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Faecal Incontinence

General SurgeryGastroenterology Hepatology

The leading causes of faecal incontinence include a weak pelvic floor, damage to the anal sphincter, and conditions like pudendal neuropathy. Persistent faecal incontinence may increase the risk of infection for patients, especially in the anal area skin.

Symptoms

Faecal incontinence can be classified into complete and incomplete incontinence.

  • Complete Incontinence: In this condition, there is a loss of control over solid stool, liquid stool, and gas, leading to leakage.
  • Incomplete Incontinence: This type allows for some degree of control. It may involve the inability to control liquid stool or gas, and the incidents might occur only when the restroom is not readily available or during periods of muscle tension (such as coughing, exertion, or exercise).

Factors

As age advances, the pelvic floor and anal sphincter muscles tend to weaken. The likelihood of women experiencing pudendal neuropathy also increases with age, making them more susceptible to faecal incontinence. Additionally, hormonal changes associated with post-menopause, multiple vaginal deliveries, or prolonged labour may contribute to the risk of pelvic floor and anal sphincter weakness, leading to faecal incontinence.

Diagnosis

Surgeons will diagnose the patient's incontinence condition through the following methods:

  • Imaging studies: including anal ultrasound, Magnetic Resonance Imaging (MRI) to examine the condition of the anal sphincter for any damage.
  • Colonoscopy (to check for issues such as colon obstruction, rectal prolapse, etc.)
  • Anorectal manometry (measuring pressure during relaxation and straining)
  • Pudendal Nerve Terminal Motor Latency Testing (to exclude an pudendal neuropathy)

Treatments

The treatment methods for faecal incontinence include:

Medication Therapy

  • Antispasmodic Medications: Used to increase sphincter muscle tone and improve bowel control.
  • Anti-diarrheal Medications: Help reduce diarrhoea, minimizing the risk of incontinence.

Biofeedback Therapy

  • This can be used to enhance control of pelvic floor muscles.

Physical Therapy

  • Pelvic Floor Physical Therapy: Involves exercises to strengthen pelvic floor muscles and enhance sphincter control.
  • Biofeedback: Monitors physiological indicators to assist patients in learning and modifying physiological responses to improve bowel control.

Surgical Treatment

  • Sphincter Repair Surgery: Repairs damaged or weakened anal sphincter muscles.
  • Sacral Nerve Stimulation (SNS): Stimulates nerves near the tailbone to improve bowel control.
  • Bowel Reconstruction Surgery: In severe cases, surgery may be considered to improve intestinal function.
Sacral Nerve Stimulation (SNS)

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