Fortnightly review : Faecal incontinence

Abstract

Faecal incontinence affects men and women of all ages. Daily or weekly episodes occur in about 2% of the adult population and in about 7% of healthy independent adults over the age of 65.1 2 3 4 The disorder causes great personal disability and has a high financial cost. In the United States, more than $400m each year is spent on faecal incontinence appliances alone, and faecal incontinence is the second commonest reason (more common than dementia) for requesting placement in a nursing home.5 A third of elderly people in retirement homes or hospital are incontinent for stool. Issues related to faecal incontinence are especially relevant with a growing population of elderly people. Advances in understanding and treatment have led to improved treatments and a good outcome for most patients. Much progress has been brought about by the recent development of accurate and simple techniques for imaging the anal sphincter muscles. This review focuses on advances in the understanding and treatment of faecal incontinence. It is not a systematic review but is based on a choice of areas that I feel are of greatest recent importance, supplemented by a Medline search using the keywords “faecal incontinence.” Summary points Anal incontinence affects 2% of all adults and 7% of all healthy adults over the age of 65 Manometry, sensory testing, and ultrasonography allow accurate characterisation of sphincter abnormality in most patients Faecal incontinence is commonly caused by structural damage during childbirth and anal surgery; neurological disease and previously corrected congenital anorectal malformations may cause faecal incontinence and constipation Loperamide or codeine phosphate are often safe and effective when symptoms are mild, infrequent, are not caused by faecal impaction with overflow, or where no easily correctable lesion is present Behavioural techniques may help where there is no structural sphincter damage and may be useful as an adjunct to other treatments Some structural damage to the anus may be repaired by simple surgery, and new operative techniques may help patients with complex sphincter injury or degenerate sphincter muscles