Anal incontinence is common. In western society, it is estimated that 10% of the population have suffered
episodes of faecal incontinence. No one talks about it though!
What is anal incontinence?- It usually refers to the inability to hold on and defer defaecation to an appropriate time and place- ie the toilet! If we have the urge to pass a motion, we should be able to hold on. We should have control of our bowels and not our bowels have control over us.
The commonest cause of anal incontinence is childbirth. There can be a lot of pelvic floor trauma associated with pushing (or pulling ) out a baby. The obstetricians even have a term for this- OASIS. It refers to obstetric anal sphincter injuries. This doesn’t have the same images that a desert oasis does to my way of thinking! Anal sphincter tears are said to happen with up to 80% of forceps deliveries. Many
are undiagnosed and heal with scarring. Initially, anal control remains satisfactory. Over the years the scarring stretches until although the sphincter muscles contract,they don’t close the anal canal. That’s when you poo your pants! Pelvic nerve damage can also occur with births. The pudendal nerves can be stretched. This can cause both faecal and urinary incontinence soon after the delivery. Often the damage in these cases is transient and control improves after 1-3 months.
The second most common cause is surgery. Sometimes the anal sphincters are cut deliberately to heal fissures or fistulae. If too much muscle is cut then control will suffer.
There are many less common conditions such as pelvic irradiation, rectal cancer surgery, nerve compression, pelvic tumours etc that can also cause issues with bowel control.
What can be done?
The easiest motion to control is a formed stool. Diarrhoea or loose motions are harder to control for everyone. There can be may causes for loose motions. Often it can be due to something we eat or drink.
Intestinal pathology such as gastroenteritis, colitis, other inflammatory conditions and even cancers also can cause diarrhoea.
Of concern is a change of your normal bowel habit. If this persists for more than a couple of days visit your doctor.
Many causes of anal incontinence are treatable. Sphincters can be repaired, muscle can be strengthened and nerves can be stimulated. Much depends upon the cause for the incontinence. Talk to your GP. Visit a pelvic floor physiotherapist. You don’t need to be embarrassed about pooing your pants, you deserve to be helped.