Faecal incontinence

Question 1

What is faecal incontinence?

Answer 1

involuntary passage of flatus or faeces.

Question 2

What are different causes of faecal incontinence>

Answer 2

• Mental function e.g. learning difficulties, dementia
  
  • Altered stool consistency and/or volume e.g. IBD, infection
  • Neurological abnormalities e.g. MS, stroke, diabetes, SCI
  ○ Impaired sensation
  • Sphincter dysfunction e.g. vaginal delivery, surgical trauma
  • Overflow e.g. encoparesis, faecal impaction
  • Idiopathic

General disability

Question 3

What are risk factors for faecal incontinence?

Answer 3

• Female
  
  • Older age
  • Nursing home
  • IBD
  • Haemorrhoids
  • Bowel resection
  • Rectal surgery or prolapse
  • Neurological disorder

Question 4

What Ix in faecal incontinence?

Answer 4

PR exam (haemorrhoids, prolapse, previous surgery, overflow - hard stool)

Check perianal and leg sensation

Stool culture

Imaging e.g. endoanal US/MRI

Nerve testing

Question 5

What is Rx of faecal incontinence?

Answer 5

• Ensure a toilet is always in easy reach
• Obey call to stool impulses e.g. gastro-colic reflex
• Refer to continence nurse specialist
• Pelvic floor rehabilitation
Loperamide before social engagements can prevent accidents