Anal Incontinence
Anal, or faecal incontinence is the inability to control bowel movements, leading to faeces unexpectedly leaking from the rectum.
Anal incontinence affects more women than men, however affects both sexes more equally with increasing age. Women can be affected by anal incontinence after childbirth. This may be as a result of a complicated delivery requiring the use of forceps or an episiotomy.
In the elderly anal incontinence can develop when muscles become weak and the supporting structures in the pelvis become loose.
Incontinence can also occur as a result of muscle damage from rectal surgery. For example, some people who have previously undergone surgery to treat haemorrhoids. It can also develop in people who are suffering from inflammatory bowel disease.
Damage to the nerves that regulate rectal sensation and control the anal muscle is another cause. In addition to childbirth, nerve damage can occur with severe and prolonged straining when using the toilet, and as a consequence of some diseases- for example diabetes, multiple sclerosis and spinal cord tumours. Loss of storage capacity in the rectum is another factor.
Symptoms of an Anal Incontinence
Symptoms of anal incontinence can vary considerably betwen individuals. Some may have urgency or inadvertent leakage of small amounts of stool or gas whilst others may have more significant loss of bowel control. We recognise two main forms of anal incontinence and some individuals may suffer with both:
- Urge incontinence - a sudden or urgent need to use the toilet and incontinence will occur as a result of not reaching it in time.
- Passive incontinence - bowel leakage that occurs at other times and an individual may lack any sensation that they are 'leaking' a stool.
How is an anal incontinence investigated?
When you are seen in clinic the consultant will take a full history and carry out a clinical examination. Usually this will involve a rigid sigmoidoscopy and sometimes a proctoscopy as well.
If you are over the age of 40 the consultant will normally recommend endoscopic examination of the bowel either by flexible sigmoidoscopy or colonoscopy to ensure that the bowel is otherwise healthy.
Anorectal physiological testing with an endoanal ultrasound scan (to look at the sphincter muscle) are usually performed. Sometimes an MRI scan can be helpful to look at all the pelvic floor muscles. If there any symptoms of rectocele or prolapse then a videoproctogram or an MRI proctogram may be recommended.
Anal Incontinence Treatment
The aim of treatment is to to give more control over bowel movements. Most patients do not require any form of surgery and can be managed with conservative therapies. When conservative therapies prove ineffective then surgical procedures can be considered. Such treatments are usually only employed when a patient is suffering wiith symptoms that are significantly affecting their quality of life.
Conservative therapies include change in diet, the use of bulking agents, anti-diarrhoeals, anal plugs, suppositories, and enemas. Sphincter muscle function and bowel urgency can be improved through pelvic floor training and biofeedback techniques to strengthen the anal sphincter muscles. Local stimulation of a nerve round the ankle, known as Posterior Tibial Nerve Stimulation or PTNS can be effective for some patients with mild symptoms.
- Sacral nerve stimulation (also known as sacral neuromodulation) is a procedure where the nerves at the base of the spine are stimulated by a mild electrical current from a small implanted device. There are two phases for this treatment - the first being where a temporary electrode is used to trial the stimulation response and if this is successful the second phase involves implantation of a device into a small pocket beneath the skin. To find out more about sacral nerve stimulation, please click here.
- Sphincter repair This is an operation performed where the sphincter muscle ring is broken usually as a result of childbirth injury or previous anal surgery. The operation involves freeing of the damaged muscles from the scar tissue round about which are then overlapped and stitched back together to recreate the anal sphincter ring. This procedure is also known as a sphincteroplasty.To find out more about sphincter repair surgery please click here.
- Artificial sphincters have been used to treat patients with anal incontinence when other treatments have failed. Unfortunately implantable devices have been associated with high levels of infection and are not currently used. The use of the patients own thigh muscle to wrap around the damaged anus has also been employed but again this has been associated with high risks of complication and failure.
- Colostomy this procedure is only recommended when other surgical treatments have been unsuccessful. It is a procedure where the colon is cut and brought through the abdominal wall to create an artificial opening- this is known as a stoma. Faeces are then collected in the bag- known as a colostomy bag, which is attached to the opening. To find out more about Colostomy formation click here.
What our Patients think :
What are the next steps?
If you think you have this condition or any of these symptoms you will need to seek medical advice.
For more information or to make an appointment:
If you have private medical care or wish to pay to see a consultant:
Take this factsheet along to your own GP and request a referral to one of our consultants.