincter muscles to show if either are damaged. This procedure only takes 5 minutes and is not uncomfortable.
This is an examination of your pelvic floor to see what happens when you empty your bowels. This can show any issues that may be interfering with normal bowel emptying.
Urinary incontinence (UI), also known as involuntary urination, is any leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It is twice as common in women as in men. Pregnancy, childbirth, and menopause are major risk factors. It has been identified as an important issue in geriatric health care.
Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners. Enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis (bed wetting).
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