Faecal incontinence and anorectal dysfunction

Abstract

Continence and normal defecation relies on the complex interaction of the colon (motility and consistency of stools), rectum (sensation, compliance, and anatomy), and the anus (sensation, structure, and function). The overriding complex neurological control is also important. A disorder of any of these may lead to faecal incontinence. This can affect over 10% of adults and at least 1–2% of patents will report these as major symptoms. In itself, faecal incontinence is not a disease but a symptom and it is necessary to take a full history and examine a patient to identify any underlying diseases or pathology that may need treatment before focusing on managing incontinence. The aim of any treatment for faecal incontinence is to improve the patient’s quality of life and give them some control back over their bowel function. Constipation is an increasing problem in the Western world and it is widely accepted that approximately 50% of adults are constipated at any point in time. Constipation encompasses a multitude of symptoms; the general mental health and social functioning of people with constipation is impaired when compared to health controls. The symptoms of constipation occur in a large percentage of the general population. The impact on quality of life when they occur for a long period of time is large. However, patients often have many coexisting other pelvic floor disorders. Although there are surgical options available, it is important to treat conservatively and understand the complexity of the other issues involved in patients presenting with constipation.