What is incontinence?

Bowel incontinence is the difficulty or inability to control flatus or stool, leading to an involuntary passage of stools. Incontinence is a common problem in the population but it is often not talked about because of the embarrassing nature of the condition. Incontinence symptoms are often hidden by patients and are therefore untreated. Bowel incontinence symptoms may vary from mild to severe; from occasionally leaking a small amount of stool and passing gas to completely losing control of bowel movements. Patients may have difficulty in the control of flatus, liquid or solid stools. In some patients, just the worry that a bowel accident may happen can severely affect their daily quality of life and limit their ability to interact socially due to fear and embarrassment.

What causes bowel incontinence?

There are many possible causes of bowel incontinence. Childbirth injury is one of the most common causes for women. Childbirth injuries may result in a tear in the anal muscles or the nerves controlling the anal muscles may be stretched or injured. Most injuries are recognized immediately and will be repaired straight away during childbirth. Some cases may go unnoticed and not become a problem until later in life; in such situations, a previous childbirth may not be recognized as the cause of bowel incontinence.

Anal muscle or nerve injury as a result of anal surgery or traumatic accidents may also cause bowel incontinence. Some people experience loss of strength and tone in the anal muscles as they age, as a consequence, a minor control problem in a younger age may become more significant later in life. Severe watery diarrhoea may also overwhelm the ability to control the passage of stool. In some cases, medical illnesses and medications play a role in problems with control.

If bleeding accompanies loss of bowel control, please consult your doctor early. These symptoms may mean inflammation of the colon (colitis), or rectal cancer – conditions that require immediate evaluation by a doctor.

What is the treatment for the problem?

A detail medical evaluation and physical examination and testing is necessary to determine the cause and severity of bowel incontinence.

Mild incontinence can be treated with dietary changes and medications. Bowel diseases which cause diarrhoea may contribute to anal control problems, and when treated may improve symptoms of incontinence. Pelvic floor physiotherapy exercise programme can improve the pelvic floor muscle tone and strength. These exercises may be performed at home to help in mild cases.

Patients who have bowel incontinence that continues even with medical treatment may benefit from surgery to correct the problem. Surgery may be necessary in some cases. Surgery may include repair and tightening of the pelvic floor and anal muscles. Recently, implantation of electrodes with pacemaker in the form of sacral nerve neuromodulation to improve bowel control is possible. This technique delivers electrical energy to the anal muscles surrounding the anus which results in improvement in muscle tone and bowel function.

Incontinence is not a hopeless situation. Proper treatment is available and can help most people, and can often eliminate the problem.