What is anal incontinence?
Anal incontinence is the inability to control bowel movements, leading to the unexpected leakage of faeces or gas from the anus.
This condition affects more women than men, though the risk increases with age in both sexes. Women may develop anal incontinence after childbirth, particularly following a complicated delivery requiring forceps or an episiotomy. In older adults, it can result from weakened muscles and loss of pelvic floor support.
Anal incontinence can also occur due to muscle damage from ano-rectal surgery, such as haemorrhoidectomy or fistula surgery. It may occur in individuals with inflammatory bowel disease. Damage to the nerves regulating rectal sensation and anal sphincter control is another common cause. This can occur from severe and prolonged straining during bowel movements, childbirth injuries, or conditions like diabetes, multiple sclerosis, and spinal cord conditions. Loss of rectal storage capacity, caused by previous surgery or radiotherapy, may also contribute to incontinence.
Symptoms of anal incontinence
Symptoms vary between individuals. Some experience occasional leakage of stool or gas, while others may struggle with more severe loss of bowel control. There are two main types of anal incontinence, and some people experience both:
- Urge incontinence – A sudden, urgent need to use the toilet, with incontinence occurring if the toilet is not reached in time
- Passive incontinence – Bowel leakage that occurs without awareness, meaning the person may not realise they are leaking
How is anal incontinence investigated?
When you visit our clinic, a consultant will take a full medical history and perform a clinical examination. This typically includes a rigid sigmoidoscopy and sometimes a proctoscopy.
For patients over 40, a consultant may recommend a flexible sigmoidoscopy or colonoscopy to check the overall health of the bowel.
Additional investigations may include:
- Anorectal physiological testing – Evaluates sphincter muscle function
- Endoanal ultrasound scan – Assesses the structure of the anal sphincter muscle
- MRI scan – Provides a detailed view of pelvic floor muscles
- Video proctogram or MRI proctogram – Recommended if symptoms suggest rectocele or prolapse
Treatment for anal incontinence
The goal of treatment is to improve bowel control and quality of life. Most patients do not require surgery and can manage symptoms with conservative treatments. Surgery is considered only when other treatments are ineffective, and symptoms significantly impact daily life.
Conservative treatments
- Dietary changes – Adjusting fibre intake and avoiding trigger foods
- Bulking agents and anti-diarrhoeals – Help regulate stool consistency
- Anal plugs, suppositories, and enemas – Provide additional control
- Pelvic floor training and biofeedback – Strengthens the anal sphincter muscles
- Posterior tibial nerve stimulation (PTNS) – A technique that stimulates a nerve near the ankle to improve bowel control in mild cases
Surgical treatments
- Sacral nerve stimulation (SNS) – A procedure that uses electrical stimulation to improve nerve function in the pelvic floor. This involves a temporary test phase, and if successful, a small device is implanted under the skin
- Sphincter repair (Sphincteroplasty) – Performed when the anal sphincter muscle has been damaged, usually due to childbirth or previous surgery. The damaged muscles are stitched together to restore function
- Colostomy – Considered only when other surgical treatments have failed. It is a procedure where the colon is cut and brought through the abdominal wall to create an artificial opening- this is known as a stoma. Faeces are then collected in the bag- known as a colostomy bag, which is attached to the opening.
Why choose the Midlands Bowel Clinic?
At the Midlands Bowel Clinic, we offer expert care for patients with anal incontinence, using the latest diagnostic tools and treatment options. Our team of experienced specialists provides personalised care to help you regain confidence and improve your quality of life.
Contact us
If you are experiencing symptoms of anal incontinence, don’t wait to seek help. Contact our clinic today to schedule a consultation with one of our specialists and explore the best treatment options for you.
