An Introduction To Faecal Incontinence

Faecal Incontinence Explained

As we have previously seen, urinary incontinence can result from problems associated with gender. Only males will get the urinary incontinence side effects often seen following treatment for prostate cancer, whereas females will only get the urinary incontinence side effects commonly seen after childbirth - faecal incontinence can also occur after childbirth, making females more likely to suffer faecal incontinence, this is due to anal sphincter damage during the birth itself or sometimes during forceps delivery. (Reference 1) (Reference 2)

Faecal incontinence is a substantial health problem – a Cochrane review stated that the numbers affected are uncertain, with considerable variation in published data largely due to variations in case definition, but for anal incontinence this is thought to be in the range from 2% to 17% and probably somewhat higher as some people are reluctant to admit to this disease. (Reference 1) (Reference 4)

Faecal incontinence has major effects on physical and emotional wellbeing due to impaired quality of life for patients, which is often a result of increased psychological anxiety caused by fear of social isolation. Faecal incontinence increases with age, for women over 65 years and living in their own homes the estimated prevalence of faecal incontinence in the UK is 10% to 20%, whilst the corresponding figure amongst men is 7% to 10%. Faecal incontinence is a common cause of admission to residential care, where more than 50% of residents are affected. (Reference 3) (Reference 4)

Causes

Neural reflexes (and voluntary activity) acting on specific muscle groups maintain normal continence of faeces. These muscles include the smooth internal and striated external anal sphincters and the pelvic floor muscles (pubococcygeus, iliococcygeus, coccygeus and puborectalis). (Reference 4)

Like Urinary Incontinence, Faecal Incontinence can happen for many reasons including congenital defects such as incorrectly formed anus or rectum (lower part of the intestine), neurological diseases, or injury during childbirth or surgery. Consultant neurologist Michael Swash identifies a major cause of faecal incontinence in women is damage to the deep parts of the anal sphincter and its innervation during childbirth. (Reference 4) (Reference 5)

What can be done?

Similar to Urinary Incontinence, there are treatment options to manage this devastating condition which include pelvic floor muscle training, electrical stimulation, drugs and surgery. Surgery is usually a last resort option and used particularly (but not exclusively) to correct defects in the muscles surrounding the anal canal.  Surgical procedures however are invasive, have variable success rates, and are associated with a risk of significant morbidity. The respected Cochrane review concluded that “Uncertainty remains on whether any surgical intervention does more good than non‐surgical treatment.” (Reference 4)

Colorectal consultant Rajeev Peravali, who runs a 4-stage program to treat functional bowel problems, described how of all the people he sees with functional bowel problems, only around 10% will have a diagnosis and overall around 95% to 97% will get better without the need to proceed to surgery which is stage 4 on his program. Mr Peravali describes how “many patients are fobbed off by medical practitioners”. (Reference 6)

As with urinary incontinence, improving the strength and thus the function of the Pelvic Floor muscles can help to manage faecal incontinence, in fact stage 2 of the program Mr Peravali and his team run, called the Finch program, incorporates pelvic floor exercises. (Reference 6)

For people not lucky enough to have access to the Finch or a similar program, TensCare’s Incontinence range of devices can help with Pelvic Floor Exercises, especially as many who suffer from faecal incontinence have trouble identifying the muscles that comprise the pelvic floor – the gentle electrical stimulation can guide the user as to where they need to apply the squeeze contractions.

TensCare’s Incontinence range is based on many years' experience in the design and manufacture and compared to some other management options such as surgery, are very safe and can be used at home.

References

Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. J Am Med Assoc 1995; 274: 559–61.

Faecal Incontinence after Childbirth. P Schofield, R Grace Clinical Risk November 1, 1999

Nelson R, Norton N, Cautley E, et al. Community-based prevalence of anal incontinence. JAMA 1995; 274: 559–61

Brown SR, Wadhawan H, Nelson RL. Surgery for faecal incontinence in adults. Cochrane Database Syst Rev 2013; 7: CD001757

Faecal Incontinence BMJ voLuME 307 1 1 SEPTEMBER 1993

https://www.bbc.co.uk/sounds/play/m000gbft