Urge Faecal Incontinence

What is Urge Faecal Incontinence?

Urgency is the sudden, immediate and unexpected desire to pass a bowel motion or flatus (gas) that feels like you cannot delay. This feeling does not always result in incontinence.

Urge Faecal Incontinence is the unintentional leaking of faeces (stool/poo) or flatus (gas) that may occur following the feeling of urgency.

What Causes Urge Faecal Incontinence?

The leading cause that can lead to urge faecal incontinence is damage, weakness or lack coordination of the pelvic floor muscles and one of the two anal sphincters (external anal sphincter) through:

• Pregnancy and childbirth
• Surgery
• Trauma
• Straining to make a bowel movement if you have a history of constipation
• Heavy lifting
• History of respiratory conditions resulting in constant coughing
• Decreased mobility/lack of exercise

However, other factors that may contribute to urge fecal incontinence can include:

• Loose stool/history of diarrhea
• Lifestyle – diet and fluid congestion
• Medical conditions that affect the bowel, e.g. IBS and Crohn’s disease
• Medical conditions that affect the nervous system, e.g.Parkinson’s disease and MS
• Some medications

What are the Symptoms of Urge Faecal Incontinence?

The symptoms of urge faecal incontinence may include:

• The sudden, immediate and unexpected desire to pass a bowel motion or flatus (gas) that feels like you cannot delay, resulting in the unintentional leakage of faeces (stool/poo) or flatus (gas) from the anus
• Unintentional faecal staining on clothing, e.g. underwear
• Loose stool consistency
• Change in usual toileting routine/bowel movements
• Urinary Incontinence

How is Urge Faecal Incontinence Diagnosed?

Your doctor or physiotherapist may perform a physical exam. During this examination, your physiotherapist may need to complete an internal exam to assess the strength and ability of the pelvic floor muscles/anal sphincter muscles to activate and coordinate correctly. Usually, using your information based on your medical history, toileting habits, and lifestyle (diet, fluid ingestion, medication, and exercise) determines your diagnosis. Your doctor or physiotherapist may recommend other tests and investigations. Tests include a bowel diary, anal manometry, balloon expulsion tests, colonoscopy, and other anorectal tests. However, these tests will only be performed if required based on your presentation.

What Treatments are Available for Urge Faecal Incontinence?

There are many treatments for urge faecal incontinence that you can achieve through participation in physiotherapy. These treatments can include:

• Education
• A pelvic floor exercise program
• Diet recommendations regarding fibre intake
• Recommendations regarding water / fluid consumption
• Recommendations regarding exercise
• Adjustment of usual toileting habits
• The addition of stool bulking agents

Other Treatments:

A large proportion of people with urge faecal incontinence will have their symptoms improved or resolved with physiotherapy treatment. However, you may also need to follow up with your doctor for additional treatment if required, including:

• Medications review / prescription
• Medical treatment for conditions that may put you at risk of urge faecal incontinence
• Potential Surgery

Your physiotherapist will work closely with your doctor to ensure the best possible treatment outcome for you.

What Results Can You Expect?

A large proportion of people with urge faecal incontinence will have their symptoms improved or resolved with adjustment of lifestyle factors and a pelvic floor exercise program through physiotherapy treatment. However, if left untreated, the problem worsens gradually and can affect other areas, including the bladder.

Will You Need Surgery?

There is a percentage of people who may not experience enough improvement with physiotherapy treatment alone. As a result, some individuals may need to go on to have surgery to resolve their symptoms.

For more information please consult your physiotherapist with a special interest in pelvic floor conditions.