Faecal Incontinence

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Faecal incontinence is a condition characterised by the involuntary loss of bowel control, resulting in the unintentional release of stool. It can range in severity from occasional stool leakage during physical activities to a complete inability to control bowel movements.

Faecal incontinence often results from dysfunction in the muscles and nerves that control the rectum and anus, which are necessary for bowel control. Identifying the causes and symptoms is key to determining the appropriate treatment options.

Causes and Risk Factors

Faecal incontinence can result from a range of underlying causes and risk factors that affect bowel control. These may include:

Muscle and Nerve Damage

Damage to the anal sphincter muscles or nerves can impair bowel control. This damage may result from childbirth, pelvic surgeries, or chronic conditions like diabetes, which can weaken nerve function.

Chronic Digestive Disorders

Conditions such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) often cause frequent diarrhoea or constipation. These symptoms can strain the rectal and anal muscles, weakening them and increasing the risk of incontinence.

Ageing

Muscle tone and nerve function may decline naturally with age, making individuals over 65 more susceptible to faecal incontinence.

Obesity

Excess body weight adds pressure to the pelvic floor muscles, which support the bowel and other pelvic organs. This strain can weaken these muscles and contribute to bowel control issues.

Colorectal Surgery or Pelvic Procedures

Previous colorectal or pelvic surgeries can lead to faecal incontinence, especially if they affect the muscles or nerves involved in bowel control. Surgical interventions in these areas may disrupt the normal function of the anal sphincter or pelvic floor muscles, reducing control over bowel movements.

Diagnosing Faecal Incontinence

A comprehensive diagnostic approach aids in identifying the causes of faecal incontinence and guiding effective treatment. Key diagnostic steps include:

Medical History and Physical Examination

A thorough medical history and physical examination, which includes a digital rectal exam, are used to assess muscle tone and structural integrity in the pelvic area. This step helps identify any immediate physical issues contributing to incontinence and offers an initial assessment of the patient’s overall health and bowel function.

Anal Manometry

Anal manometry measures the pressure and coordination of the anal sphincter muscles, necessary for bowel control. This test detects muscle weakness or nerve dysfunction, both of which can contribute to faecal incontinence and evaluates whether muscles and nerves respond correctly during bowel activity.

Endoanal Ultrasound

This imaging technique produces high-resolution images of the anal sphincter muscles, revealing any muscle damage or structural irregularities. Endoanal ultrasound helps identify tears, scarring, or abnormalities that may impair sphincter function, providing precise information for targeted treatment planning.

MRI Defecography

MRI defecography captures dynamic images of the pelvic floor in motion, providing insights into muscle coordination and pelvic floor support. This test identifies coordination issues or anatomical abnormalities, such as rectal prolapse, that can affect continence. MRI defecography is especially useful for assessing how the pelvic muscles function together during bowel movements.

Stool Analysis

Stool tests check for infections, inflammation, and other digestive factors that could worsen incontinence symptoms. Identifying inflammatory markers or infections can clarify if an underlying gastrointestinal condition is contributing to symptoms.

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Treatment Options

Faecal incontinence is managed through a combination of non-surgical and surgical approaches tailored to each patient’s needs. The primary goals of treatment are to enhance bowel control, reduce discomfort, and provide lasting symptom relief.

Non-Surgical Treatment
Dietary Adjustments

Adjusting dietary intake can help regulate bowel movements and reduce incontinence episodes. A high-fibre diet may be recommended to improve stool consistency, while avoiding common bowel irritants, such as caffeine, alcohol, and spicy foods, may help stabilise symptoms. These adjustments support digestive health and reduce the frequency of incontinence.

Pelvic Floor Exercises

Targeted pelvic floor exercises strengthen the muscles involved in bowel control, potentially reducing episodes of incontinence. A customised exercise plan, often developed with a pelvic floor specialist, can help patients improve muscle tone and gain better control over bowel movements through consistent practice.

Medication

Medications may be prescribed depending on specific symptoms, such as anti-diarrhoeal agents for urgency or stool softeners for constipation-related incontinence. These medications provide targeted and immediate control of bowel movements and help manage daily symptoms alongside other treatments.

Injectable Bulking Agents

Bulking agents like collagen are injected around the anal sphincter to increase tissue bulk and support muscle function. This minimally invasive option is suitable for mild to moderate cases and provides temporary relief.

Surgical Treatment

When non-surgical treatments are ineffective or structural damage is present, surgical options may be recommended.

Sphincteroplasty

Sphincteroplasty is performed to repair damaged sphincter muscles in patients with compromised bowel control. This procedure involves suturing the torn or weakened muscle to restore function and improve continence. Often using robotic assistance, sphincteroplasty allows for precise targeting of the damaged area, leading to improved outcomes and a shorter recovery time with less post-operative discomfort.

Sacral Nerve Stimulation (SNS)

Sacral nerve stimulation is recommended for patients with nerve-related incontinence. This procedure involves implanting a device to stimulate the sacral nerves, which control the anal sphincter and pelvic floor muscles. By enhancing nerve function, SNS can improve bowel control and significantly reduce symptoms.

Artificial Bowel Sphincter

For severe cases of incontinence, an artificial sphincter can be implanted around the anus. This device mimics natural sphincter function, giving patients more control over bowel movements.

Managing Faecal Incontinence

Managing faecal incontinence involves practical steps to reduce its impact on daily life. Establishing a routine for bathroom visits can help avoid urgency and accidents. Using absorbent products, such as pads or disposable underwear, provides added security. Applying barrier creams helps prevent skin irritation from frequent cleaning. Monitoring hydration and maintaining a regular fluid intake also aid in managing stool consistency. Together, these strategies help patients manage symptoms more effectively.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Can faecal incontinence be temporary?

    Yes, faecal incontinence can sometimes be temporary, especially if caused by a reversible issue like an infection, temporary muscle strain, or certain medications. However, persistent incontinence may require treatment.

    Will faecal incontinence return after surgery?

    Faecal incontinence may return after surgery, particularly if underlying conditions progress or new issues develop. Following bowel health guidelines, practicing pelvic floor exercises, and attending regular follow-ups can help manage symptoms and reduce recurrence.

    Can faecal incontinence be a sign of a more serious underlying condition?

    In some cases, it may indicate serious conditions like colorectal cancer, rectal prolapse, or advanced nerve damage. Persistent symptoms should be evaluated by a healthcare provider.

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