An ESCP Guide for Patients
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What is faecal incontinence?
Faecal incontinence means you have trouble controlling bowel movements. This can lead to accidental leakage of stool or gas. It is a medical condition if:
- It lasts for three months or more as an adult
- It affects children over age 4 who were previously toilet trained
It’s more common than many people realise - and it’s nothing to be ashamed of.
How does bowel control work?
Bowel control depends on a few parts of your body working together:
- Anal sphincter muscles: keep stool and gas inside until you're ready to go
- Pelvic floor muscles: support the organs and help with control
- Rectum: stores stool until you can use the toilet
- Nerves: carry messages between your brain and rectum, letting you know when you need to go
If any part of this complex system is weak or damaged, leakage may occur.
Common causes of faecal incontinence
- Childbirth: vaginal delivery can injure muscles or nerves, especially after a long labour or with larger babies
- Surgery: operations near the anus may weaken muscles
- Chronic diarrhoea or constipation: Diarrhoea makes it harder for the rectum to hold stool, while constipation can stretch and weaken muscles
- Nerve conditions: e.g. Parkinson’s disease, multiple sclerosis or stroke
- Diabetes: can damage nerves that control the bowel
- Obesity: extra weight weakens pelvic muscles over time
- Certain medications: may affect bowel movement control
Symptoms of faecal incontinence
- Leaking stool or gas without warning
- A sudden, urgent need to go, but not making it in time
- Staining in underwear or trouble cleaning after a bowel movement
How is faecal incontinence diagnosed?
Many people feel embarrassed to talk about faecal incontinence, but it is more common than you think (affecting up to one in 10 adults). A doctor or colorectal surgeon can help.
- Medical history and gentle physical exam
- Endoanal ultrasound: uses sound waves to check for sphincter muscle damage (common after childbirth or surgery)
- Anorectal function tests: measure muscle strength and nerve signals
- Proctogram: a special X-ray to look for structural issues like rectal prolapse
Treatment options for faecal incontinence
The goal is to improve control and quality of life. Many options are available - and most do not require surgery.
Non-surgical treatments
- Diet and lifestyle
- For diarrhoea: avoid caffeine, alcohol, and spicy foods. Eat binding foods like bananas and rice.
- For constipation: increase fibre (fruits, vegetables, grains) and fluids
- Medications
- Anti-diarrhoeal (like loperamide) to slow things down
- Fibre supplements or mild laxatives for constipation, making stools easier to pass
- Pelvic floor exercises
- Special exercises strengthen muscles and improves bowel control, which will help you 'hold it in'
- A physiotherapist can teach you the right technique
- Biofeedback therapy: uses a small sensor in the anus to help retrain muscles for better control
- Nerve stimulation (PTNS): a small needle near the ankle sends gentle electric pulses to nerves controlling bowel function
- Transanal irrigation: a small tube is inserted into the anus to flush out the stool, preventing accidents for several hours or up to a day
- Anal Plugs: small, expandable devices placed in the anus to block leakage for specific situations (e.g. long meetings or travel)
Surgical options (if others don’t help)
If non-surgical treatments do not provide enough relief, surgery may be an option.
- Sphincteroplasty (sphincter repair): best for damaged anal sphincter muscles, often due to childbirth or surgery.
- The torn muscle is sewn back together to restore strength
- Helps improve control but may weaken over time
- Sacral nerve stimulation (SNS): a small device (like a pacemaker) is implanted under the skin in the buttock to send mild electrical signals to the sacral nerves, improving bowel control.
- A trial phase is done first to see if it works
- Can significantly reduce leaks and improve quality of life
- Sphincter substitution (muscle transfer)
- If anal sphincters are severely damaged, a muscle from another part of the body (e.g. thigh or abdomen) is used to create a new sphincter
- Results vary, and the procedure may need follow-up care
- Stoma (colostomy or ileostomy)
- Considered a last option when other treatments fail
- The bowel is rerouted to an opening in the abdomen (stoma), where waste is collected in a bag
- Can completely stop leakage and improve quality of life for some patients
When to see a doctor
Consult your doctor if bowel control problems affect your daily life. The sooner you seek help, the more treatment options will be available.
If you have any questions, speak with your doctor or colorectal surgeon for personalised advice.
Key takeaways
- Faecal incontinence is common and treatable
- You are not alone, and you are not to blame
- Many non-surgical and surgical treatments exist
- Don’t be embarrassed to seek help - your doctor is there to support you!
Disclaimer
The information provided here is general and hopes to correctly inform the patient to the extent possible. However, this document cannot discuss all aspects of a specific condition or procedure, or of the individual patient.
The decision on which procedure will give you the best result is made by your doctor or colorectal surgeon during consultation and based on shared and informed decision-making with the patient.