Faecal incontinence

Overview

Faecal incontinence is the loss of control over bowel movements, meaning you may leak stool (poo) or gas without meaning to. It can range from a small amount of gas to a complete bowel movement. This condition can be embarrassing but is treatable.

Yes, faecal incontinence is quite common, though many people don't seek help due to embarrassment. Studies suggest it affects up to 1 in 10 adults at some point.

It can affect anyone, but is more common in women (especially after childbirth), older adults, and people with certain bowel conditions like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD).

Symptoms

Common symptoms

• Leaking stool when you pass gas or cough
• Sudden, urgent need to have a bowel movement that is hard to control
• Not being able to sense when you need to have a bowel movement
• Leaking a small amount of stool – sometimes without knowing it

Symptoms in children

• Accidentally soiling underwear (sometimes called encopresis)
• Constipation with liquid stool leaking around hard stool
• Holding in stool for long periods, leading to accidents

Symptoms in older adults

• Weakening of anal muscles that control stool
• Difficulty reaching the toilet in time due to mobility problems
• Leaking stool after having a bowel movement or when passing gas

Causes

Main causes

• Weakness in the anal muscles (sphincter) – often from childbirth or aging
• Nerve damage – from diabetes, stroke, or spinal cord injury
• Severe constipation – hard stool stretches and weakens the bowel
• Bowel conditions – like Crohn’s disease, ulcerative colitis, or IBS
• Diarrhoea – loose stool is harder to hold in than solid stool

Risk factors

• Giving birth (especially with a tear or episiotomy)
• Getting older – muscles and nerves may weaken
• Long-term constipation or straining to pass stool
• Pelvic surgery (e.g., for piles or prostate issues)
• Certain conditions like diabetes, multiple sclerosis, or dementia

When to see a doctor

See a doctor urgently if:

• If you have new incontinence along with severe abdominal pain, fever, or vomiting
• If you see bright red blood in the toilet or on toilet paper in large amounts

Book a routine appointment if:

• If faecal incontinence lasts more than a few weeks
• If it is affecting your daily life or causing embarrassment and distress
• If you also have diarrhoea, constipation, or changes in bowel habit

Diagnosis

A doctor will ask about your symptoms and medical history. They may do a gentle examination to check the strength of your anal muscles. Sometimes they will recommend tests to look at the structure and function of your bowel.

Tests that may be done

• Anorectal manometry – a thin tube measures muscle pressure in your rectum
• Endoanal ultrasound – a small probe inside the rectum shows the muscle around the anus
• Defecating proctogram – an X-ray video of you having a bowel movement after a special paste is placed in your rectum
• Stool tests – to check for infection or inflammation

What to expect at your appointment

Most tests are done in the clinic and are not painful. The doctor will explain each step. You may be asked to keep a bowel diary for a week or two. All information you share is private and confidential.

Treatment

Treatment depends on the cause. Many people improve with simple changes to diet and habits. Others may need medicines, physiotherapy, or in some cases surgery. Your doctor will work with you to find the best plan.

Self-care at home

• Keep a food diary to see if certain foods (like spicy foods, dairy, or alcohol) make symptoms worse
• Eat plenty of fibre – from fruit, vegetables, whole grains – to keep stools firm and regular
• Drink enough water, but avoid large amounts of caffeine or fizzy drinks
• Practice good toilet habits – don’t ignore the urge to go, and take your time
• Use pads or incontinence products to feel more confident when out and about

Medical treatments

Medicines such as anti-diarrhoeal drugs or bulking agents can help control diarrhoea or constipation. Your doctor may prescribe them in low doses. Pelvic floor exercises (like Kegels) strengthen the muscles. Biofeedback therapy helps you learn to control these muscles. In some cases, a special device that sends mild electrical pulses to the sacral nerves (nerve stimulation) can improve bowel control.

When is surgery considered?

Surgery is considered when other treatments haven't worked. Options include repairing the anal muscle, creating a muscle sling, or implanting a small device to stimulate nerves. Your doctor will explain risks and benefits.

Living with this condition

Living with faecal incontinence can be challenging, but many people manage well with the right support. Plan ahead: carry a change of clothes and wipes. Know where toilets are when you go out. Use discreet incontinence products to feel secure.

Lifestyle tips

• Try to eat at regular times – this helps create a predictable bowel routine
• Do pelvic floor exercises daily – your doctor or a physiotherapist can show you how
• Consider using a ‘bowel habit training’ plan – schedule time on the toilet after meals

Diet and exercise

A balanced diet with moderate fibre helps keep stool consistency right. Gentle exercise like walking can improve overall bowel function. Avoid heavy lifting that may strain your pelvic floor.

Mental health and emotional wellbeing

Faecal incontinence can cause embarrassment, anxiety, depression, and social isolation. It's normal to feel upset. Talk to your doctor – they can refer you to a counsellor or support group. You are not alone.

Prevention

Not always, but some things may help. Avoid long-term constipation by eating enough fibre and staying active. Do pelvic floor exercises, especially after childbirth. Manage chronic conditions like diabetes to protect nerve health.

Complications

If left untreated

• Skin irritation or sores around the anus from constant contact with stool
• Urinary tract infections (UTIs) if bacteria spread from stool
• Social withdrawal, depression, and loss of quality of life

Long-term outlook

With the right treatment, most people see improvement. Many become fully able to control their bowel movements. Even if complete control is not possible, symptoms can often be managed well enough to let you live a full, active life. Help is out there – don’t give up.

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