4.10 – Common causes of faecal incontinence
Please note that as of 6th June 2023, the Association for Continence Advice (ACA) has now changed its name to the Association for Continence Professionals (ACP). Some of the videos included in this module will still have the ACA branding, and we can confirm that these videos are still current.
Clinician Kate Boyce has many years of experience in continence care. In this video she shares her clinical expertise and sets the scene by talking about the wide-ranging causes of faecal incontinence.
A summary of common causes of faecal incontinence is shown in the table below.
| Primary problem (Type of incontinence) | Common cause |
|---|---|
| 1. Anal sphincter and pelvic floor damage (Stress/passive) | Obstetric trauma; Trauma following surgery – haemorrhoidectomy, anal stretch, sphincterotomy, gynaecological surgery; Direct trauma from injury or anal sex; Chronic straining; Effect of ageing reducing strength of contraction; Congenital anorectal malformation |
| 2. Gut motility and stool consistency – diarrhoea (Urge) | Infection – a virus eg norovirus, a bacteria eg Clostridium difficile or Escherichia coli, salmonella or shigella which can cause food poisoning or a parasites eg the Giardia intestinalis parasite that causes giardiasis; Medications – laxatives, antibiotics, antacids containing magnesium; Inflammatory bowel disease – Crohn’s disease, Ulcerative Colitis; Irritable bowel disease; Pelvic radiation; Reduced colonic absorption following removal of part of colon; Diet – change of food, too much fibre, intolerance eg gluten; Psychological state – anxiety |
| 3. Ano-rectal pathology (Passive) | Rectal prolapse; Anal or recto vaginal fistula; Haemorrhoids or skin tags; Pruritus – perianal soiling irritates the perianal skin resulting in itching burning and pain |
| 4. Neurological disease (Reflex) | Congenital conditions – Spina bifida, sacral agenesis (usually secondary to constipation); Spinal cord injury; Neurological conditions – Multiple sclerosis, Stroke, Parkinson’s Disease, Diabetes |
| 5. Secondary to degenerative neurological disease (Reflex) | Alzheimer’s Disease (if caused by dementia, urinary incontinence always precedes faecal incontinence) |
| 6. Faecal impaction with overflow – spurious diarrhoea (overflow) | Institutionalised care, immobility, frail elderly |
| 7. Environmental / lifestyle | Poor toilet facilities, incorrect posture on toilet, inadequate care, non-availability of carer, frailty and dependency, drugs with gut side effects, poor diet and fluid intake |
| 8. Idopathic | Unknown causes |
Table 4.1: Summary of common causes of faecal incontinence. Available to download in PDF format.