Faecal Incontinence

Faecal incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you can get to a toilet (urge incontinence) or leakage from the rectum unexpectedly passive incontinence).

1 in 10 individuals at some point in their life will have faecal incontinence. It affects people of all ages—children as well as adults. Faecal incontinence is more common in women than in men and more common in older adults than in younger ones. It is not, however, a normal part of aging.
People who have faecal incontinence may feel ashamed, embarrassed, or humiliated. The impact on quality of life of individuals can be profound. The social isolation is unfortunate but common. Timely interventions may be reduced its impact.

Common Causes:
Faecal incontinence can have several causes:
• Constipation ( Faecal impaction)
• damage to the anal sphincter muscles
• damage to the nerves of the anal sphincter muscles or the rectum
• loss of storage capacity in the rectum

Constipation causes large, hard stools to become lodged in the rectum. Watery stool can then leak out around the hardened stool (spurious diarrhea). Constipation also causes the muscles of the rectum to stretch, which weakens the muscles so they can't hold stool in the rectum causing urgency.

Muscle Damage
Faecal incontinence can be caused by damage to one or both of the ring-like muscles at the end of the rectum called the anal internal and external sphincters. The sphincters keep stool inside. In women, the damage often happens when giving birth. The risk of injury is greatest if birth is complicated by use of forceps to help deliver the baby.

Pudendal Nerve Damage
Faecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that sense stool in the rectum or both. If the nerves that control the sphincters are injured, the muscle doesn't work properly and incontinence can occur. If the sensory nerves are damaged, they don't sense that stool is in the rectum. Nerve damage can be caused by childbirth, a long-term habit of straining to pass stool, stroke, and diseases that affect the nerves, such as diabetes.

Loss of Storage Capacity
The rectum is designed to hold stool until you can get to a toilet. But rectal surgery, radiation treatment, and inflammatory bowel disease can cause rectum to loose its capacity. This results in faecal incontinence.

Pelvic Floor Dysfunction
Abnormalities of the pelvic floor muscles can lead to faecal incontinence. Some abnormalities are decreased perception of rectal sensation, decreased sphincter pressures, reduced anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocoele).Often the cause of pelvic floor dysfunction is childbirth, and incontinence doesn't show up until the later in life.

What can we offer?
We have colorectal surgeons working closely within the multidisciplinary team of GI Physiologists, Uro-Gynecologist, Radiologist and Physiotherapists offering state of the art assessment and interventions for the management of faecal incontinence, pelvic floor dysfunction including rectal prolapse.

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