It is estimated that 2-5% of individuals anywhere may experience some degree of faecal incontinence at some point, with older people more at risk. Here’s what you need to know.

What is faecal incontinence?

Incontinence is the inability to control the passage of contents from the body. Faecal incontinence is the inability to control the passage of faeces from the anus. This can happen either with or without the person being aware.

Causes

1. While a normal central nervous system can assess the proper time for defecation, a person with brain abnormalities will defecate at inappropriate times (although this is not, strictly speaking, faecal incontinence).
2. A working peripheral nervous system regulates defecation by correctly sensing the contents of the rectum and contracting/relaxing the anal muscles depending on the need to defecate or control. A person with abnormal sensory nerves in the rectum/anal area may not sense the contents of the rectum correctly so he may not know that he has an overloaded rectum or may incorrectly sense that he is going to pass gas when he is going to pass faeces.
3. When the anal musculature or sphincter is working normally, the anus can be contracted so there is no leak. Lax, poorly functional, injured or torn anal muscles work like a loose bottle cap that allows contents to flow out.
4. Normal faecal control depends on the contents being adequately solid. If not, even an otherwise healthy person will experience incontinence. Many of us have experienced food poisoning during which we have liquid stools and a severe urge to defecate. In such a situation, the force may be such that faecal urge overcomes an otherwise normal functioning system and the person has an episode of faecal incontinence.

Age factors

Faecal incontinence is more common with increasing age as nerve dysfunction increases. This applies especially to those with conditions like diabetes and vascular disease, where sensory nerves and anal muscles weaken; and dementia patients, who have a weakened central nervous system. Young people with anal muscle or nerve injuries are also prone to faecal incontinence, for instance, following an accident that injured the anus. Anal sexual abuse or nervous degenerative conditions.

Reason for hope

If the specific causes of faecal incontinence are determined, the condition can be cured.

• Brain degeneration (like dementia) Difficult to reverse
• Sensory nerve dysfunction Rarely treatable
• Muscle injury Can be repaired with surgery or nerve stimulation
• Acute or chronic diarrhoea Can be treated with bulking agents to make stools more solid

This condition involves a severe loss of dignity. Patients experience many emotions, from humiliation to self-consciousness and loss of self-esteem. The condition impacts them such that they isolate themselves. It can also result in the loss of employment and friends. This combination of factors can lead to suicidal thoughts.

Who is at highest risk?

• The elderly, especially those with dementia, nervous disorders, diabetes mellitus and vascular problems
• Women with multiple normal vaginal delivery childbirths, especially those for whom labour was prolonged and facilitated by forceps and episiotomies
• Women who have delivered at home
• Ano-receptive individuals, especially those with a history of anal abuse

Stay positive

Most of the time the problem can be treated, so those with this condition should consult a doctor who can diagnose and treat the condition appropriately.