Overview

Bowel incontinence (or faecal incontinence), is when you have difficulties controlling your bowel movements. 

If the muscles in your intestine and the muscles around your bottom (called the anal sphincter muscles), are not working correctly, you may not be able to control your bowel movements properly. This can lead to farts, or liquid or solid poo, leaking from your bowel either with or without your awareness or control.

Many people find it embarrassing to talk about their problem and may suffer for many years. Treatment can help so it’s important that you do get medical advice. 

Types of bowel incontinence

There are two types of bowel incontinence. 

• Urge incontinence is when you have a sudden urge to have a poo or fart but are unable to hold on until you get to a toilet, resulting in leakage.
• Passive incontinence is when you leak poo or fart without being aware that it is going to happen. 

Your can read more about bowel incontinence on the NHS.uk website.

Symptoms

You may experience the following symptoms:

• constipation 
• runny or watery poo
• difficulty have a poo 
• leakage from your bowel, with or without your awareness

Causes

It is a common problem that can affect everyone and all ages. It can occur for a variety of reasons, including:

• childbirth
• bowel (anal) surgery
• damage to the nerves or muscles in the bowel or rectum (end section of the bowel) that normally control opening your bowels to have a poo.
• irritable bowel syndrome (IBS)
• X-ray treatment to the pelvis and bottom (anus)
• diet
• anxiety or stress
• infection
• trauma or injury
• multiple sclerosis
• constipation with diarrhoea
• diabetes 

Bowel incontinence may also happen for no known reason.

Treatment

Your referring doctor may send you to our telephone assessment clinic or to the Pelvic Floor Unit to see a consultant for assessment and tests if needed.  

Your appointment letter will give further details about where to go and what you should bring with you. You can eat and drink as normal and take your regular medicines before your appointment.

In the Pelvic Floor Unit, you will be seen by a nurse specialist or physiotherapist for a discussion and advice on managing your symptoms. This may include advice on:

• medications, for example Loperamide which makes your poo more solid and easier to control
• suppositories
• skincare to prevent soreness
• using pads 
• anal plugs
• emotional support
• biofeedback (retraining your muscles)  
• diet and fluid advice
• nerve stimulation
• rectal irrigation
• exercises to strengthen the muscles around your bottom and pelvic floor
• referral to the Bowel Function Clinic

You may also see a consultant to discuss sacral neuromodulation or posterior tibial nerve stimulation. This is electrical stimulation to the nerves in your bowel, sphincter or leg that control bowel function.

Surgery

People who have damage to the muscles around their bottom (sphincter), can be offered surgery to:

• repair the sphincter (overlapping sphincteroplasty)
• create a new sphincter from the patient’s own muscle (dynamic graciloplasty)
• implant an artificial sphincter

Some people need surgery to have a stoma (their bowel brought through an opening in the tummy) created, and to use a stoma bag.

Surgery might improve incontinence, but it might need major operations. While results can be good, all major surgery has risks which need to be considered, and some results might not be permanent.