Getting to the Bottom of Faecal Incontinence

Most people aren’t quick to admit that they’re dealing with faecal issues such as experiencing struggles with bowel control, passing stool when they don’t mean to, or dealing with excessive flatulence. Dealing with bowel problems can feel embarrassing to talk about, which is why many people struggling with faecal incontinence will keep it to themselves.

To learn more about faecal incontinence, let’s explore what the condition is, and the different treatment options available today.

What Is Faecal Incontinence?

Faecal incontinence is a condition where a person will experience the involuntary loss of stool from the anus, leading to the accidental bowel leakage of solid or liquid faeces, and/or bowel mucus. This condition can also lead to excessive flatulence and faecal smearing (the staining of the underwear).

This condition can be further broken down into different kinds of faecal incontinence a person can experience. These include:

Urge Faecal Incontinence

This type of faecal incontinence refers to a person who feels the sudden urge to go to the toilet but is having trouble controlling anal muscles to prevent accidental bowel leakage. This is usually caused by a weak anal sphincter muscle or weak pelvic floor muscle, although stress & anxiety are also significant contributors.

Post-Defecatory Soiling

With this form of faecal incontinence, a person will experience bowel leakage after normal bowel movements. This can be a result of the sphincter muscles not properly closing after a bowel movement, or the bowels not fully emptying.

Passive Faecal Incontinence

Those who experience passive incontinence are having bowel movements without experiencing the urge to go, meaning they are having a bowel movement without realising it. This can be a result of several things, including nerve damage in anal muscles and reduced sensation.

Is Faecal Incontinence Common?

Accidental bowel leakage is nothing to be ashamed of, affecting more people than you might think. In fact, the Continence Foundation of Australia estimates that faecal incontinence affects 5-10% Australians.  This is a condition that primarily affects older adults, but it can impact people of any age.

Bowel problems aren’t fun, but there are things to be done to help with bowel incontinence, lessen symptoms, and get back to having a more regular bowel movement schedule.

What are the Symptoms of Faecal Incontinence?

The main symptom of faecal incontinence is a loss of regular bowel control. When a person has a healthy bowel, it will usually empty thirty minutes following a meal and they can choose when to respond to that sensation of needing to go. With faecal incontinence, this isn’t the case, and bowel movements will happen involuntarily.

This can be seen when looking at faecal incontinence symptoms. The common symptoms of faecal incontinence include:

  • Involuntary bowel movements
  • Bowel leakage occurring after having a bowel movement
  • Increased feelings of faecal urgency

How Is Faecal Incontinence Diagnosed?

Health centres like the Sydney Pelvic Clinic can help an individual find a faecal incontinence diagnosis and appropriate treatment plan. When visiting us, we can begin the diagnosis process by doing the following:

  • Performing a digital rectal exam
  • Take a digital x-ray or defecating Proctogram (an x-ray of your bowels)
  • Performing an endoanal ultrasound and manometry (test to determine anus and bowel function)

What Causes Faecal Incontinence?

Faecal incontinence can be caused by many things, including:

Constipation

Constipation and faecal impaction can sometimes lead to faecal incontinence issues. When patients experience constipation, the bowels will work to produce mucus to lubricate the bowels to pass stool. Sometimes this mucus will work its way out of the anal canal, appearing like loose stool.

Weak Pelvic and Anal Muscles

As we touched on above, weakness or nerve damage to the anal muscles and anal canal can lead to faecal anal incontinence. A weak pelvic floor and weak pelvic muscles can have the same effect as well. This can be caused by a number of things, including previous colorectal surgery, nerve damage, existing health conditions, childbirth, and more.

Other Diseases and Conditions

If you have bowel issues such as Crohn’s disease, ulcerative colitis, or irritable bowel syndrome, it can lead to faecal incontinence issues. Conditions such as multiple sclerosis, dementia, or spina bifida can also cause nerve issues that lead to a loss of bowel control and faecal incontinence. Pelvic radiation like radiotherapy, done to treat existing malignancies like cancer, can also impact the bowels.

Medication

Some medications can lead to nerve issues, a loss of muscle control, or impact the bowels in a way that causes faecal incontinence.

Stress and Anxiety

In some cases, increased levels of stress and anxiety can lead to the development of incontinence issues.

How Do You Manage Faecal Incontinence?

A proper Physio healthcare provider will get to ‘the bottom’ of your problems by asking you questions about your bowel history and habits.

They may do an objective pelvic floor and/or anal sphincter assessment using real time ultrasound or an internal assessment if needed (and you are comfortable with it). We will then select a range of treatment types to address your individual problem:

Muscle Retraining

Also referred to as defecation dynamics, this is a type of training done with a Physiotherapist that teaches you how to use your abdominal muscles to generate better rectal pressure. This can also be achieved with rectal balloon training, which can teach a person to train their pelvic floor and sphincter muscles the correct action required during a bowel movement.

Electrical Stimulation

This is a therapy that can address concerns around reduced sensation in the bowel area. Using a rectal probe, small electric currents can be used to stimulate a person’s anal sphincter muscles and pelvic floor to gain strength, and learn to feel what a proper bowel contraction feels like. It can also be used to calm the sensation of urgency.

Nervous System Management

The nervous system can play a huge role when it comes to issues around bowel movements. Finding strategies that can help to regulate the nervous system response can be done to help a person gain better bowel control.

Stool Manipulation

In some cases, adjusting a person’s diet – specifically fluid and fibre intake – can help alleviate faecal incontinence issues by achieving a desired stool type. A patient’s stool will be assessed using the Bristol Stool Chart to see where current bowel movements are at and to assess a new diet approach.

Sacral Stimulation or Surgery

Sacral stimulation involves the use of a small machine to send electrical impulses to muscles. This therapy, and surgery, are treatment options reserved for use when other Physiotherapy techniques have not helped to treat faecal incontinence.

Get Treatment for Faecal Incontinence

Those dealing with faecal incontinence issues should look into Physiotherapy to address symptoms. There are many different Physio treatments, like the ones we listed above, that can do wonders to help you stop involuntary bowel leakage, and get back to living a normal life.

If you’re looking for help dealing with faecal incontinence, reach out to the team at the Sydney Pelvic Health Clinic! Click here to book an appointment, and meet with a member of our team.

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