This is one of the more troublesome bowel conditions and is often not reported to doctors because it is an embarrassing problem which people don’t like to talk about. It can be, however, severely disabling for sufferers and can lead to people feeling reluctant to go out of the house. It is by far more common in women, but can affect men as well.

What are the causes?
There is not usually a single cause, but more likely a combination of things which have contributed to the problem. Traumatic childbirth (including tears at the time of delivery, or the need for forceps or Ventouse) is a major contributor as it leaves the pelvic floor relatively weak and can cause damage to the sphincter muscles which control the passage of stool. Some neurological problems can also weaken the muscles, but even if the
muscles are working normally it can be hard to control very loose stools and diarrhoea is one of the commonest causes of faecal incontinence in both men and women.

How is the diagnosis made?
In most cases, the details of the incontinence episodes in your history, together with the findings on internal examination of the back passage will give major clues as to the possible causes. Further information is gleaned from tests which are designed to identify where specific therapy can help improve the symptoms. Usually a flexible sigmoidoscopy or colonoscopy will be needed to make sure the bowel looks healthy as a starting point. Beyond that, a range of tests exist to look at the function of the back passage and often a combination of these will build up a full picture of what is wrong.

What can be done to improve things?
Sometimes simple measures like combating diarrhoea is all that is needed to resolve the incontinence altogether. Where this is not possible, most people with incontinence will improve with specialist physiotherapy (traditionally known as “pelvic floor exercises,” now better know as biofeedback), designed to strengthen the muscles and improve the co-ordination of the pelvic floor. Surgery is rarely needed, except in very specific situations such as isolated sphincter muscle injuries. Some people who continue to experience problems may also respond to stimulation of the nerves to the pelvic floor using specifically implanted electrodes, but again this is seldom needed and may not benefit all types of incontinence.