What is Incontinence?
Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. It is also sometimes known as faecal incontinence. It’s thought 1 in 10 people will be affected by it at some point in their life. It can affect people of any age, although it’s more common in elderly people. It is also more common in women than men.
What causes Incontinence?
This may occur because a specific component of the anatomy does not function properly. For example:
The rectum – The rectum is the part of the large bowel that acts as a reservoir, holding faeces until you are ready to go to the toilet. If this doesn’t function normally, it may lead to incontinence. Causes include inflammation of the rectum (proctitis).
Anal sphincter – These are the muscles at the very bottom of the anus which keeps faeces within the rectum. Damage to the sphincter may cause incontinence. This commonly occurs after having a baby. 1 in 10 women have a tear which may result in difficulty in controlling their bowels. Tears are more common in older mothers (over 35), if the baby is large or if assistance with forceps or a suction cup is needed.
Nerves – Nerves control the reflex that allows defaecation and they provide information on sensation. Any problems with theses nerve pathways may lead to a degree of incontinence.
The cause of incontinence is not always simple, and it is common for a combination of problems to occur together.
What are the symptoms of Incontinence?
The experience of bowel incontinence can vary from person to person.
Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence. Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind.
This may occur variably although severely affected patients experience incontinence on a daily basis. In severe cases is can have a dramatic influence on quality of life, and some patients feel unable to leave the house.
How is Incontinence diagnosed?
Your doctor will take a full history and they will examine you. If you are female they will ask you about your experiences during child birth. As part of the examination they will feel the pelvic floor and they may also ask you to squeeze your anus around their finger to assess how well the muscles in your anus are working.
Your doctor may refer you for an endoscopy. During an endoscopy, the inside of your rectum is examined using a long, thin flexible tube with a light and video camera at the end. Images can also be taken of the inside of your body.
He or she may also refer you for physiological analysis of the muscles of the bottom and pelvic floor:
Anal manometry uses a small probe which is passed into the anus and it assesses the muscles and nerves in and around your rectum.
Anal ultrasound uses an ultrasound probe which is used to detect damage to the sphincter muscles.
Defecating MRI proctogram: Water soluble x-ray dye is placed into your rectum. You will be asked to pass stools in the usual way while scans are taken.
How is Incontinence treated?
Your doctor may refer you to a dietitian or ask you to make some changes to the types of food you eat, so that your bowel motions become easier to manage. They may also prescribe medicines to help control the consistency of your bowel movements.