Faecal Incontinence Surgeon

Faecal Incontinence

The Loss of Bowel Control

Faecal incontinence (FI), is a condition where you lose control of your bowel movements, leading to involuntary leakage of stool. This can be a highly distressing and embarrassing issue, significantly impacting your daily life and social interactions.

Understanding the Mechanism

Several factors contribute to maintaining bowel control. Muscles in your pelvic floor, rectum, and anus work together to hold stool and release it at the appropriate time. Nerves in these areas send signals to your brain about rectal fullness. When these mechanisms malfunction, FI can occur.

Causes of Faecal Incontinence

There are various reasons why you might experience FI, including:

  • Weakened pelvic floor muscles: Childbirth, vaginal delivery, and aging can weaken the pelvic floor muscles, leading to difficulty controlling stool.
  • Diarrhoea: Loose stools or frequent diarrhea can overwhelm the sphincter muscles, causing leakage.
  • Constipation: Straining during constipation can damage the anal sphincter muscles, leading to future incontinence.
  • Surgery: Rectal surgery or surgery on the pelvic area can damage nerves and muscles responsible for bowel control.
  • Neurological conditions: Conditions like stroke, spinal cord injury, or dementia can affect the nerves that control bowel movements.
  • Hemorrhoids: Large or swollen hemorrhoids can irritate the anus and interfere with stool control.
  • Rectal prolapse (protrusion of the rectum into the anal canal or beyond anus)

The Spectrum of FI

FI can range in severity, from occasional leakage of gas to complete loss of bowel control. Some common symptoms include:

  • Passing stool unintentionally
  • Leaking mucus from the rectum
  • Urgency to have a bowel movement but not being able to control it
  • Staining of underwear with stool

Investigations

  • Colonoscopy to exclude malignancy
  • Endoanal ultrasound to assess local anorectal anatomy
  • Anal manometry / physiology
  • Defecating proctogram (X-Ray or MRI)

Treatment of Faecal Incontinence

FI can be isolating and affect your self-esteem. However, it’s important to remember that you’re not alone and treatment options are available. Here’s how to manage FI:

  • Dietary changes: Increasing fiber intake and staying hydrated can help regulate bowel movements and stool consistency.
  • Pelvic floor muscle exercises: Strengthening your pelvic floor muscles can improve bowel control. This is done via an experienced pelvic floor physiotherapist.
  • Medication: Anti-diarrheal medications can help manage loose stools, while medications like bulking agents can improve stool consistency.
  • Bowel management techniques: These might involve using a schedule for bowel movements or biofeedback therapy.

Surgical for Faecal incontinence

Many different techniques are available to treat the difficult problem of FI, failing conservative management. These options should be carefully considered in the context of each patient.

  • Sacral nerve stimulator (SNS) – A temporary trial of wires are initially placed, and if there is >50% improvement, permanent wire and stimulator are then inserted 1-2 weeks later.
  • Sphincteroplasty – is a technique of sphincter repair where the muscles are overlapped back together. The efficacy reduces over time.
  • Colostomy – Often the last resort, where an opening is made in the abdomen, through which the colon is brought to the surface of the skin, with poo emptying into stoma bags.