Clinical Review

Management of faecal incontinence in adults

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c2964 (Published 15 June 2010) Cite this as: BMJ 2010;340:c2964
  1. Mukhtar Ahmad, specialist registrar, general surgery1,
  2. Iain J D McCallum, teaching and research fellow2,
  3. Mark Mercer-Jones, consultant surgeon1
  1. 1Queen Elizabeth Hospital, Gateshead NE9 6SX
  2. 2North Tyneside General Hospital, North Shields NE29 8NH
  1. Correspondence to: mark.mercer-jones{at}ghnt.nhs.uk
  • Accepted 27 May 2010

Summary points

  • Faecal incontinence is common and socially debilitating

  • Most cases of faecal incontinence can be managed in the community by non-specialists

  • The aetiology is multifactorial and treatment must be individually tailored

  • Often the condition cannot be “cured” but its effects mitigated to improve patients’ lives

  • When conservative methods fail referral to a specialist is indicated

Faecal incontinence is the involuntary loss of stool or flatus. It is a distressing condition that can have a substantially negative effect on quality of life.1 2 According to a systematic review it may affect 11-15% of the population.3 The estimated cost of absorbent products (such as pads) is around £94m (€112m; $138m) per annum in the United Kingdom.4 Because faecal incontinence is a heterogeneous problem that ranges from minor faecal soiling to incapacitating urge or passive faecal incontinence and embarrassment may prevent patients from seeking help, estimates of prevalence may not be accurate. Incontinence is a common reason for admission to residential care even though in many cases simple measures are available in primary care that could enable people to remain at home. We review evidence on causes, diagnosis, and management of faecal incontinence in adults and summarise the findings of systematic reviews and guidelines where possible.

Sources and selection criteria

We searched PubMed, National Institute for Health and Clinical Excellence guidelines, Embase, and the Cochrane library using the search terms faecal/fecal incontinence. We retrieved potentially useful studies and critically evaluated them for inclusion.

Who is affected by faecal incontinence?

An epidemiological survey showed a rising incidence with advancing age and the highest prevalence in elderly people in long term care, with no sex difference in adults aged over 40.5 The higher reported prevalence of faecal incontinence in younger women is probably the result of childbirth related injuries, and a prospective study showed that the greatest risk follows the first vaginal …

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