Dr Naseem Mirbagheri:
Faecal incontinence is the inability of a person above the age of four to control the passage of stool or gas. It can be passive, that is, gas or stool leaks into the underpants without the person being aware. Or it can be what’s called urge incontinence where the person experiences the urgency to open their bowels, but can’t hang on.
One in 10 Australians suffer from faecal incontinence, so it’s a very common problem. The physical and psychological effects on sufferers can be devastating and includes social isolation, stigma and loss of independence. People can also experience loss of income. All this put together can make people living with faecal incontinence extremely fragile psychologically. Those of us who can control our bowels take it for granted not realising that being continent is a complicated process involving strong tissues, a functioning rectum and anal canal, a good-consistency stool, and input from the brain.
Faecal incontinence is commonest in the middle-aged menopausal woman with a history of childbirth-related trauma such as forceps delivery. Men can also suffer from faecal incontinence, usually related to inadequate emptying of stools. Other risk factors include injury to the anal sphincter muscles, dementia, spinal cord injuries, irritable bowel syndrome and rectal prolapse. It is rarely just one problem that results in incontinence, but multiple factors that have accumulated over many years.
The treatment starts with a full history and tests for a better understanding of the underlying disorder. Initial treatment includes dietary changes, use of medication that thickens up the stool, pelvic floor muscle training exercises, and biofeedback therapy.
In people who have a surgically correctable abnormality for example, a large tear in the sphincter muscles or rectal prolapse, then surgical repair may be offered.
When simple dietary changes, medications and pelvic floor physiotherapy don’t work and a correctable surgical problem is not identified then a procedure called sacral nerve stimulation may work. In this procedure, a small wire is inserted surgically under anaesthesia in the lower back. This pacemaker-like device then stimulates the nerves that control your bowel and send signals to your brain resulting in improvement in symptoms in most people.
So in summary, faecal incontinence is a complicated problem but help is available. Please see your doctor for advice and appropriate referral to a specialist if needed.