Digestive health centre

Bowel incontinence

Bowel or faecal incontinence is the loss of voluntary control of stool, or bowel movements. This condition can vary from being partial, in which a person loses only a small amount of liquid waste, to complete, in which the entire solid bowel movement cannot be controlled.

One to ten percent of adults living in the community in the UK suffer from faecal incontinence, and up to 1 % have long term incontinence affecting quality of life. Both men and women suffer from this problem, though it is more common in women because of injury to the anal muscles or nerves that can occur during childbirth. Bowel incontinence becomes more common with advancing age as the muscles that control bowel movements (anal sphincter muscles) weaken.

Often, embarrassment and the stigma associated with incontinence prevent people from seeking treatment, even when incontinence affects their quality of life. Many people resort to altering their social and physical activities, even their employment, to cope with the problem. In addition, some people with bowel incontinence do not see a doctor because they just don't realise that their problem can be effectively treated. It's important to understand that bowel incontinence is not uncommon and can be successfully treated.

What causes bowel incontinence?

Normal control of bowel movements depends on proper functioning of the colon and rectum, the muscles surrounding the anus (anal sphincter muscles), the brain and the body's nerves (the nervous system), plus the amount and consistency of waste products produced.

There are many causes of bowel incontinence, including:

• Damage or injury to the anal sphincter muscles or the nerves surrounding these muscles, most often occurring after childbirth.
• Anal surgery, such as for haemorrhoids.
• Neurological disease, such as multiple sclerosis.
• Congenital disorders, such as spina bifida.
• Certain medications, such as some antibiotics or gabapentin (an anti-seizure medication).
• Improper diet.
• Radiation treatment to the lower pelvic region.
• Chemotherapy.
• Stroke.
• Conditions associated with chronic diarrhoea or constipation.
• Systemic (whole-body) diseases such as diabetes or scleroderma.
• Spinal cord damage.

What can I do if I have bowel incontinence?

See your doctor if you have bowel incontinence. Tests to determine the cause for incontinence can be completed during an outpatient appointment and are not painful.

Once these tests have confirmed the cause of your incontinence, your doctor can make specific recommendations for treatment, many of which do not require surgery.

No matter how serious the problem seems, incontinence is a condition that can be significantly helped and, in most cases, cured.

How is bowel incontinence diagnosed?

Anal ultrasound makes it possible to view the anal sphincter muscles and precisely identify abnormalities. Ultrasound can be used to locate the exact position of a tear in a muscle, even before bowel incontinence becomes a problem.

Other procedures to diagnose bowel incontinence that may be used include:

• Flexible sigmoidoscopy. By using a thin, flexible lighted tube called an endoscope, your doctor can examine the lining of the final third of the lower digestive tract.
• Manometry. This test measures the pressure and strength of the anal muscles and can determine if they are too weak to function properly.
• Nerve studies. These tests check for nerve damage to determine if the nerves that communicate with the sphincter muscles are working properly.
• MRI. Magnetic resonance imaging can help identify areas of weakness in the sphincter muscles.