Faecal Incontinence

Dr. Sulaiman Bin Yusof

MbChB (Sheffield) M.Med (Surg) FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士

Faecal incontinence is the inability to control bowel movements, leading to unintentional loss of stool.

This condition can range from mild leakage, especially during physical activities, to a complete inability to control bowel movements. Faecal incontinence often results from issues affecting the muscles, nerves, or structural support within the rectum and anus, which are necessary for bowel control.

Symptoms of Faecal Incontinence

The symptoms of faecal incontinence can vary in intensity and may include:

Unintentional Stool Leakage: Stool may leak during activities such as lifting, walking, or bending, often without warning.

Sudden Urgency and Increased Frequency: A sudden, intense need to pass stool may occur, giving the individual limited time to reach a restroom. This urgency often involves frequent bathroom visits, disrupting daily routines.

Total Loss of Bowel Control: In severe cases, individuals may lose all ability to control bowel movements, resulting in the involuntary release of stool.

Discomfort or Bloating: Discomfort, bloating, or abdominal cramping can occur alongside faecal incontinence, especially in individuals with digestive issues. These sensations may worsen with diarrhoea or constipation, further complicating bowel control.

Causes and Risk Factors

Faecal incontinence may develop due to a combination of factors and underlying conditions. These may include:

Damage to Muscles and Nerves

Injury to the anal sphincter muscles or nerves, often from childbirth, surgery, or certain medical conditions like diabetes, can impair bowel control. Muscle damage may weaken the ability to retain stool, while nerve damage can disrupt the signals needed for bowel control, contributing to episodes of incontinence.

Chronic Digestive Conditions

Conditions such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) can weaken the rectal muscles and reduce bowel control. These conditions often involve inflammation, diarrhoea, or constipation, which put strain on the bowel and increase the risk of incontinence.

Ageing

As people age, declines in muscle tone and nerve sensitivity may make bowel control more difficult. Individuals over 65 are at higher risk due to the weakening of pelvic and anal muscles, and reduced tissue elasticity, which further affects continence.

Rectal Prolapse or Pelvic Floor Disorders

Rectal prolapse, where the rectum protrudes through the anus, can disrupt normal bowel function and lead to incontinence. Pelvic floor disorders weaken the muscles that support the bladder and rectum, further limiting bowel control. Both conditions strain the structures required for bowel control.

Previous Colorectal Surgery or Pelvic Trauma

Prior surgeries, injuries, or trauma in the pelvic area may weaken muscles or damage nerves involved in bowel control. Surgical procedures, such as those for colorectal cancer, may result in residual weakness in the anal sphincter, making it difficult to maintain bowel control over time.

Diagnosing Faecal Incontinence

A comprehensive diagnostic approach is used to assess the factors that contribute to faecal incontinence. Key steps include:

Medical Evaluation and Physical Examination

A complete medical history and physical examination, including a digital rectal exam, can help determine muscle tone and structural abnormalities. This assessment also identifies previous injuries or medical conditions that may be contributing to incontinence. Evaluating the patient’s history helps tailor the diagnostic and treatment plan.

Anal Manometry

This test measures the pressure and coordination of the anal sphincter muscles, helping detect weakness or dysfunction. It reveals potential nerve or muscle impairment by assessing muscle strength and response. The information obtained guides the treatment approach by identifying areas where muscle strength or control can be improved.

Endoanal Ultrasound

Endoanal ultrasound produces high-resolution images of the anal sphincter muscles, allowing for a detailed view of any structural issues. This imaging technique can detect tears, scarring, or other abnormalities that may impair bowel function. It is particularly helpful for diagnosing physical damage that may be contributing to faecal incontinence.

MRI Defecography

MRI defecography captures dynamic images of the pelvic floor in motion, allowing for the assessment of coordination issues and structural problems, such as prolapse. This test identifies anatomical abnormalities, such as muscle dysfunction, that may affect continence. It also helps determine the need for surgical intervention based on the observed movements and structural changes.

