Faecal Incontinence

Question 1

What is faecal incontinence?

Answer 1

Inability to control or involuntary discharge of stool or gas

Question 2

What is the difference functionally between the internal and external sphincters?

Answer 2

Internal= non-voluntary control

External= voluntary control

Question 3

What are the risk factors for faecal incontinence?

Answer 3

Increasing age 
Diarrhoea 
Childbirth-> can have perianal tear with vaginal birth
Surgery 
Stroke or MS i.e. neurology 
Learning difficulties
Constipation I.e. overflow diarrhoea 
Faecal prolapse

Question 4

What conditions need to be excluded and managed when someone is presenting with faecal incontinence?

Answer 4

Faecal loading

IBD/IBS

Lower GI cancer
-look for weight loss/anaemia and bleeding/ abdo pain

Rectal prolapse

Haemorrhoids

Acute anal sphincter injury i.e. surgery or child birth

Acute disc prolapse or cauda equina

Question 5

What can be started as initial management and what is the aim of this management?

Answer 5

High fibre diet

Loperamide for diarrhoea

Bowel and toileting habits
I.e. proper position for passing stool

Key for disabled toilets

Psychological support

Aim= promote consistent stool frequency and consistency

Advice on incontinence products

Question 6

What specialist management options are there for faecal incontinence when initial measures fail?

Answer 6

Rectal irrigation (when constipated or SC injury) 
-water injected into rectum to try and stimulate flushing of stool 

Bowel retraining

Pelvic floor muscle training
-Keegal exercises to try and strengthen pelvic floor

Biofeedback
-probe can be used to see when/if pelvic floor is contracting

Question 7

What surgical options are there to help managed faecal incontinence?

Answer 7

Sphincter repair

Neosphincter

Sacral nerve stimulation

Antegrade irrigation via appendicostomy
-when there is colonic motor disorder or constipation

Stoma (late stage)