It is estimated that 10% of people will be affected by faecal incontinence at some point in their lives. Faecal incontinence is the lack of control over when your bowels open, resulting in leakage and accidents. The condition is also commonly referred to as bowel incontinence.
Causes of faecal incontinence are usually triggered by a physical issue with parts of the body containing passage of stool. The main common causes of faecal incontinence are the following:
The most common cause of faecal incontinence is constipation, which occurs when a hard plug of impacted stool builds up in your rectum. As a result, loose, watery, diarrhoea like fluid can pass around it and leak out. These watery faeces are extremely difficult to control. This is a cause that is especially popular amongst the elderly.
Damage to the anal sphincter muscles
Injury to one or both of the sphincter muscles can cause faecal incontinence. When the internal anal sphincter muscles are damaged or weakened, they may not be strong enough to keep the anus closed and prevent stool from leaking.
Injury to the sphincters may be called by factors such as trauma, childbirth injuries, cancer surgery, and haemorrhoid surgery. Haemorrhoids are swollen blood vessels in and around the anus and lower rectum.
Irritable bowel syndrome (IBS)
With irritable bowel syndrome, the bowel is very sensitive and squeezes very strongly, often occurring at an embarrassing or inconvenient time. The individual will get a strong urge to pass stool, resulting in the inability to reach the toilet in time.
Food and drink which cause the faeces to become more liquified than normal can make it harder to hold in. Foods that increase flatulence can also sometimes cause leakage, as the anus has to relax to let out gas. You should avoid eating food that can make your incontinence symptoms worse, which include the following:
> alcoholic beverages
> drinks and foods containing caffeine
> dairy products such as milk, cheese, and ice cream
> fatty and greasy foods
> drinks and foods containing fructose
> fruits such as apples, peaches, and pears
> spicy foods
> products, including candy and gum, with sweeteners ending in “–ol,” such as sorbitol, mannitol, xylitol, and maltitol
It is estimated that one in ten women have problems controlling when they pass stools post childbirth. Faecal incontinence is more common in older mothers and women who have larger babies. This problem is often due to damage to the anal muscles during birth, or due to the episiotomy cut that is made to help deliver the baby.
As the sphincter muscles become weaker with age, older people often find it harder to control the need to go to the toilet. Individuals with Dementia or other cognitive impairments are also likely to suffer from faecal incontinence as they can often fail to recognise when they need to pass stool.
The loose stools that are caused by Diarrhoea are more difficult to control than solid stools, which can lead to leakage.
Certain medications, for example, those containing magnesium trisilicate, make the faeces looser or cause diarrhoea. Over-use of laxatives can also have the identical effects. if you are having problems with faecal incontinence and are taking any medication, you should contact a GP immediately. They can then check if this may be a side-effect and if necessary they will suggest an alternative.
What to do if you are suffering from faecal incontinence
It is important to get in touch with a professional or Doctor if you have faecal incontinence, even though you may feel uncomfortable talking to someone else about your condition. Your MS nurse, GP or continence advisor are all experienced in dealing with these problems and should be able to put you at your ease. Your Doctor will ask questions about your condition and perform a physical exam that usually includes a visual inspection of your anus. A probe may be used to examine this area for nerve damage. Normally, this touching causes your anal sphincter to contract and your anus to pucker.
Possible treatment methods for faecal incontinence include the following:
Your Doctor may prescribe you certain medications to help you manage the condition. Depending on the cause of faecal incontinence, options include:
>Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil), if chronic constipation is causing your incontinence
> Anti-diarrheal drugs such as loperamide hydrochloride (Imodium) and diphenoxylate and atropine sulfate (Lomotil)
> Injectable bulking agents such as Dextranomer Microspheres/Hyaluronate Sodium in 0.9 % Nacl (Solesta) are injected directly into the anal canal
Making changes to your diet
What you eat and drink affects the consistency of your stools. If constipation is causing faecal incontinence, your doctor may recommend drinking plenty of fluids and eating fibre-rich foods. If diarrhoea is contributing to the problem, high-fibre foods can also add bulk to your stools and make them less watery.
Additionally, it may help to keep a diary of the food and liquid you are consuming and the effect it has on your body. Try and identify problem foods that are worsening your faecal incontinence, and stop eating them and see if your incontinence improves. Foods that are known to cause diarrhoea or worsen faecal incontinence include spicy foods, fatty and greasy foods, cured or smoked meat, carbonated beverages, and dairy products. To help keep stools soft and formed, it is also important to drink at least eight glasses of liquid, preferably water, a day.
You can read our blog on creating a bladder diary for guidance on creating your bowel diary.
Kegel exercises strengthen the pelvic floor muscles supporting the bladder and bowel. This can drastically improve symptoms of faecal incontinence. To perform Kegel exercises, contract the muscles that you would normally use to stop the flow of urine. Hold the contraction for three seconds, then relax for three seconds. Repeat this pattern 10 times. As your muscles strengthen, hold the contraction longer, gradually working your way up to three sets of 10 contractions every day.
Sacral nerve stimulation (SNS)
The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can strengthen muscles in the bowel. This treatment is usually done only after other treatments are tried.
This procedure repairs a damaged or weakened anal sphincter. During this procedure, Doctors identify an injured area of muscle and free its edges from the surrounding tissue. They then bring the muscle edges back together and sew them in an overlapping fashion, strengthening the muscle and tightening the sphincter. The procedure is used for people who have faecal incontinence right after childbirth.
If surgery for strengthening the anal sphincter is unsuccessful, it can be replaced with an artificial anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you are ready to defecate. To go to the toilet, you use a small external pump to deflate the device and allow stool to be released. The device then inflates itself.
Colostomy (bowel diversion)
A Colostomy is a surgical procedure in which your colon is cut and brought through the wall of your stomach to create an artificial opening. This surgery diverts stool through an opening in the abdomen. Your stools can then be collected in a bag, known as a colostomy bag, which is attached to the opening. A colostomy is generally considered as a last resort when other treatments have been tried.
Shop our range of faecal incontinence products so you can be pro-active and ensure you are effectively managing your condition.