Incontinence of faeces

Incontinence of faeces is the involuntary passage of faeces. It is always abnormal, and nearly always curable.

• NICE note that faecal incontinence is a sign or a symptom, not a diagnosis (1) - therefore, it is important to diagnose the cause or causes for each individual
  • no consensus on methods of classifying the symptoms and causes of faecal incontinence
  • most commonly classified according to symptom, character of the leakage, patient group or presumed primary underlying cause
  • little is known about the natural history of the condition but for some groups (such as women immediately after childbirth) there does seem to be some spontaneous resolution of symptoms
• epidemiological information shows that between 1% and 10% of adults are affected with faecal incontinence, depending on the definition and frequency of faecal incontinence used (1)
  • is likely that 0.5-1.0% of adults experience regular faecal incontinence that affects their quality of life

Because faecal incontinence is a socially stigmatising condition, healthcare professionals should actively yet sensitively enquire about symptoms in high-risk groups:

• frail older people
• people with loose stools or diarrhoea from any cause
• women following childbirth (especially following third- and fourth-egree obstetric injury)
• people with neurological or spinal disease/injury (for example, spina bifida, stroke, multiple sclerosis, spinal cord injury)
• people with severe cognitive impairment
• people with urinary incontinence
• people with pelvic organ prolapse and/or rectal prolapse
• people who have had colonic resection or anal surgery
• people who have undergone pelvic radiotherapy
• people with perianal soreness, itching or pain
• people with learning disabilities

A review notes (2):

• perform a digital rectal examination to assess sphincter muscle function
• management can take a step-up, individualised approach within primary care, and includes dietary changes, anti-diarrhoeal medication such as loperamide, and pelvic floor exercises
• be aware of possible red flags that might be related to bowel cancer or other conditions, such as inflammatory bowel disease, that should be investigated promptly, include:
  • rectal bleeding, in the absence of an obvious cause such as bleeding haemorrhoids or fissures
  • unintentional weight loss of more than 10% within three months
  • nocturnal symptoms, occurring during sleep
  • recent onset sustained change in bowel habit, including diarrhoea or constipation
  • microcytic anaemia or iron deficiency.
• if eligible patients have not had up-to-date bowel screening then they should be referred for a colonoscopy

Reference:

1. NICE (2007).Faecal incontinence: the management of faecal incontinence in adults
2. Pazidis A, Scot M, Davie C, Ziyaie D. Diagnosis and management of faecal incontinence in primary careBMJ 2025; 388 :e079980