Faecal incontinence

Faecal incontinence is when you accidentally leak solid or liquid poo (faeces). It is also known as anal incontinence.

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What causes faecal incontinence?

Faecal incontinence affects one in 25 (or four percent of) women who have given birth. 

It can have a big impact on your quality of life. Many women find it so embarrassing that they don’t seek medical help; however, there are a range of treatments that can help. 

You are most likely to have faecal incontinence if you’ve given birth. This is because pushing in labour can damage the nerves and ring of muscles (called your anal sphincter) that help open and close your bowels.

You are also more likely to have faecal incontinence if you have:

  • constipation frequently and strain to empty your bowels completely
  • a prolapse of your back passage (or rectum) where it ‘drops down’ through your bottom hole (or anus)
  • an inflammatory bowel disease (e.g. ulcerative colitis or Crohn’s disease)
  • a fistula or haemorrhoids
  • a condition that affects your brain’s ability to send messages to your bowel (like Parkinson’s disease, multiple sclerosis or a stroke).

How is faecal incontinence diagnosed?

Your local doctor or GP will most likely:

  • ask you questions about the history of your health
  • examine your body
  • ask you to cough, push down or tighten your pelvic muscles. 

They may refer you to a women’s health physiotherapist or a doctor who specialises in women’s incontinence (called a urogynaecologist). They may send you for: 

  • an ultrasound to get a picture of the area around your back passage
  • an anal manometry test to check your anal sphincter muscles. This involves putting a small, flexible tube the size of a thermometer into your back passage. This tube has a small balloon at the end which is inflated so you can squeeze it or try to push it out
  • an electromyograph (EMG) to checks the nerves connected to your anal sphincter. This involves putting a small electrode plug in your back passage that you will squeeze or try to push out
  • a test to check your pelvic floor muscles. 

How is faecal incontinence treated?

The kind of treatment you have will depend on:

  • how long you’ve had faecal incontinence or anal sphincter damage
  • how severe it is
  • your age, health and medical history.

Your doctor may recommend one or more of these treatment options: 

Lifestyle changes such as including more fibre in your diet. 

Medication to slow down your large bowel and increase water absorption.

Regular enemas to keep your back passage relatively empty. This involves putting a tube into your back passage that pushes liquid up into your bowel causing it to empty.

Physiotherapy to strengthen the pelvic floor which supports your bowel. A physiotherapist can design a special pelvic exercise program for you. 

Surgery to improve or repair damaged anal sphincter muscles or nerves. 

More about surgery

You may consider surgery or your doctor may recommend it if you:

  • made lifestyle changes and tried physiotherapy without success
  • have severe faecal incontinence.

What surgical options are there and how do they work?

There are a number of operations used to treat faecal incontinence. 

If your incontinence is caused by damage to the anal sphincter muscles, there are operations which try to repair them, ‘tighten’ them (by injecting thickening materials into it) and give them more support (by putting a ‘sling’ around them). 

There is also an operation that puts a ‘cuff’ around the faecal sphincter muscles that is connected to a pump you use to open and close your bowels (called an artificial bowel sphincter). 

If your incontinence is caused by damage to the anal sphincter nerves, there is a device that can be installed which stimulates these nerves using mild electrical impulses. 

For severe cases of anal incontinence, a colostomy operation re-directs the end of your bowel through an opening in your belly so your waste collects in a bag. 

Related information

Disclaimer

The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.