Faecal incontinence is a lot more common than you might think with about one in 12 people experiencing it. However, many cases can be treated, generally without surgery.
Faecal incontinence is when you are unable to hold a bowel movement until you can reach a toilet. Healthy bowel control relies on muscles and nerves in your rectum and anus that work together to hold in stool, to send you a signal that the rectum is full and that you need to have a bowel movement, and to relax when you’re ready to allow the stool to release. These healthy muscles are called sphincters, and they close tightly, like rubber bands, around the anus.
Although people can experience faecal incontinence at any age, the typical onset is between the fifth and seventh decade of life. Women, in particular, can sustain injuries to the sphincter muscle or nerves during child birth .
Although we often talk about the lack of awareness of urinary incontinence and it’s high prevalence, we rarely mention the prevalence of faecal incontinence.
However new research shows that faecal incontinence also has a high prevalence amongst women, especially those in older age groups, those who have had numerous babies, women whose deliveries were assisted by forceps or vacuum devices, and those who have had a hysterectomy.
Many women in the study who had fecal incontinence also had another medical condition, such as diabetes, and often experienced urinary incontinence as well. The findings are reported in the American Journal of Obstetrics and Gynecology.
“Increased attention should be paid to this debilitating condition, especially considering the aging of our population and the available treatments for faecal incontinence,” said Dee E. Fenner, M.D., Senior Author of the study and Associate Professor of Obstetrics and Gynecology, and Director of Gynecology, at the University of Michigan Medical School.
The study, led by the University of Washington, was a postal survey of 6,000 women ages 30-90 (only women were involved in the study). Of the 64% of respondents, 7.2% reported experiencing faecal incontinence, with the prevalence increasing with age.
Faecal incontinence, or the inability to control the bowels, is a highly underreported and stigmatized condition, according to colorectal surgeons at Loyola University Health System (LUHS) in Chicago.
“This is a debilitating condition, which drastically affects a person’s quality of life,” said Dana Hayden, MD, MPH, colorectal surgeon, LUHS. “People with Fecal incontinence avoid leaving the house to prevent an embarrassing accident from happening in public.”
Faecal incontinence is more common in older adults, and although it affects women more commonly, men can also suffer from this disorder. This condition can be caused by a variety of factors, including damage to the pelvic nerves or muscles from trauma such as childbirth, and anal or rectal surgery; diseases like diabetes; or complications from radiation. The National Institutes of Health (NIH) estimates that more than 18 million Americans have faecal incontinence, yet Loyola doctors believe it is much higher.
“Fecal incontinence isn’t something that people talk about, yet we know from our practice that it is extremely common,” said Dr. Hayden, who also is an assistant professor in the Division of Colorectal Surgery at Loyola University Chicago Stritch School of Medicine. “The good news is there are options to manage this condition.”
Faecal incontinence improves after surgery for rectal prolapse, but recent research shows that the degree of improvement is quite low. After a mean follow-up period of 36 months, 68% of surgically treated patients had a reduction in the continence score. In spite of this, nearly 60% of patients remained incontinent, with 55% reporting urgent incontinence and 32% reporting passive leakage.
“Despite an improvement in quality of life and symptoms, Faecal incontinence remains a frequent and troublesome complaint after surgery for rectal prolapse,” say researcher Laurent Siproudhis (Universitaire de Pontchaillou, Rennes, France) and colleagues.
The study, published in Colorectal Disease, included 85 patients undergoing laparoscopic rectoplexy to treat full-thickness rectal prolapse between 2003 and 2009.
Prior to referral for surgery, the patients had symptoms for nearly 4 years and 10 individuals had prior surgery for rectal prolapse. Faecal incontinence was the main symptom prior to surgery, reported in 46% of patients, but 88% of individuals had some degree of incontinence before the laparoscopic procedure.
Three years after surgery, 58 patients, or 68%, had an improvement in Faecal incontinence, with the mean incontinence score declining from 10.4 before surgery to 7.0 after surgery, a statistically significant difference.
However, 58.9% of patients remained incontinent. Incontinence for liquid stool, for solid stool, and the need for protection was observed in 51%, 41%, and 51% of patients, respectively.
“Despite a significant surgical effect on continence at least one half of the study group still required pads and/or suffered from Faecal incontinence,” report the researchers.
Older patients, individuals with symptoms for a longer duration, individuals with a higher preoperative urinary incontinence score, and those with a higher Faecal incontinence score were more likely to suffer with postoperative incontinence.
We’ve just added a new video to our “About Incontinence” website page. The video talks through incontinence and bladder issues and talks about the common types and what causes them including Stress Incontinence, Urge Incontinence, Overflow (or Drip), Mixed Incontinence, Reflex Incontinence and Faecal Incontinence.
The video can also be seen below.
Faecal incontinence is something that people don’t often talk about. Faecal incontinence often effects women who have had an injury during child birth and can affect between two to twenty percent of the population.
“It could be due to trauma, post-surgical, radiation, neurologic,” explained Dr. Elsa Goldstein, Colon and Rectal Surgeon.
Patients who have trouble controlling bowels are first instructed to change their diets. “High fibre foods and good fibre supplements,” suggested Dr. Goldstein.
Some patients get biofeedback, others get surgery.
“Some people undergo sphincter repair if there is a specific sphincter injury due to child birth or surgery, and if that didn’t work, that would generally be the end of the line, except for a colostomy,” said Dr. Goldstein.
Ellen Moskal has been dealing with faecal incontinence for eight years.
Moskal was always told she needed a colostomy bag, but thanks to Dr. Goldstein, she was given a brand new option, Interstim. It is a device that is temporarily placed under the skin in the upper buttocks, and after a two week trial period, if they patients gain control of their bowels by at least 50%, it can be placed permanently.