Stool and Blood Tests

Stool and blood tests are performed to rule out infections, inflammation, or other digestive conditions that may affect bowel control. Blood tests can also detect signs of anaemia, which may result from chronic gastrointestinal issues. These tests help confirm or rule out underlying medical conditions that could be contributing to symptoms.

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Treatment Options

Treatment for faecal incontinence aims to restore bowel control and provide lasting symptom relief. Options include non-surgical and surgical methods tailored to the patient’s needs and the underlying cause of their condition.

Non-Surgical Treatment
Dietary Adjustments

Increasing fibre can help improve stool consistency and make bowel movements easier to control. Avoiding trigger foods, such as caffeine or spicy foods, may also help reduce symptoms. These dietary changes are often effective in managing mild incontinence without further intervention.

Pelvic Floor Exercises

Targeted pelvic floor exercises can help strengthen the muscles responsible for bowel control, potentially reducing episodes of incontinence. This therapy may include working with a specialist to create a personalised exercise plan. Over time, improved muscle tone in the pelvic region can support better bowel control.

Medication

Anti-diarrhoeal medications can help manage urgency, while stool softeners may be used for constipation-related incontinence. Medications are prescribed to provide relief based on individual symptoms and, when used as directed, can be effective in managing chronic conditions.

Injectable Bulking Agents

Bulking agents, such as collagen, are injected around the anal sphincter to increase tissue bulk and improve muscle support. This option is minimally invasive, suitable for mild to moderate cases, and offers temporary symptom relief.

Surgical Treatment
Sphincteroplasty

For patients with sphincter damage, sphincteroplasty repairs the affected muscles to restore bowel control. This minimally invasive procedure helps reinforce the anal sphincter muscles, improving their ability to maintain continence. It is particularly beneficial for patients whose incontinence is caused by trauma or surgical injury to the sphincter.

Sacral Nerve Stimulation (SNS)

Sacral nerve stimulation involves implanting a device that stimulates the sacral nerves, which control bowel movements and sphincter function. This treatment improves nerve signalling and is typically recommended for patients with nerve-related incontinence who have not responded to other treatments.

Artificial Bowel Sphincter

In severe cases of incontinence, an artificial sphincter can be surgically implanted around the anus. The device replicates the function of a natural sphincter, allowing patients more control over bowel movements.

Managing Faecal Incontinence

Managing faecal incontinence involves practical strategies to minimise symptoms and improve daily functioning. Establishing a consistent routine for bowel movements can help reduce the unpredictable nature of accidents. Using absorbent products or protective undergarments offers a discreet way to handle leakage. Proper skin care, such as gentle cleansing and the application of barrier creams, prevents irritation and maintains skin integrity. Monitoring fluid intake and avoiding dehydration can help regulate stool consistency.

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Dr. Sulaiman Bin Yusof

MbChB (Sheffield)

M.Med (Surgery)

FRCSEd (General Surgery)

蘇萊曼·尤索夫博士

Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.

Education & Specialist Training
  • MbChB(Sheffield)
  • M.Med(Surgery)
  • FRCSEd(General Surgery)

Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.

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    Frequently Asked Questions

    Can stress or anxiety worsen faecal incontinence?

    Yes, stress and anxiety can increase bowel activity, potentially worsening symptoms for individuals with faecal incontinence. Managing stress through relaxation techniques or counselling may help reduce symptom severity.

    Can faecal incontinence be a side effect of certain medications?

    Yes, some medications, such as laxatives, antibiotics, or medications affecting nerve function, can contribute to or worsen faecal incontinence. A healthcare provider can assess medication use and suggest adjustments if necessary.

    Are men equally affected by faecal incontinence as women?

    Women are more likely to experience faecal incontinence due to childbirth-related injuries, but men can also be affected, particularly due to age-related changes or medical conditions.

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