Faecal incontinence in adults: management

Introduction

Faecal incontinence is a sign or a symptom, not a diagnosis. Therefore, it is important to diagnose the cause or causes for each individual. Because it is a stigmatising condition, active case-finding will often be needed, probably best targeted at high-risk groups.

Current 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. It is likely that 0.5% to 1.0% of adults experience regular faecal incontinence that affects their quality of life. 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. For understandable reasons, faecal incontinence has remained a largely hidden problem, with many patients feeling too embarrassed or ashamed to admit their symptoms to healthcare professionals, or even to family and friends.

There is no consensus on methods of classifying the symptoms and causes of faecal incontinence. It is most commonly classified according to symptom, character of the leakage, patient group or presumed primary underlying cause. For many people faecal incontinence is the result of a complex interplay of contributing factors, many of which can co-exist. Some factors may be relatively simple to reverse. Therefore, a detailed initial assessment and structured approach to management is needed, starting with addressing reversible factors and, only if this fails to restore continence, progressing to specialised options and investigations.