What is bowel incontinence?

Bowel incontinence is a condition whereby an affected person is unable to prevent involuntary passage of gas (flatus) or stools from the anus. This can be very distressing as soilage around the anus can lead to itching or burning sensations. Furthermore, the affected person may feel anxious of others noticing the soilage. Sometimes, the sufferers are so traumatized that they withdraw socially from their friends and family.

How does bowel incontinence happen?

Normal bowel continence is maintained by coordination of the nerves and muscles of the pelvic floor and anus. When there is damage to sensory nerves of the pelvis, the affected person may not sense the gas or stools and that can lead to leakage of content from the anus. Damage to motor nerves can weaken the muscles of the pelvic floor and the affected person is therefore unable to hold back the urge to pass a bowel movement. Muscles of the anus and pelvic floor can be weakened by age, damaged by trauma or surgery to the anus or even difficult childbirth. In many cases with bowel incontinence, it is difficult to pinpoint the exact cause as the traumatic event could have been decades before or it is multi-factorial.

What are the common causes of bowel incontinence?

  1. Traumatic childbirth – This is the commonest cause of bowel incontinence in women. It can be difficult to diagnose early as the tearing of the anus muscles are not visible from the outside and a woman can overcome the weakness of the damaged muscle by using other pelvic muscles to compensate. It only becomes evident with age as the rest of the pelvic muscles weaken.
  2. Ageing – The general weakening of muscles of the pelvic floor and anus with age can lead to inability to shut the anus tight.
  3. Nerve damage – Pelvic nerves can be damaged by surgery in the spine or pelvis, primary nerve disorders or frequent and excessive stretching (such as chronic constipation or obesity).
  4. Diabetes Mellitus – One of the complications of prolonged diabetes or poor diabetic control is damage to autonomic nerves, such as sensory nerves of the anus and nerves to the internal anal sphincter muscle.
  5. Anal sphincter damage – This usually happen secondary to surgery of the anus or anal trauma.

Can it be treated?

It is important to know that this condition is treatable and not a natural part of ageing. Treatment is based on the severity of the problems and cause of bowel incontinence. It is important to note that surgery is not commonly required for treatment of bowel incontinence unless it is very severe. The treatment involves modifications of lifestyle and diet as well as anorectal biofeedback (a form of pelvic floor rehabilitation physiotherapy) first. Medications are sometimes helpful to ensure a patient does not have overly hard stools or diarrhoea. There are various types of surgery and these will only be considered if conservative treatment is not enough.

Where can I find out more about Bowel Incontinence?

  1. National Association for Continence (USA) – www.nafc.org
  2. National Institute of Health (NIH) Bowel Control Awareness Campaign (USA) – https://www.niddk.nih.gov/health-information/health-communication-programs/bowel-control-awareness-campaign/Pages/default.aspx
  3. The Bladder and Bowel Foundation (UK) – https://www.bladderandbowelfoundation.org/bowel/bowel-problems/faecal-incontinence/
  4. The Continence Foundation of Australia – http://www.continence.org.au/pages/faecal-incontinence.html

Dr. Lim Jit Fong
General and Colorectal Surgeon
President, Society for Continence Singapore (2019 – )