Faecal Incontinence
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Introduction

Occurs in 15% aged >65Y, increasing incidence with age in men only. Causes include:
  • Sphincter weakness (following childbirth/surgery);
  • Anal/rectal pathology e.g. fistulae, Crohn’s, proctitis;
  • Neurological disease (chorda equine, pudendal nerve);
  • Dementia and unconsciousness;
  • Diarrhoea (infective or due to malabsorption);
  • Constipation (common in the elderly, diabetes, hypothyroid);
  • Drugs e.g. antibiotics, muscle relaxants, PPIs, metformin.

Investigations

  • DRE/PE – assess sphincter function and rule out impaction. Check perianal sensation to rule out neurological cause.

Management

  • Perianal exercises may be used in sphincter weakness.
  • Surgical anal sphincter repair.
  • Steroids or GTN gel – In the presence of anorectal pathology.
  • Bowel training can be used to develop predictable pattern.
  • Diarrhoea and constipation should be managed

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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