Causes for Faecal incontinence
- Faecal incontinence occurs in significant numbers in the elderly. This can be related to poor mobility and dementia illness.
- The condition can occur in young women after sphincter injury related to child birth.
- This can lead on from tearing or sometimes poorly placed episiotomies during the delivery time.
- The sphincter weakness can present immediately with poor control of bowel movements or the injury may be occult and present later, sometimes after many years, this is presumably due to natural age-deterioration of muscle function.
- Incontinence that requires sphincter surgery is uncommon in men, but can be related to muscle weakness related to anal surgery such as surgery for fistula and sometimes very low rectal surgery.
- Incontinence can also be secondary to rectal prolapse.
In the rooms we examine the sphincter by looking and digital examination, as well as rigid sigmoidoscopy.
Often patients will require assessment in the pelvic floor laboratory where the pressure the sphincter muscle generates is measured and the sphincter is imaged by a special 360 degree ultrasound probe.
- Medical: Often antidiarrhoeals or even fibre supplements can help. Pelvic floor physiotherapy, if performed by a specialist can be very good.
- Surgical: Sacral Nerve Stimulation: This procedure, involving insertion of a small wire in the lower back which is guided to sit near the sacral nerves that innervate the anal sphincter. The wire is then sent stimulation impulses to the nerve which makes the sphincter and pelvic muscles contract. The source of the stimulation is a small battery which is eventually inserted under the skin and so the whole system is under the skin. This system has proved very useful in the treatment of faecal incontinence. The battery is simply replaced if it wears out by another small operation.
- Anal sphincter repair: This operation is a direct approach to the sphincter muscle using an incision around the anus and dissecting the muscle and then stitching it tighter. This surgery is still done in the young female that has sustained a sphincter injury at child birth.
- Results: The results of these treatments are usually good. The SNS treatment has a 90% success rate. The anal sphincter repair has a 80% success rate but the incontinence can come back over time.