What is bowel incontinence?

Bowel incontinence or fecal incontinence is a condition that is a primarily associated with an inability to control bowel movements. This means that the patient is unable to hold stools that leak uncontrollably from the rectum via the anus.

The stool movement is a complex process which integrates the rectal muscles and the internal and external anal sphincter complex along with pelvic floor muscles and nerve complexes around the area.

The nerve complexes are situated in the wall of the rectum, pelvic floor and lining of the anal canal. These send signals to the brain for deferring defecation until social conditions are suitable. 1-6

Causes of bowel incontinence

Bowel incontinence is not a condition in itself but a symptom of an underlying problem or medical condition that could be due to damage to a muscle or a nerve that controls the sphincter (anal sphincter) that controls bowel evacuation.

It can affect people of any age but is most common among the elderly who have weakened muscles and nerves around their rectum and as a complication of pregnancy. In this way this condition is slightly more common in women than men.

Risk factors of bowel incontinence

Risk factors include:

• patients with diarrhoea

• women who have had severe (third- and fourth-degree) injury to their pelvic muscles while giving birth vaginally

• those with rectal prolapse or pelvic organ prolapse due to weak pelvic floor muscles

• those who have undergone radiation therapy or colon surgery due to cancers

• those with urine incontinence

• frail elderly patients

• those with dementia and severe cognitive impairment or learning difficulties

• those with nerve damage like spinal injury, spina bifida, multiple sclerosis etc.

Epidemiology of bowel incontinence

Around 2.2% of the population is diagnosed with bowel incontinence. However, the actual figures may be higher as many patients do not seek therapy for the embarrassment caused by the condition.

In people over 65 living in care facilities, the prevalence of the condition is as high as 7%. More than 5.5 million Americans have fecal incontinence and some studies believe that as many as 25% of the population that is institutionalized may have some symptoms of fecal incontinence.

Symptoms of bowel incontinence

The severity varies from individuals and for some it may be passing just a small piece of stool when passing wind and in some it may be complete evacuation of stool. There is a severe impact of this condition on the quality of life, self-esteem and emotional wellbeing of the sufferer.

It hampers social life to a great extent as well and may lead to other mental health conditions like depression and anxiety disorders. Bowel incontinence is much more common than most people realise as many patients are unwilling to come forth with their condition until it worsens.

Diagnosis of bowel incontinence

Many people with bowel incontinence do not seek medical treatment for their condition until it is too late. Bowel incontinence will not always go away without treatment and is not a normal part of aging or pregnancy after-complication.

Diagnosis is made by physical examination or digital rectal examination that helps in assessing the sphincter function.

Other tests include:

• Endoscopy

• anal manometry

• anal electromyography

• defecography to test the nerve and muscle functions of the rectum and pelvic floor muscles

Treatment of bowel incontinence

There are a range of medical and surgical therapies available for bowel incontinence that may treat the condition successfully. With the right therapy at the right time a person can maintain normal bowel function throughout their life.

Treatment options include changes in lifestyle, bowel habits and diet as well as exercise programmes. Medications and surgery is also undertaken as part of therapy.