Faecal incontinence
Faecal incontinence is a sign or a symptom not a disease. It is therefore important to diagnose the cause(s) for each individual.
Types of faecal incontinence
Faecal incontinence is defined as the uncontrolled passage of solid or liquid faeces at a socially inappropriate time and place. Anal incontinence is the involuntary loss of flatus, liquid or solid stool that is a social or a hygienic problem. Passive soiling (liquid or solid) occurs when an individual is unaware of liquid or solid stool leaking from the anus. This may be after a bowel movement or at any time.
Causes of faecal incontinence
Constipation is the most common cause which can lead to loading/impaction with overflow diarrhoea. Passive soiling due to poor internal anal sphincter pressure is the most likely cause. This may be as a result of inadvertent surgical damage, for example following haemorrhoidectomy. Urgency and urge faecal incontinence is when the individual has to rush to the toilet, or is unable to get there in time resulting in a bowel accident. External anal sphincter weakness or defect is a common cause, often due to obstetric trauma. Increased gut motility causing loose stools – infection, inflammatory bowel disease, irritable bowel syndrome diet or stress, ano-rectal pathology. Rectal prolapse, fistula, haemorrhoids. Neurological disease – spinal cord injury, cauda equina syndrome, multiple sclerosis, spina bifida, dementia. Lifestyle and environmental issues – poor toilet facilities, diet, dependence on carers for mobility and managing clothing. Idiopathic or unknown cause.
Patients who continue to have episodes of faecal incontinence after assessment, treatment and management should be discussed with a specialist. A referral can be made to a Bladder and Bowel Nurse Specialist, Colorectal Specialist Nurse or Colorectal Consultants.
Bladder and Bowel Nursing Team Page 1 of 3 June 2016
High risk groups Frail older people. People with loose stools or diarrhoea from any cause. Women following childbirth (especially following third and fourth degree tears, obstetric surgery). People with neurological or spinal disease/injury (for example spina bifida, stroke, multiple sclerosis, spinal cord injury). People with severe cognitive impairment. People with urinary incontinence. People with pelvic organ prolapse and/or rectal prolapse. People who have had colonic resection or anal surgery. People who have undergone pelvic radiotherapy. People with perianal soreness, itching or pain. People with learning disabilities.
Assessment and initial management Nurses should identify and record the contributory factors that cause faecal incontinence. This assessment should include: relevant medical, surgical and obstetric history a general examination an anorectal examination accurate bowel chart Once identified, the following causes of faecal incontinence should be investigated and treated. Specialist referral made if appropriate, before progressing to management of faecal incontinence: constipation/faecal loading potentially treatable causes of diarrhoea red flag signs for lower gastrointestinal cancer rectal prolapse or third degree haemorrhoids acute anal sphincter injury including obstetric and other trauma acute disc prolapsed/cauda equine syndrome Nurses should evaluate the individual’s bowel habit, aiming for ideal stool consistency and satisfactory bowel emptying at a predictable time.
Bladder and Bowel Nursing Team Page 2 of 3 June 2016
Specialised management People who continue to have episodes of faecal incontinence after treatment and/or management should be referred to a bladder and bowel nurse specialist, colorectal consultant or colorectal nurse specialist. Treatment and/or management may include: specialist dietary assessment and management bowel management programme bowel retraining pelvic floor muscle training biofeedback electrical stimulation rectal irrigation
Bladder and Bowel Nursing Team Page 3 of 3 June 2016