Faecal Incontinence

Question 1

factors of faecal incontinence

Answer 1

external anal sphincter weakness
loss of anal sensation (neurological)
immobility (loss of gastrocolic reflex)
loose stools
loss of cognitive awareness
bowel disorders
medications
constipation with overflow

Question 2

external anal sphincter weakness

Answer 2

eg. childbirth stretch injury, chronic constipation, post radiotherapy, lifestyle (heavy lifting - weak pelvic floor muscles)

Question 3

bowel disorders

Answer 3

IBS, IBD, bowel cancer

Question 4

constipation with overflow

Answer 4

faecal loading, especially with soft faeces (including diarrhoea) = most common cause of faecal incontinence in the elderly
<10% have rectum loaded with hard stool

Question 5

more common in men or women

Answer 5

men

Question 6

important points on the history

Answer 6

changes in bowels
leakage frequency and amount
straining/bloating/bleeding/mucous
pain
sexual dysfunction
diet: fibre/fluids
gynaecologist/surgical Hx
mobility
cognition
toilet access
carer availability
medications
bowel diary

Question 7

important points on examination

Answer 7

PR exam: scars, fissure, anal tone, haemorrhoid, constipation
check for rectal prolapse
neurological assessment

Question 8

Ix

Answer 8

review meds
stool culture
AXR
blood and/or changes in bowel habit can suggest cancer (colonoscopy recommended)
consider pelvic ultrasound

Question 9

general management points

Answer 9

increase fibre
increase water intake
increase exercise
toilet position
use bowel chart
laxatives if required
consider enema/suppositories each day to empty and prevent soiling

Question 10

what is the gastrocolic reflex

Answer 10

physiological reflex controlling the motility of the lower gastrointestinal tract following a meal.
allows room for consumption of more food

Question 11

specialist referrals

Answer 11

colorectal specialist, dietitian, continence nurse, continence physiotherapist