How is faecal incontinence treated?

Many people are hesitant to see a doctor for faecal incontinence as they believe it can't be treated or that the problem will eventually go away. This may be true in a few cases, but most people will require treatment.

Once your doctor has established the underlying cause of faecal incontinence, they will decide on the most suitable treatment, which could involve a combination of medication, exercise and other methods.

Let’s look at some of the treatment options available for FI:

Dietary changes: If your FI is caused by diarrhoea or constipation, making changes to your diet may sometimes help to normalise and regulate bowel movements. Your doctor may ask you to keep a food diary to monitor the impact of dietary changes. For example, he or she may suggest increasing your intake of high-fibre foods and fluids, or to eliminate foods that may exacerbate the problem.

Medications: Your doctor may recommend specific medication or bulking agents such as fibre supplements to change stool consistency, depending on whether you suffer from diarrhoea or constipation. Another option is Solesta, an injectable FDA-approved gel that's injected into the anus and effectively reduces or completely treats FI in some people. This gel narrows the anal opening by increasing the growth of rectal tissue and helping it to remain tightly closed.

Bowel retraining: This routine encourages normal bowel movements and helps you achieve greater control by becoming more aware of the need to use the toilet. It may incorporate various aspects such as making a conscious effort to have a bowel movement at a specific time of day and using suppositories to stimulate bowel movements.

Biofeedback: This improves the strength and coordination of the anal muscles that help control bowel movements, and heightens the sensation related to the rectum filling with stool. It usually involves a specially trained physiotherapist teaching you simple exercises to strengthen your pelvic-floor muscles, sense when stool is ready to be released and contract the muscles if it's not appropriate to have a bowel movement at a specific time.

Kegel exercises: Also called pelvic-floor exercises, these focus on strengthening the muscles of the anus, buttocks and pelvis. When done correctly, they can be effective in improving or resolving FI. They involve a routine of repeatedly contracting muscles used when making a bowel movement. Hold these muscles as if you're trying to stop the flow of stool or passing gas for a slow count of five, and then relax. Kegel exercises should be done in a series of 30 contractions three times a day. They usually strengthen the pelvic-floor muscles within a few weeks.

Surgery: In some cases, surgery may help people with severe FI who haven't responded to other treatments or people with an underlying condition causing incontinence that need surgery to regain control. There are various surgical options and your doctor will probably refer you to a specialist.

When to see your doctor
Speak to your doctor if you experience any of the following:

• Regular accidents or bowel mishaps
• Unexplained weight loss
• Dark or black stools
• Rectal pain or bleeding
• Change in normal bowel habits
• Sensing that your bowel is never quite empty

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