Faecal incontinence: causes, grades and what helps

Key facts at a glance

• Around 5 percent of all Germans are affected – an estimated five million people
• The professional society distinguishes three grades of severity, starting with uncontrolled passing of wind
• The causes fall into four groups – muscular, neurological, sensory, rectal storage disorder
• See a doctor early: already with passing wind, not only with loss of control
• There is a whole range of effective treatments – from diet to pacemaker

Hardly any subject carries as much shame as this one. That is exactly why many people affected come forward late – often years after the first signs. This article sorts out what is behind it and what can be done.

How common it is

The German Continence Society estimates that around 5 percent of all Germans – some five million people – suffer from faecal incontinence. Women are affected more often than men.

Five million: that is not a marginal phenomenon. Anyone who feels alone with it is statistically far off the mark.

The three grades of severity

The classification is sober and helps to put your own experience into perspective:

• Grade 1 – uncontrolled passing of wind and bowel mucus with slight soiling of underwear
• Grade 2 – uncontrolled passing of liquid stool and wind
• Grade 3 – completely uncontrolled passing of solid and liquid stool

The lower limit is important: even grade 1 is faecal incontinence. Anyone who can no longer reliably hold back wind does not have a minor ailment but a first sign – and at this point the prospects for treatment are best.

The four groups of causes

Muscular. The muscles that hold back stool are weakened – for example after a perineal tear during childbirth, through pelvic floor weakness or through declining tissue elasticity in old age.

Neurological. Nerve impulses are transmitted incorrectly, for example in multiple sclerosis or diabetes.

Sensory. Sensation in the anal canal is disturbed, for example after surgery. The body no longer reliably reports what is coming – and whether it is solid, liquid or air.

Rectal storage disorder. The storage function of the rectum is impaired, for example by inflammatory bowel disease.

This classification is more than a system: it determines treatment. A weakened muscle is trained, disturbed sensation is trained with biofeedback, nerve damage is stimulated if necessary. That is why assessment comes first, not the product.

What helps

Regulating bowel movements

The first and often underestimated step. The professional society's recommendations:

• balanced, fibre-rich diet
• at least 1.5 to 2 litres of alcohol-free and caffeine-free drinks a day
• avoiding foods that irritate the bowel such as coffee and alcohol
• avoiding foods that cause wind such as beans or cabbage

The background: formed stool is much easier to hold back than liquid. Anyone who gets the consistency under control often already gains a grade of severity.

Pelvic floor training

An intact pelvic floor contributes a lot to reducing bowel incontinence. Specialised physiotherapy is expressly recommended – not exercises from a video, but individual instruction.

Biofeedback and electrostimulation

A biofeedback device makes the pressure values visible. This is the only way to check whether the right muscle is being tensed – with disturbed sensation this is the decisive point. In addition, the sphincter can be trained by electrostimulation.

Sacral nerve stimulation

With proven nerve damage in the pelvic area, a small pacemaker can help, implanted in the buttock and sending weak electrical impulses to the sacral nerves.

Surgical procedures

For injuries to the sphincter, reconstructive procedures are an option, up to muscle transplants, for example from the thigh.

Bowel irrigation

For neurogenic causes and severe cases, transanal irrigation is an established procedure: the bowel is emptied according to plan, making the time in between controllable. How this works is explained in our article on anal irrigation.

Where to turn

Consultation at a recognised advice centre or a certified continence and pelvic floor centre is recommended. A diary is helpful, in which you record over a few days:

• when and in what form the loss occurred – air, liquid, solid
• whether there was a warning sensation or not
• what you ate and drank beforehand
• how often you had regular bowel movements

And the most important sentence from the professional society, which only few follow: “Do not be ashamed.” You should see a doctor as soon as the body sends clear signals – already with uncontrolled passing of wind or the beginning of soiled underwear.

Frequently asked questions

Is this a normal part of ageing?

No. Declining tissue elasticity in old age is one of the causes named, but does not make faecal incontinence normal – and certainly not something untreatable.

I only lose wind. Is that already something?

Yes, that is grade 1. That is exactly the best time for an assessment.

Do I have to change my diet permanently?

Regulating bowel movements is a central part of treatment. What you have to leave out in detail becomes clear from the diary – blanket lists of forbidden foods help little.

Can I get pads on prescription?

Absorbent aids for faecal incontinence can be prescribed. How the supply process works is explained in our article on medical aids on prescription.

Can constipation be behind it?

Yes. Constipation can overstretch and weaken the sphincter – which is why regulating bowel movements comes so early in treatment.

Your next step

We stock absorbent products for faecal incontinence as well as bowel irrigation systems from Coloplast, Qufora and Braun. Clarifying the cause, however, belongs in medical hands – care is the second step, not the first.

Sources

• Faecal incontinence, Deutsche Kontinenz Gesellschaft e.V. (in German)
• Urinary and faecal incontinence – inform yourself, Deutsche Kontinenz Gesellschaft e.V. (in German)