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Common causes of faecal incontinence

Common causes of faecal incontinence are presented in a table.

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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