How to treat: Faecal incontinence
BMJ 2003; 327 doi: https://doi.org/10.1136/sbmj.0312456 (Published 01 December 2003) Cite this as: BMJ 2003;327:0312456
- Michael A Kamm, professor of gastroenterology1
- 1St Mark's Hospital, Harrow HA1 3UJ
Faecal incontinence, not a glamorous area of medicine, has changed markedly in its recognition and management over the past 10 years. Patients and doctors can now talk about it because the taboo is disappearing. The pathophysiology is better understood, helped by advances in imaging. Treatments are improving as they move away from invasive sphincter surgery as an early step to the use of simple pharmacological treatments, behavioural techniques, injectable biomaterials, and, when necessary, minimally invasive surgery.
Causes of faecal incontinence
Faecal incontinence affects both sexes and all age groups. Approximately 2% of the adult population have it on a frequent basis.1 The commonest cause of faecal leakage is probably degeneration of the delicate smooth muscle of the internal anal sphincter--the muscle that maintains sphincter closure.2 The commonest cause in young women is obstetric anal sphincter damage. Most sphincter damage is occult; approximately a third of first vaginal deliveries result in endosonographically identifiable structural sphincter damage; about a third of these are associated with new bowel symptoms of faecal incontinence or urgency.3 Delivery with forceps is the greatest risk factor; others are a large baby, occipitoposterior position, and a prolonged second stage …
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