Wirral Surgeon - Bowel (faecal) incontinence is the inability to control the release of flatus and/or stool. It is a common problem, especially in older people, and is said to affect around 2% of the population.

Condition treated

The most important point to remember is that everyone with a bowel problem can be helped and many can be completely cured.
It is never too late to get help with your bowel problems. If you would like some advice on how to approach your GP regarding your bowel problem do get in touch.

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Mid age person wearing incontinence pants. It is visible just the area with the incontinence pants, the face or the legs are not presented on the picture.

Bowel Incontinence

Bowel (faecal) incontinence is the inability to control the release of flatus and/or stool.

It is a common problem, especially in older people, and is said to affect around 2% of the population.

Bowel Incontinence

Bowel (faecal) incontinence is the inability to control the release of flatus and/or stool.

It is a common problem, especially in older people, and is said to affect around 2% of the population.

Causes

More than one cause for bowel incontinence is frequently present. It's also not unusual for bowel incontinence to occur without a clear cause.

The most common causes of bowel incontinence are:

Damage to the muscles around the anus (anal sphincters) during childbirth or after anal surgery (haemorrhoidectomy, fistulotomy, anal stretch)

Diarrhoea (often due to an infection or irritable bowel syndrome)

Impacted stool (due to severe constipation, often in older adults)

Inflammatory bowel disease (Crohn's disease or ulcerative colitis)

Nerve damage (diabetes, spinal cord injury, multiple sclerosis)

Radiation damage to the rectum (after treatment for prostate cancer)

Cognitive impairment (such as after a stroke or advanced Alzheimer's disease)

Diagnosis

Stool testing

If diarrhoea is present, stool testing may identify an infection.

Endoscopy

This identifies any potential problems in the anal canal or rectum/colon. A short, rigid tube (proctoscopy) or a longer, flexible tube (sigmoidoscopy or colonoscopy) may be used.

Anorectal manometry

A pressure monitor is inserted into the anus and rectum. This allows measurement of the strength of the sphincter muscles.

Endosonography

An ultrasound probe acquires images that can help identify problems in the anal sphincter and rectal walls.

Nerve conduction tests

These tests measure the responsiveness of the nerves controlling the sphincter muscles and can detect nerve damage that can cause bowel incontinence.

Defaecating proctogram and/or MRI defecography

These can provide information about the muscles and supporting structures in the anus, rectum, and pelvis.

Treatment

Bowel incontinence is usually treatable and, in many cases, it can be cured completely. Often, more than one type of treatment might be required.

Non-surgical methods are often the first step in treating bowel incontinence.

Diet. Increase fibre intake to 20-30 grams per day; avoid caffeine; drink several glasses of water a day.

Loperamide (Immodium) reduces the number of bowel movements and the urge to open bowels.

Biofeedback is a dynamic technique that aims to improve voluntary sphincter contraction and rectal sensation, and to co-ordinate squeeze efforts. Approximately 50% of incontinent patients are cured by biofeedback and two thirds are improved.

Surgical methods are generally reserved for cases not responding to medical management.

Sphincter repair and muscle transposition are employed in cases who sustained a tear in the anal sphincter muscles.

Peripheral tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS) are most effective in cases of faecal incontinence due to nerve damage.

Faecal diversion (colostomy) is only considered in severe cases where all other therapeutic options have been unsuccessful.