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Faecal incontinence (FI) occurs when a person loses the ability to control their anal muscles and bowel movements, resulting in leakage of faeces and/or gas. If left untreated or mismanaged, faecal incontinence can lead to severe skin irritation as well as depression, causing affected individuals to withdraw from their families and society.
Although surveys of the general adult population have estimated the prevalence of faecal incontinence to be between 1 and 18 per cent, the majority of sufferers do not seek medical help due to embarrassment and social stigmatisation. These figures thus likely underestimate the true extent of the condition, which unfortunately remains largely undiagnosed.
What causes faecal incontinence?
The most common cause is injury to the anal muscles or sphincters.
In women, faecal incontinence is most commonly caused by the delivery of a baby. Up to 30 per cent of first-time vaginal deliveries can result in sphincter injury. This risk is increased with instrument-assisted delivery (eg. forceps and vacuum-assistance), large birth weight and a prolonged second stage of labour.
In men, anal sphincter injuries are more often due to anorectal procedures including surgery for haemorrhoids, anal fissures or anal fistula.
Bowel incontinence can also arise following major surgery for colorectal cancer or benign conditions, in which the rectum is removed. The problem will stem from the reduction or removal of the storage capacity of the rectum and the disruption of nerve pathways. Function can be further worsened when chemotherapy and/or radiation are added to the treatment regimen. Trauma to the perineum or pelvis, such as pelvic fractures after road traffic accidents or penetrating injuries, can result in significant damage to the anal sphincter and surrounding tissue. Occasionally, injuries associated with sexual assault can result in bowel incontinence.
How can faecal incontinence be treated?
Treatment has to be individualised and depends on the cause and severity of the faecal incontinence. More than one type of treatment may be required to achieve the best outcomes, as continence relies on a complex chain of events.
Fortunately, the majority of patients will benefit from conservative measures such as dietary modification, tailored medical therapy and pelvic floor rehabilitation. However, when the above measures fail, surgery is often the only recourse to improve symptoms and the quality of life.
Some of the treatment options offered at SGH include:
- Dietary changes (involving a gradual increase in fibre)
- Medication to improve stool consistency (eg. anti-diarrhoeal agents)
- Pelvic floor rehabilitation exercises (anorectal biofeedback)
- Injectable anal bulking agents (eg. silicone spheres, carbon beads)
- Neuromodulation (Sacral nerve stimulation/SNS): this minimally-invasive technique involves inserting a fine electrode next to the nerves supplying the anal sphincter muscles and rectum.
- Surgical repair (muscle repair, artificial sphincters): the Magnetic Anal Sphincter comprises a series of titanium beads interlinked with magnetic cores that are implanted around the anal canal to passively reinforce the native muscles.
The Magnetic Anal Sphincter device
Could you have faecal incontinence?
If you answer ‘YES’ to any of the questions below, you may have faecal incontinence and you should see your doctor as soon as possible for further advice.
- Do you worry about having bowel accidents?
- Do you often need to check out the locations of the nearest bathrooms before going out because you have to go a lot more frequently or fear accidents?
- Do you have difficulty controlling your bowels?
- Do you find that you need to use sanitary pads other than for menstrual periods as a measure of reassurance?
How to find out more?
Although faecal incontinence is not life-threatening, it can nonetheless rob patients of their dignity and self-confidence. The SGH Pelvic Floor Disorder Service is here to help affected individuals ‘stay in control’ and to improve their quality of life through individualised therapy.
For more information, please contact the SGH Call Centre at 63214377 and ask for the Pelvic Floor Nurse in charge
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