What is faecal incontinence?

Most of us take it for granted that we can control our bowels. We barely have to think about controlling the release of wind (gas), or of liquid or solid (stools or faeces) from the bowel. We do not have "accidents" nor are we "caught short", unless perhaps we suffer a short lived bout of diarrhoea.

Sometimes, however, control is lost because the bowel or the muscular ring (sphincter) around the back passage (anus) does not function properly. Bowel contents escape. Faecal (or anal) incontinence, also known as soiling, is the loss of stool, liquid or gas from the bowel at an undesirable time. It can occur at any age and may effect one in 20 people. It is certainly more common than was thought some years ago. Simple tests can often show where the problem is, and treatment is frequently successful.

How do we normally control the bowel?

Normally the bowel and the ring of muscle around the back passage (anal sphincter) work together to ensure that bowel contents are not passed until we are ready. The bowel contents move along the bowel gradually. The sphincter has two main muscles which keep the anus closed; the inner (internal anal sphincter) ring, which keeps the anus closed at rest, and the outer (external anal sphincter) ring, which provides extra protection when we exert muscles ourselves or when we cough or sneeze. These muscles, the nerves supplying them and the sensation felt within the bowel and sphincter all contribute to the sphincter remaining tightly closed. This balance enables us to stay in control (or "continent").

What causes incontinence?

Faecal incontinence occurs most commonly because the anal sphincter is not functioning properly. Damage to the sphincter muscles or to the nerves controlling these muscles, or excessively strong bowel contractions, or alterations to bowel sensation can all lead to this disturbance of function.

Who suffers from faecal incontinence?

Males and females of any age may be incontinent, for example

	children and teenagers - if they are born with an abnormal sphincter or if they have persistent constipation.
	mothers following childbirth - due usually to a tear hidden or obvious in the sphincter muscles
	people of any age who experience an injury or infection of the sphincter; that may be affected immediately or in later life.
	people suffering from inflammatory bowel disease (colitis) or irritable bowel syndrome (alternating constipation or diarrhoea together with abdominal pain) - because the bowel is very sensitive and squeezes strongly
	elderly people - because of constipation and overflow from the bowel due to failing mental capacity, or due to sphincter damage persisting from a younger age
	people suffering from disorders such as multiple sclerosis, stroke and epilepsy resulting in damage to the nerves supplying the sphincter.

What tests may be needed?

Tests of sphincter function are relatively simple, do not require preparation, are quick to perform and are usually pain free. The strength of the muscles, sensation and nerve function, for example, can all be tested using simple measuring devices. An ultrasound scan can provide a clear picture of both the sphincter muscle rings, showing if one or both is damaged. This test is not uncomfortable, takes only five minutes, and involves no radiation.

These tests are performed by doctors with a special interest in continence. Your family doctor can advise.

What is the treatment?

Drugs
Drugs may be useful when Drugs may be useful when

	the bowel is squeezing too strongly (urgency to get to the toilet quickly)
	the stool is very loose
	the sphincter muscles are weak.

Surgery
When the sphincter has been injured, leading to a gap in the sphincter muscles, an operation performed through the skin around the anus can cure the problem for many patients. When there is nerve damage to sphincter muscles a different operation to tighten the sphincter will sometimes help.

Other Treatment
Techniques such as "biofeedback" are now available to retrain the bowel to be more sensitive to the presence of stool, so that the sphincter contracts when necessary.

What else might help

In the very unusual situation that nothing can be done to decrease incontinence, appliances and advice are available which can make life much more comfortable. Advice should be sought from a local continence advisor: your family doctor can help.

Where should I go for help?

Your family doctor will be able to put you in contact with a specialist who has expert knowledge about faecal incontinence. These problems are common so you need not feel embarrassed about discussing them. Most of the treatments are simple and effective, so do not hesitate to seek advice.

If you would like to talk to a nurse in confidence about your problem, you could call the Continence Foundation Helpline: 0171 831 9831 Monday to Friday 2.00 - 7.00pm

The need for research

How much do we know about faecal incontinence?
The causes and treatment for faecal incontinence are still not fully understood and more work is needed to improve methods for helping sufferers. The causes and treatment for faecal incontinence are still not fully understood and more work is needed to improve methods for helping sufferers.