Bowel incontinence

Many people suffer in silence with bowel incontinence as they feel embarrassed that they can’t control their bowel movements. However, it is a very common condition which doctors are used to dealing with.   

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What is bowel incontinence?

Also called faecal incontinence, it is the uncontrolled loss of solid or liquid stools, or the loss of wind (gas) with some leakage.

It is very common, in total, 1.4% of the sample reported major faecal incontinence (0.9% of adults aged 40–64 years and 2.3% of adults aged 65 years). Faecal incontinence was found to be a considerable problem for older people in that it was more prevalent and severe and more likely to have an impact on quality of life.

It may also affect young people. After having a baby, more than 1 in 10 women have a tear which may result in difficulty in controlling their bowels. Tears are more common in older mothers (over 35), if the baby is large or if assistance with forceps or a suction cup is needed.

Few conditions are more embarrassing or create more anxiety than BI. It can result in an almost constant fear that another leak may happen. As well as the distress, this fear may restrict what the patient feels able to do, therefore affectting their quality of life. Many people with BI remain untreated for years as they are too embarrassed to ask for help. This is a great shame as for a lot of people there are simple measures to prevent BI as well as treatments to help, or even cure the problem.

Few conditions are more embarrassing or create more anxiety than BI. It can result in an almost constant fear that another leak may happen. As well as the distress, this fear may restrict what the patient feels able to do, therefore affecting their quality of life. Many people with BI remain untreated for years as they are too embarrassed to ask for help. This is a great shame as for a lot of people there are simple measures to prevent BI as well as treatments to help, or even cure the problem.

What are causes of bowel incontinence?

The causes of incontinence can be divided into three main categories:

1. Rectal – The rectum is the part of the large bowel that acts as a reservoir, holding faeces until you are ready to go to the toilet. Any problem with the rectum or the way in which it works may lead to incontinence. This may include proctitis (inflammation, perhaps due to Crohn’s disease or Ulverative Colitis).
2. Anal sphincter – The anal sphincter is the muscle at the very bottom of the anus which keeps faeces within the rectum until we are ready to open our bowels. Damage to the sphincter (for example as described above during child birth) may cause incontinence.
3. Nerves – Nerves transmit signals between the brain and parts of the body.  Any problems with the nerve pathways between the brain and rectum / anal sphioncter muscles may lead to a degree of incontinence.

Sometimes a patient may suffer from a combination of problems occurring together.

How is bowel incontinence investigated?

Often your surgeon will ask you about your symptoms (sometimes you may be asked to complete a questionnaire), and whether you have any other ongoing medical problems. If you are female and have had children they may also ask you about your experiences during child birth. It is common for the surgeon to examine you by looking at your anus and the surrounding area to check for scars and carry out a rectal examination (inserting a gloved finger into your bottom). They may also ask you to squeeze your anus around their finger to assess how well the muscles in your anus are working.

There are several investigations your surgeon may refer you for. Endoscopy is a camera test of the bowel, to look closely at you rectum in particular; anal manometry involves a probe being passed into the anus and used to assess how well the muscles and nerves in and around your rectum are working;  anal ultrasound uses an ultrasound probe used to detect damage to the sphincter muscles and a defecating or MRI proctogram is a study used to see how you pass stools. A proctogram involves a dye called barium, which is injected into your rectum through a small tube. The barium helps make it easier to highlight problems using an X-ray. Once the barium is in place, you’ll be asked to pass stools in the usual way while scans are taken. This test can also be carried out using a magnetic resonance imaging (MRI) scanner instead of an X-ray.

What is the treatment of incontinence?

The treatment of BI will depend on the underlying cause. Your surgeon will explain what they think the cause is and tailor your treatment accordingly. Many people improve with the use of simple medical treatments or specific exercises aimed at getting your rectum and sphincters to work better together (often called biofeedback). Occasionally patients require surgery. If this is the case your surgeon will explain the type of operation that will be, the aim of which will be to omporve your symptoms and quality of life.

Further information

• MASIC Foundation (Mothers with Anal Sphincter Injuries in Childbirth)
• NHS Choices
• ERIC: the children’s bowel and bladder charity