Faecal incontinence

Many treatment options now exist for this embarrassing condition

Faecal incontinence, not a glamorous area of medicine, has changed markedly in its recognition and management over the past 10 years. Patients and doctors can talk about it now as the taboo is disappearing. Pathophysiology is better understood, helped by advances in imaging. Treatments are improving as they move away from invasive sphincter surgery as an early step to the use of simple pharmacological treatments, behavioural techniques, injectable biomaterials, and, when necessary, minimally invasive surgery.

Faecal incontinence affects both sexes and all age groups. Approximately 2% of the adult population have it on a frequent basis.1 The commonest cause of faecal leakage is probably degeneration of the delicate smooth muscle of the internal anal sphincter—the muscle that maintains sphincter closure.2 The commonest cause in young women is obstetric anal sphincter damage. Most sphincter damage is occult; approximately a third of first vaginal deliveries result in endosonographically identifiable structural sphincter damage; about a third of these are associated with new bowel symptoms of faecal incontinence or urgency.3 Forceps delivery is the greatest risk factor; others are a large baby, occipito-posterior position, and a prolonged second stage of labour. The same risk factors apply to …