Fecal incontinence is a lack of control over defecation, leading to involuntary loss of bowel contents including flatus, liquid stool or solid faeces. It can result from different causes and might occur with either constipation or diarrhea.
The causes of incontinence have their basis in two main factors. There may be excessive propulsion from the bowel or/and poor function of the anal sphincters. Continence is maintained by several inter-related factors, and usually there is more than one deficiency of these mechanisms for incontinence to develop. The most common causes are thought to be immediate or delayed damage from childbirth, complications from previous anorectal surgery and altered bowel habits (e.g irritable bowel syndrome, Crohn’s disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence).
Main consequences of faecal incontinence are local reactions which include damage to perianal skin, urinary tract infections and an impact on quality of life of patients leading to significant life style restrictions and embarrassment. There is also a financial implication for patients, employers and the society.
FI is one of the most psychologically and socially debilitating conditions in an otherwise healthy individual, but it is generally treatable. Management may be achieved through an personalised treatment plan including dietary, pharmacologic, and surgical measures.
Diagnosis of the causes of faecal incontinence needs a detailed history and methodical clinical examination followed by focused investigations. It is essential to rule out and treat correctable causes which include haemorrhoids, polyps, Inflammatory bowel disease or colonic cancer.
Tests needed may include flexible sigmoidoscopy or colonoscopy, endoanal ultrasound and physiology, defecating or MR proctograms, bowel transit studies or MRI pelvis.
Functional FI needs to be treated with a combination of dietary modifcation, physiotherapy (including exercises, biofeedback, irrigation), medication or surgery.
Surgery may be carried out if conservative measures are inadeqaute. The surgical options can be considered in four categories: restoration and improvement of sphincter function (sphincteroplasty, sacral nerve stimulation, tibial nerve stimulation, correction of anorectal deformity), replacement / imitation of the sphincter or its function (anal encirclement, SECCA procedure, non-dynamic graciloplasty, perianal injectable bulking agents), dynamic sphincter replacement (artificial bowel sphincter, dynamic graciloplasty), antegrade continence enema (Malone procedure), and finally fecal diversion (e.g. colostomy).