Feature Article

Faecal incontinence: under-reported, underdiagnosed

Le Thi Kim Lien, Christopher S Pokorny
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Faecal incontinence is an embarrassing condition that can lead to social isolation and an impaired quality of life. Conservative treatment measures can be trialled but more aggressive management is often needed.

Key Points

  • Faecal incontinence is common and often under-reported.
  • It impacts significantly on a patient’s quality of life and may result in social isolation.
  • Faecal incontinence may occur as a result of neurological conditions, anorectal trauma and conditions such as inflammatory bowel disease, constipation and diabetes.
  • Obesity, smoking, cholecystectomy and immobility are risk factors for faecal incontinence.
  • A cause for faecal incontinence should be sought. Investigations include endoscopy, manometry and imaging with CT or MRI if indicated.
  • Conservative measures, including the use of oral bulking agents, should be trialled initially but may not be successful.
  • Pelvic floor exercises, biofeedback and newer treatments such as sacral nerve stimulation and injection of biocompatible materials into the anal sphincter complex may lead to symptomatic improvement.
  • Surgery, including colostomy, may need to be considered in severe refractory cases.

    Picture credit: © Gina Sanders/