What is faecal incontinence?

Faecal incontinence is the accidental loss of stools (poo) or gas/wind (flatus).

It is more common in the elderly, severely ill and frail, the very young, and individuals with spinal and neurological disorders, severe cognitive impairment or learning disabilities.

Outside these groups, it is more common in women, where it is usually associated with obstetric injury to the pelvic floor. It remains under-reported but estimates are that it affects as many as 1 in 20 women who have had vaginal deliveries.

It is also often a complication of pelvic organ prolapse, colonic resection or anal surgery, pelvic radiotherapy and the result of taking some medications.

What are the symptoms of faecal incontinence?

It varies from only occasionally not being able to stop wind to losing an entire bowel action. Some people lose stools (poo) when walking or being active (passive incontinence) whilst others have to get to a toilet in a hurry but may not make it in time (urge incontinence). Some people can’t wipe themselves clean completely or leak stool after opening their bowels (post-defaecatory leakage).

It is possible to have both passive and urge faecal incontinence and some people with bowel incontinence may have difficulty controlling their bladder as well.

How is faecal incontinence diagnosed?

Faecal incontinence can be caused by a variety of factors, including accident trauma, surgery, problems in or some time after childbirth or another condition or disease. An endoscopy can be organised to help establish the cause.

Once an endoscopy has been performed and any problems excluded or treated, a series of brief, painless tests that examine the way the anus and rectum function together can be carried out. This is called an Anorectal Physiology Assessment.

How is faecal incontinence treated?

Often faecal incontinence can be treated through diet, lifestyle modification, exercises, medication and, in some cases, ‘bowel re-training’ (methods to allow you to open your bowels correctly).

Sometimes this may not lead to improvements and surgery will be the next step. Occasionally surgery will be offered straightaway if symptoms are very severe. Any operation would be discussed with an appropriate medical and nursing team so the patient is able to make an informed decision about whether its appropriate.

Outcomes and further sources of support

Outcomes are variable depending on just what is causing the incontinence, and how it is being managed.

The National Bowel Research Centre is leading a trial to examine an intervention called Sacral Neuromodulation. Our section about the trial, called SUBSoNIC, explains more about how this will be conducted.