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What Causes Faecal Incontinence?

To understand the causes of faecal incontinence it is important to appreciate the mechanisms which prevent the leakage of material from the anus. As infants we are faecally incontinent and we generally learn to control our bowel actions during ‘potty training’. This learning process involves getting to know what it feels like when faecal material accumulates in the rectum and subconsciously keeping the anus shut by contraction of surrounding muscles until it is convenient to empty the bowels. Hence, the essential elements of faecal continency are:


			Brain control over bowel action developed by learning

			The nerve connections between the brain and the muscles in the pelvic floor that relay sensations from the rectum and anus to the brain and others that convey instructions to the muscles which control the opening and shutting of the anus.

			The muscles of the pelvic floor which pass around the rectum and anus.

Faecal incontinence can occur when one or more of these elements are defective. Some common examples are:


			Damage to the muscles of the pelvic floor, often sustained during childbirth.

			Loss of brain control as in dementia or stroke

			Damage to the nerve connections between the rectum and anus and the brain, as may arise from spinal injury or multiple sclerosis. Nerve damage can also result from diabetes.

			Weakening of the muscles around the anus. This can occur with ageing, but can also occur in younger people, especially women, for no apparent reason.

In addition, disturbances occurring within, or damage to, the bowel or rectum can cause faecal incontinence. For example, the sudden onset of diarrhoea occurring when it is not possible to get to the lavatory may result in faecal incontinence.

Constipation

Long standing constipation can cause faecal incontinence in two ways. Firstly, straining to empty the bowels may damage the pelvic floor muscles and the passage of hard stools may injure the anus, giving rise to tears (fissures) which can be extremely painful. Secondly, when the bowels are not emptied regularly, water is reabsorbed from the faeces by the rectum which causes them to become extremely hard. The faeces get stuck in the rectum and cannot be expelled by the muscle contractions which usually empty the bowel during defecation. This condition is known as faecal impaction. As more faecal material build up behind the impacted faeces, irritation to the lining of the rectum occurs and the faecal material is broken down by bacteria into a foul smelling liquid. This seeps around the impacted faeces and leaks from the anus.

Anal fistula

An anal fistula is an abnormal channel that forms from within the anal canal to the outside through which faecal material can leak. It may be caused by injury or infection and can be treated surgically with excellent results.

Lack of Mobility

Faecal incontinence can arise in the absence of any of the above causes simply because the person is unable to get to the lavatory in time. This may be due to physical conditions that limit mobility such as arthritis, Parkinsonism and paralysis.

Print the full Guide to Incontinence
A full version of Dr Alan Riley's Guide to Incontinence is now available as a printer friendly 'PDF' document. If you click on the link above you can print a full copy of the guide NOW from your own computer or if you would prefer you can call us and we will send you a copy FREE of charge.

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	EMS Medical Ltd, Whitworth Court, Baird Road, Waterwells Business Park, Gloucester GL2 2AF Tel: 01452 728770 Fax: 01452 728894 Registered office: 41 Rodney Road, Cheltenham, Gloucestershire GL50 1HX. Company Number 6645705.