Faecal Incontinence is loss of control of bowel motions or gas. The loss of control could result in varying degrees if incontinence from light soiling of underwear to no control to hold on to motions or gas.

You control when you go to the toilet using muscles (called sphincter muscles) and nerves in and around the rectum and anal canal. When you need to pass a bowel motion, the nerves in and around the rectum and anus send a message to the sphincter muscles telling them to relax and open the anus. If this is inconvenient, for example, because you cannot get to a toilet, the brain sends a message to stop the muscles relaxing. You usually aren't aware of doing this until the rectum becomes very full and a conscious effort is needed to keep the anus closed. If the muscles and nerves do not work properly, bowel incontinence can develop.


Causes of faecal incontinence
Age: the anal sphincter muscles become weaker as one gets older and this may result in difficulty to holding on when there is an urge to pass motions Injury or damage to the sphincter muscles or nerves: This can happen during childbirth, following surgery, or as a result of neurological (nervous system) conditions such as stroke, epilepsy and multiple sclerosis

Childbirth: After childbirth, one in ten women has problems controlling when they pass wind or stools. It's more common in older mothers (35 and over), and women who have large babies. The problem can develop if the anal muscle tears during birth, or because of the episiotomy cut that is made to help deliver the baby.

Constipation and diarrhoea

Lower bowel disorders: Conditions such as haemorrhoids, cancer and anal fistula/ fissure can also lead to bowel incontinence. Medication: certain medications can cause your motions to become looser and result in diarrhoea.

Diet: Food particularly spicy food which makes your motions more loose or liquid and liquids such as beer can make it harder to hold in.



Diagnosis
Incontinence management is a specialist area and we recommend that you consult your family doctor who can refer you on to a specialist in this field. Investigations used to establish a diagnosis and ascertain the cause of incontinence include

Proctosigmoidoscopy: This test uses a small telescope to look at the lower end of the colon, rectum and anus to look for causes of incontinence

Anorectal Manometry: this test measures the pressures in the rectum and anus. This will give the specialist an idea of how well the muscles are functioning.

Endoanal ultrasound: This test shows the quality of the sphincter muscles.



Treatment
Patients with anal incontinence can be managed conservatively in the first place.

Conservative measures include
Diet: The simplest approach is to modify your diet to include more fibre rich food. This includes fruit, vegetables, brown rice and wholemeal bread. This will help if incontinence is caused by constipation.

Medication: drugs can be used to slow down your colon contractions thus giving more time to absorb the water in the motions.

Pelvic floor exercises and Biofeedback: Exercises to strengthen the pelvic floor muscles help to control the bowel motions. Biofeedback is a behavioural therapy by which the patient is taught to identify fullness in the rectum and to resist the desire to rush to the toilet.

When conservative treatment has not improved patient symptoms, surgical therapy should be explored
Sphincter repair: This operation involves repairing the damaged anal sphincter from previous injury such as injury from childbirth.

Muscle transposition procedures: In this operation a muscle from some other area in the body is wrapped around the anal canal to act as the control mechanism. This is used when the nerves to the sphincter muscles are damaged resulting in their non function.

Artificial Sphincter operations: Mechanical sphincter devices are wrapped around the anal canal instead of muscle from the patient.

Sacral Nerve Stimulation: structurally weak but intact muscles around the anus can be stimulated with low level electrical stimulation to improve nerve and muscle function

Colostomy: If other treatments fail, colostomy is an option to relieve symptoms. It is a surgical procedure to divert motions from the rectum into a small bag attached to your skin.