Anal incontinence

Anal incontinence is the inability to control bowel movements, leading to the unexpected leakage of faeces or gas from the anus.

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This condition affects more women than men, though the risk increases with age in both sexes. Women may develop anal incontinence after childbirth, particularly following a complicated delivery requiring forceps or an episiotomy. In older adults, it can result from weakened muscles and loss of pelvic floor support.

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Anal incontinence can also occur due to muscle damage from ano-rectal surgery, such as haemorrhoidectomy or fistula surgery. It may occur in individuals with inflammatory bowel disease. Damage to the nerves regulating rectal sensation and anal sphincter control is another common cause. This can occur from severe and prolonged straining during bowel movements, childbirth injuries, or conditions like diabetes, multiple sclerosis, and spinal cord conditions. Loss of rectal storage capacity, caused by previous surgery or radiotherapy, may also contribute to incontinence.

Symptoms of anal incontinence

Symptoms vary between individuals. Some experience occasional leakage of stool or gas, while others may struggle with more severe loss of bowel control. There are two main types of anal incontinence, and some people experience both:

• Urge incontinence – A sudden, urgent need to use the toilet, with incontinence occurring if the toilet is not reached in time

• Passive incontinence – Bowel leakage that occurs without awareness, meaning the person may not realise they are leaking

How is anal incontinence investigated?

When you visit our clinic, a consultant will take a full medical history and perform a clinical examination. This typically includes a rigid sigmoidoscopy and sometimes a proctoscopy.

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For patients aged over 40 years, a consultant may recommend a flexible sigmoidoscopy or colonoscopy to check the overall health of the bowel.

Additional investigations may include:

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• Anorectal physiological testing – Evaluates sphincter muscle function

• Endoanal ultrasound scan – Assesses the structure of the anal sphincter muscle

• MRI scan – Provides a detailed view of pelvic floor muscles

• Video proctogram or MRI proctogram – Recommended if symptoms suggest rectocele or prolapse

Treatment for anal incontinence

The goal of treatment is to improve bowel control and quality of life. Most patients do not require surgery and can manage symptoms with conservative treatments. Surgery is considered only when other treatments are ineffective, and sym

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