Causes of Faecal Incontinence
Continence is complex and relies on a number of factors. Incontinence is a complex problem with many possible causes, some are very common and others seen less frequently. Presentations and symptoms may be multifactorial, requiring a dynamic person-centre
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Causes of Faecal Incontinence Rhian Sunderland and Lorraine O’Brien
7.1
Introduction
Continence is a complex bodily function relying on several factors. A combination of a normal transit of a normal consistency of stool (Type 3–4, Bristol Stool chart), a rectum with a normal capacity which provides a holding space with normal v oluntary control and a fully-functioning sampling reflex provided by the anal sphincters [51]. Faecal incontinence is defined as involuntary leakage of liquid or solid stool at a socially inappropriate time [6]. The term anal incontinence is used if including flatus incontinence within the definition of faecal incontinence [1].
7.2
Measuring Faecal Incontinence
Measurement of faecal incontinence is difficult due to its subjective nature and some might argue that it should be assessed as simply present or absent [5]. This does not allow for assessment of clinically important changes such as assessing the severity of the patient’s symptoms, nor does it reflect on how the patient’s quality of life is affected. The subjective perception of the patient must always be considered when trying to evaluate faecal incontinence in a clinical setting. This means that a symptom based approach rather than a disease based approach is needed [79], as it encompasses a subjective assessment i.e. how the patient would describe their symptoms and in their own words how it is affecting their lives. This is not to say that objective measurements are not needed. Measurements such as anorectal manometry, endo-anal ultrasound and electrophysiology testing are necessary in determining possible causes for faecal incontinence in a measurable way [79]. R. Sunderland, BSc (Hons) Physiotherapy (*) • L. O’Brien, MSc, RGN The Sir Alan Parkes Physiology and Neuromodulation Unit, St. Marks Hospital, Watford Road, London, UK e-mail: [email protected] © Springer International Publishing Switzerland 2016 B. Collins, E. Bradshaw (eds.), Bowel Dysfunction, DOI 10.1007/978-3-319-43214-4_7
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Most commonly used measuring tools for faecal incontinence include the Wexner score and St Mark’s scoring system, [93] which are both severity measures. In a study by Seong et al. [79], they were compared to establish if there was correlation between the severity measure and the patient’s subjective perception. The study found that the Wexner, Vaizey (St. Mark’s score), Rothenberger and Faecal incontinence Scoring Index (FISI) all had significant correlation. Of the scores, the highest was seen with the Wexner score and the lowest with the Rothenberger score. The St Mark’s score however has been shown alongside the Wexner score to reflect well a patient’s subjective view on how treatment for faecal incontinence has affected their symptoms [22]. Much of the research into these scoring systems displays a lack of assessment of symptom severity and quality of life for people with faecal incontinence. The International Consultation on Incontinence Questionnaire Bowel (ICI-QB) has been reported fo
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