©2018   Mukhtar Ahmad

Anal Incontinence

Anal incontinence (sometimes referred to as faecal incontinence) is the inability to control the release of flatus (wind) and/or faeces (liquid or solid stool) from the anus.

Anal incontinence (AI) can be embarrassing and discussingyour symptoms with your doctor might seem daunting. However, there are several treatments available that could improve your quality of life.

Anal incontinence can cause huge embarassment but is treatable

Causes 

Anal continence is maintained by a complex interplay of muscles, nerves, stool consistency and rectal capacity. For many people, there is more than one cause:

 

  • Diarrhoea

    • Infection

    • Colitis

    • Medications

  • Pelvic floor muscle damage

    • Childbirth

    • Previous surgery

    • Ageing

  • Nerve damage

    • Childbirth

    • Diabetes 

    • Progressive diseases of the nervous system e.g multiple sclerosis

  • Loss of storage capacity in the rectum

    • Previous surgery​

    • Radiotherapy

    • Inflammatory bowel disease

Anal plugs
Sacral Nerve Stimulation

​​Symptoms

There a broadly two types of anal incontinence though patients might experience a combination of the two. Urge incontinence occurs when there is a sudden urge to defecate, which comes on so suddenly that they don't make it to the toilet in time. Passive incontinence occurs when there is no awareness of the need to pass stool.  

Risk factors

  • Age: AI can occur at any age but it's more common in middle-aged and older adult

  • Female: This is likely a consequence f childbirth though women who have not had children can develop AI

  • Dementia 

  • Physical disability:  Difficulty reaching the toilet in time, rectal nerve damage from the injury that caused the disability, inactivity leading to constipation and overflow

 

Complications

 

  • Emotional distress: The loss of dignity associated with losing control over one's bodily functions can lead to embarrassment, shame, frustration, anger and depression. Many people with AI to try to hide the problem or avoid social engagements.

  • Skin irritation: The skin around the anus is delicate and sensitive. Repeated contact with stool can lead to pain and itching, and potentially to sores (ulcers) 

 

Treatment

Your own doctor can discuss initial measures and will consider referring you to a specialist if if your symptoms fail to improve.

 

  • Reduce constipation: Increase your exercise, eat more high-fibre foods and drink plenty of fluids.

  • Control diarrhoea

    • Treat any underlying cause  e.g bowel infection or inflamma​tion

    • ​Antidiarrhoeals e.g loperamide

  • ​Biofeedback: a package of measures including pelvic ​​floor exercises aimed at improving anorectal awareness. A pelvic floor physiotherapist or specialist nurse will guide you. 

  • Anal plugs and incontinence pants​

  • Surgery 

    • Sacral nerve stimulation​

    • Anal sphincter repair

    • Artificial sphincter devices

    • Stoma (bowel brought to the skin of your tummy)​