what is anal incontinence?
Anal incontinence can be defined as the accidental loss of wind or stools (either liquid or solid)
We think that around 1 in 10 people will experience it at some point, but statistics are hard to come by as it is such a difficult topic to discuss
Leaks may happen without any warning, or you may get a strong urge to empty your bowels and be unable to reach the toilet on time
Sometimes it is called faecal incontinence, but the term anal incontinence includes the accidental loss of wind too
Whatever the cause, and however hard it is to discuss, there is plenty of help available so don’t put up with it!
1. The majority of women who develop FI have had a childbirth injury in the past. It is not normal and you don’t have to
just accept it. The highest risk is in women who had had tears and needed stitches afterwards (OASI -Obstetric Anal
Sphincter Injury). Sometimes women don’t know if they have had tears or a cut (episiotomy) and how bad they were.
2. Don’t forget, women who have had a caesarean section can have problems with their bowels too. This could be due to
nerve injury during pregnancy or from having a trial of vaginal delivery and then needing an emergency C-section.
3. Most women develop FI around or after the menopause, even if the main contributing factor is childbirth injury from
many years ago. The effect of an ageing pelvis and loss of muscle strength from reduced hormone levels play a
significant role. But you don’t have to just accept this as a ‘normal’ part of getting older. Seek help!
4. Don’t forget that sometimes bowel cancer can occasionally present as faecal incontinence. Things to look out for
include; change in your bowels for more than 3 weeks (poo is more loose/hard, change in the number of times you do
a poo), blood in the poo, weight loss, feeling tired, anaemia. If you have these symptoms see your GP urgently.
5. Faecal incontinence doesn’t just affect women, men can also develop FI after some cancer treatments (rectal cancer
surgery, radiotherapy to the pelvis for bowel, bladder or prostate cancer, surgery around the bottom (e.g.
haemorrhoids). Don’t just hide away – there are treatments that can help you but you need to ask for it.
Coping with symptoms
It is so important that you talk to your GP, pelvic health physiotherapist or other health care professional about your symptoms, so that you can get treated whenever possible!
Until you have a treatment or management plan in place, try getting yourself a “Just can’t wait” toilet card from www.bladderandbowel.org, or download their app, to make access to toilets in shops and restaurants easier
Take spare underwear and wet wipes when you are out and about, to help cope with leakage
If you need to use pads at times, ask your GP, health care provider or pharmacist for specialised products that are designed for leakage of stools – as they usually work much better than those designed to manage urine leaks. Shaped pads and absorbent pants are often more secure than standard rectangular pads, for example.
1. It can be a difficult topic to talk about, but seeing your GP is the first step in getting assessed and started on the road to
2. You can see a Pelvic Health Physiotherapist or Colorectal Nurse for an assessment and they will start by taking a full
history of your symptoms and how they are affecting your daily life and wellbeing.
3. The second part of the assessment may involve a gentle rectal examination to assess the strength and function of your
pelvic floor and anal sphincter muscles. This helps determine what treatment or investigations you may need.
4. You may also be sent for some tests that can include an ultrasound scan of the anal sphincter muscles and anal
manometry which checks the squeeze pressures of your muscles and the nerve function.
5. The hardest part is taking that first step in speaking up about the symptoms you may have of AI. Once you’ve done it
there is a lot of help and support available to get you managing your symptoms and feeling better! The assessment
process isn’t something to worry about, it is all done at your pace by health care professionals who are experienced in
– Conservative management:
2. biofeedback / tibial nerve stim / bowel retraining ‘holding on’
3. pelvic floor exercises
4. medication / rectal irrigation
– Surgical management:
5. bulking agents, sacral nerve stim, sphincteroplasty
Try keeping a food and symptom diary to see the impact that food and drink has on your symptoms. This is very individual but you may find items that trigger an increase in wind, small or bowel activity. You can then manage your diet to support your bowels more.
Peppermint tea can be very helpful at reducing wind, thereby decreasing that amount of wind leakage that you may experience
Try and develop good bowel routines to encourage your bowels to empty fully and regularly. This helps reduce leakage too. Try going to the toilet around 20 minutes after having breakfast and a hot drink, don’t rush and try not to ignore it when you need to go and empty your bowels!
Do your pelvic floor exercises daily! Try the Squeezy app to help remind you
Managing stress can help considerably – take the time to learn some relaxation nd mindfulness techniques that you can call on in stressful moments
How to access treatment
See your GP
Visit a pelvic health physiotherapist – you can find one by using the directory at www.squeezyapp.com/directory or going to www.thepogp.co.uk – you can refer yourself in some cases, or your GP can refer you to your nearest service
If you have had a baby recently, ask your midwife or health visitor for advice
Don’t give up until you have accessed help!
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