“Placing a wire into the lower back, and goes into an area where there are sacral nerves, and that wire is connected to an external neurostimulator,” Dr. Goldstein explained.
Dr. Goldstein said, “It seems to effect both the sensory component and motor component, so patients are able to sense when they have to go to the bathroom, and can control it if they have the urge.”
With the use of this remote device, they can increase the stimulation with a click of a button. Of those patients who use this device, “40% of patients have complete continence,” said Dr. Goldstein
InterStim Therapy is an FDA-approved neurostimulation therapy that targets the communication problem between the brain and the nerves that control bowel function. The InterStim Therapy system uses an external neurostimulator during a trial assessment period. For long-term therapy, the neurostimulator is inside your body.
Care for patients with faecal incontinence costs $4,110 per person for both medical and non-medical costs like loss of productivity, according to new research from the University of Michigan.
The prevalence of faecal incontinence is expected to increase substantially, as the elderly population continues to grow rapidly. The study, published this month in the journal Diseases of the Colon & Rectum, is unusual in that it assesses the per-patient annual economic costs of the condition.
“Very few studies have looked at the cost of this embarrassing and socially-isolating condition,” says the study’s senior author Dee E. Fenner, M.D., “The disease is prevalent among men and women, and this study shows the cost is a significant burden to patients and to society.”
The condition usually involves unintentional loss of solid, liquid or mucous stool, and it affects 8.3% of adults who are not living in an institution such as a nursing home. It is equally prevalent in women and men, and the prevalence increases significantly with age.
Among women in their 80s, research shows about 15% report monthly bouts of faecal incontinence, says Fenner, who also is Professor of Obstetrics and Gynecology and Urology.
In the study, the researchers included three categories of cost: direct medical cost (diagnosis, treatment and management of the condition); direct non-medical cost (costs of non-medical resources like incontinence products or transportation to care); and indirect cost (loss of productivity).
“Our study suggests that the annual cost of faecal incontinence is similar to that of urinary incontinence,” says Fenner, adding that urinary incontinence doesn’t carry the same stigma as faecal incontinence and is more often talked about in the media and by health care providers.
Those who suffer with faecal incontinence find it difficult to hide odour issues, and the condition can lead to depression and social isolation. Many suffer for five years or more before seeking treatment options, Fenner says.
“For many patients, the sooner you are treated, the better,” Fenner says. Diet management, physical therapy for pelvic floor issues, anti-diarrhoeal medications can all be used, and more and more surgical options are available.
“This study shows that more attention should be directed to the prevention of this condition,” Fenner says. “In addition, interventions that can help patients manage their symptoms could generate financial benefits as well, because the results show that patients with more severe incontinence also have higher annual costs of care.”
If you are one of the thousands of people who experience faecal, or bowel, incontinence at some point you are not alone. Some studies have found that 10 per cent or more of adults experience this condition, and there are many things you can do to prevent it.
If your bowel movements tend to be loose and watery, and come frequently, you may find that it’s worth considering some changes to your diet. For example, specific foods may be triggering your diarrhoea. Try cutting out or reducing these common triggers:
· cured or smoked meats
· spicy foods
· fatty and greasy foods
· dairy products
· sweeteners such as sorbitol, xylitol, mannitol and fructose (found in many diet drinks, fruit drinks, sugarless gums and candies).
It might also be worth considering taking a daily fibre supplement. This can be a simple but effective way to reduce faecal leakage. Over-the-counter products can be found most pharmacies, some of these dissolve more completely in liquids and are tasteless so can be added to any hot or cold liquid you drink — and you won’t know they’re there.
Drink plenty of liquid with the supplement to help control diarrhoea, the fibre absorbs the water and prevents leakage of watery stool.
Medications being taken could also be contributing to your diarrhoea and incontinence so it’s important to discuss all of your medications with your doctor. Your doctor may suggest an anti-diarrhoeal medicine. Loperamide (Imodium) has the added benefit of increasing muscle tone in the internal anal sphincter.
You can further strengthen the muscles of your pelvic floor, including the anal sphincters, with specific exercises. Biofeedback can help you learn to do the exercises correctly. Biofeedback can also improve your ability to sense the presence of stool in your rectum. This, in turn, may allow you to get to a bathroom before the situation becomes desperate.
Talk to your doctor about which of these treatments might work best for you.
Constipation can cause urinary or faecal incontinence as the impacted stool puts pressure on the bladder and weakens rectal and intestinal muscles so strategies for managing constipation-related incontinence are important including dietary changes and using products that keep skin dry and healthy.
Incontinence caused by constipation can affect individuals of all ages. Wake Forest Baptist Medical Center researchers in the U.S.A. recently published a study in the journal Urology that found constipation often is a cause of bedwetting in children. Laxative therapy cured 83% of the children and adolescents studied within three months, reported an article published in U.S. News & World Report.
Constipation is one of the more easily treatable, temporary medical causes of urinary or faecal incontinence, here a some tips for managing constipation-related incontinence:
-It’s important that older people consult their doctors about how much water to drink. Drinking water helps prevent constipation, but too much can cause frequent urination.
-Eating more fibre can help soften stool and improve digestion. Foods rich in insoluble fibre include vegetables, whole grains, nuts, beans and berries.
-Food and beverages that can cause bowel irritation include spicy or oily foods, alcohol, caffeine, and dairy products for the lactose-intolerant.
-A health care professionsal may suggest medications, stool softeners, laxatives, or enemas to loosen impacted stool.
-Use quality incontinence products that are made from advanced, absorbent materials that keep urine and stool away from skin.
-Implement a proper skin care regime that includes cleansing, moisturizing and protecting, to keep skin healthy and prevent infection.