What is faecal incontinence
The term faecal incontinence indicates the difficulty in controlling the leakage of solid stools, liquid stools or intestinal gases.
Anal incontinence is a widespread disorder, especially among adults. Based on the data reported in the literature, the problem affects about 2% of adults in general and about 7% of healthy adults over 65 (Kamm MA., Fecal Incontinence, BMJ 1998 Feb 14; 316 (7130): 528-32).
However, sufferers often hide the problem and do not even talk about it with their doctor because of embarrassment and shame. This is why the actual spread of the disorder is probably much greater.
Faecal incontinence has a heavy impact on quality of life. Those who suffer from this disorder tend to limit activities outside the home and interpersonal relationships and to lose self-esteem and self-confidence.
It is therefore important to overcome the shame and to contact your doctor who will be able to recommend specialised centres for treating this disease.
A rectal examination is fundamental for a correct diagnosis since the characteristics and the frequency of the leaks identify different levels of severity of the disease.
First, it is necessary to distinguish between urge or active incontinence, passive incontinence, stress incontinence and obstructive incontinence:
- urge or active incontinence: a sudden and intense urge to defecate which often does not leave enough time to reach the toilet. Urge incontinence is caused by the inability to properly contract the sphincters when the passage of the faeces is felt. Active incontinence is often caused by damage to the external anal sphincter (voluntary muscle).
- passive incontinence: difficulty in perceiving the stimulus to defecate and the consequent loss of faeces. The patient often notices faecal leaks only when they come into contact with the skin around the anus. Passive incontinence is often caused by damage to the internal anal sphincter (involuntary muscle).
- Stress incontinence: occurs when sneezing, coughing or when undergoing intense physical exertion. Stress incontinence is due to the abrupt and intense increase in abdominal pressure, which does not correspond to an adequate counter-pressure at the anal level.
- Obstruction or overflow incontinence: incontinence caused by obstruction of the colon. The obstruction is due to blocked stools which make the passage of other faecal material difficult. For this reason, the faeces can be evacuated only in liquid form with leaks which are difficult to control.
We must then distinguish between minor and major faecal incontinence based on the characteristics, consistency and frequency of the faecal leaks:
- Minor faecal incontinence: often occurs with soiling and loss of intestinal gas. For the Società Italiana di Chirurgia Colorettale (Italian Society of Colorectal Surgery), the term soiling identifies unperceived or uncontrollable leaks of small amounts of mucus, faeces or other anal or perianal secretions. Minor faecal incontinence, which is often underestimated, can cause problems of a hygienic nature such as itching, dermatitis, urinary and genital tract infections. Minor faecal incontinence may also be the first stage of more severe forms of incontinence.
- Major faecal incontinence: occurs with consistent leaks of liquid and solid stools. Major faecal incontinence is associated with a more advanced stage of the disease.
Faecal incontinence: symptoms
The different types of faecal incontinence are therefore associated with different symptoms.
Only the accurate assessment of the symptoms by the specialist during the rectal examination identifies the type of incontinence and the most suitable treatment.
The most common symptoms of faecal incontinence are:
- involuntary loss of solid stools, liquid stools, mucus and intestinal gases.
- lack of perception of the stimulus to evacuate or perception of the stimulus to evacuate with inability to retain faeces or gas and to postpone evacuation.
- abdominal swelling.
Faecal incontinence: causes
Faecal continence is the result of a complex synergy between different factors and it involves:
- the internal anal sphincter muscle: a smooth muscle which relaxes involuntarily when there is pressure from faeces or gas in the rectum.
- the external anal sphincter muscle: a striated muscle which relaxes on the basis of a voluntary stimulus when we are ready to evacuate faeces or gas.
- the levator ani muscle: supports the activity of anal sphincters.
- pelvic floor muscles: support the activity of anal sphincters.
- the anorectal canal: an area rich in nerve endings which help to perceive the faecal stimulus and to control the leakage of faeces and gases.
- stool consistency.
- neurological functions.
- haemorrhoids: contribute to continence, especially of liquid faeces and of gas. When they dilate, haemorrhoids facilitate the closure of the anus and therefore the ability to retain faeces. On the other hand, the outflow of blood inside them and the consequent reduction in their volume, facilitates the evacuation of the faeces to the outside.
Diseases or lesions which alter how one or more of these factors function can lead to the onset of faecal incontinence. In fact, among the most frequent causes of faecal incontinence we find:
- sphincter weakness or lesion
- nerve lesion in the anorectal area
- loss of elasticity of the rectum
- pelvic floor dysfunctions
- neurological diseases and cognitive disorders
- haemorrhoidal disease
- rectal prolapse
- constipation or diarrhoea
- old age
Faecal incontinence affects both men and women. In both sexes, old age causes weakening and loss of elasticity of the anatomical structures involved in the mechanism of continence.
In young women, one of the most frequent causes of faecal incontinence is due to obstetric lesions or changes to the pelvic floor following childbirth.
In young men, faecal incontinence may instead occur following surgery in the anorectal area.
Due to the multiplicity and complexity of the possible causes, the specialist examination is often associated with instrumental exams such as an anorectal manometry.
Faecal incontinence: complications
The most frequent and disabling symptoms are then associated with some complications which aggravate discomfort for the patient:
- psychological complications, such as anxiety, stress and depression. Those who suffer from incontinence often live with the fear of involuntary leaks in uncomfortable situations such as business meetings or during intimate moments with the partner.
- dermatitis and skin irritation.
- Bedsores: maceration of the skin around the anus and pressure ulcers are one of the possible complications of the most serious cases of faecal incontinence.
- urinary tract infections.
- anal and genital itching and burning.