Chapter 19 FAECAL INCONTINENCE
• A detailed history and clinical examination is important. A special note on vaginal delivery and any complications should be noted.
• On rectal examination, it is important to ask the patient to strain to assess resting tone and squeeze tone.
• Medical treatment includes dietary changes, perineal exercises and, if needed, high doses of antidiarrhoeal drugs.
PREVALENCE
The reported prevalence rates of faecal incontinence in the world vary from 0.7%–11%, depending on the definition and population group studied. This is demonstrated in Table 19.1.
Country | Population | Prevalence |
---|---|---|
Holland | Women >60 y | 4.2% to 16.9% with rising age |
France | All >45 y | 11%, 6% to faeces, 60% women |
UK | Community service | 1.9% |
USA | Market mailing | 7% soiling, 0.7% to faeces |
USA | Wisconsin households | 2.2%, 63% women |
USA | Wisconsin nursing homes | 47% |
New Zealand | >65 y | 3.1% |
Australia | Household survey | 6.8% men |
10.9% women >15 y | ||
Australia | Postal survey | Liquid incontinence 9% |
Random selection from electoral roll (subjects ≥18 y) | Solid incontinence 2% |
Based on Continence Foundation of Australia. Incontinence: some key statistics and quotes clarified. Online.
Available: www.contfound.org.au/pdf/Keystatsquotsmay03.pdf.
AETIOLOGY
Table 19.2 lists the possible causes of faecal incontinence. Looser stool consistency is an important precipitating factor in those predisposed to faecal incontenance by anorectal abnormalities.
Altered stool consistency—diarrhoeal states |
Inadequate reservoir capacity or compliance |
Inadequate rectal sensation |
Abnormal sphincter mechanism or pelvic floor |