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