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Common causes of faecal incontinence

Common causes of faecal incontinence are presented in a table.
There’s lots of causes of faecal incontinence. One can be damage to the anal sphincter or the perineal area. Often for women that is as a result of child birth, but there can be many other reasons and the reasons are very often very, very difficult for people to talk about. We live in a society where people tend to be quite constipated a lot of the time, so we do encounter quite a lot of people with urinary symptoms, who have them because of constipation. So that’s something that I always look at quite carefully.
Sometimes you find though with constipation that laxatives have been prescribed and suddenly this person’s become faecally incontinent and for some reason the two have not been related to each other, so the penny hasn’t dropped and sometimes I just say, well maybe you could cut down on the laxatives and, it’s oh, right, okay we’ll do that then. But the doctor in the hospital prescribed the laxatives so we thought that we had to keep them going. But sometimes as well people don’t give the laxatives because the person has been a bit lose and they end up being constipated again and so it’s actually really important for laxatives to be used correctly and unfortunately very often they’re not.
Either by being not prescribed properly or by the person administering the, not fully understanding how they work. Sometimes people experience problems with gut motility where things start to move through too fast, so they end up with diarrhoea which is very difficult to control because essentially the loser the stool the more difficult it is for the anal sphincter to control it and that can be caused by a variety of different reasons, sometimes things like Crohn’s Disease and ulcerative colitis sometimes it’s even medication and it’s always worth checking if somebody suddenly develops faecal incontinence whether if they’re on laxatives maybe they don’t need the same strength of laxatives that they were on or maybe they’re on the wrong ones and so on.
It’s always worth looking at that. We come across people who have other damage down below, so we come across vaginal prolapse and rectal prolapse and sometimes even haemorrhoids can have an impact as well and there are many neurological causes of faecal incontinence. Anything that interferes with the nerve pathways can lead to this, so people with motor neurone disease, multiple sclerosis, having had a stroke and so on, very often there is an impact there.

Clinician Kate Boyce has many years of experience in continence care. In this video she shares her clinical expertise and sets the scene by talking about the wide-ranging causes of faecal incontinence.

A summary of common causes of faecal incontinence is shown in the table below.

Primary problem (Type of incontinence) Common cause
1. Anal sphincter and pelvic floor damage (Stress/passive) Obstetric trauma; Trauma following surgery – haemorrhoidectomy, anal stretch, sphincterotomy, gynaecological surgery; Direct trauma from injury or anal sex; Chronic straining; Effect of ageing reducing strength of contraction; Congenital anorectal malformation
2. Gut motility and stool consistency – diarrhoea (Urge) Infection – a virus eg norovirus, a bacteria eg Clostridium difficile or Escherichia coli, salmonella or shigella which can cause food poisoning or a parasites eg the Giardia intestinalis parasite that causes giardiasis; Medications – laxatives, antibiotics, antacids containing magnesium; Inflammatory bowel disease – Crohn’s disease, Ulcerative Colitis; Irritable bowel disease; Pelvic radiation; Reduced colonic adsorption following removal of part of colon; Diet – change of food, too much fibre, intolerance eg gluten; Psychological state – anxiety
3. Ano-rectal pathology (Passive) Rectal prolapse; Anal or recto vaginal fistula; Haemorrhoids or skin tags; Pruritus – perianal soiling irritates the perianal skin resulting in itching burning and pain
4. Neurological disease (Reflex) Congenital conditions – Spina bifida, sacral agenesis (usually secondary to constipation); Spinal cord injury; Neurological conditions – Multiple sclerosis, Stroke, Parkinson’s Disease, Diabetes
5. Secondary to degenerative neurological disease (Reflex) Alzheimer’s Disease (if caused by dementia, urinary incontinence always precedes faecal incontinence)
6. Faecal impaction with overflow – spurious diarrhoea (overflow) Institutionalised care, immobility, frail elderly
7. Environmental / lifestyle Poor toilet facilities, incorrect posture on toilet, inadequate care, non-availability of carer, frailty and dependency, drugs with gut side effects, poor diet and fluid intake
8. Idopathic Unknown causes

Table 4.1: Summary of common causes of faecal incontinence. Available to download in PDF format.

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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

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