Faecal incontinence is the involuntary or inappropriate passage of stool; the term 'anal incontinence' also includes incontinence of flatus (wind or fart). Incontinence of flatus is a horrid and unsociable problem and unfortunately is common in CES. You cannot predict or feel it happen and it is uncontrollable. Some proprietary agents are available to reduce the odour.

In CES patients, who generally have a decreased sensation of rectal fullness, the back passage is not emptied regularly and the stool becomes dry, hard and difficult to pass. Thus a hard faecal lump develops in the rectum of which the patient is not aware. This is called faecal impaction and it is a common problem in CES. Overflow incontinence occurs when liquid stool bypasses the hard mass and causes faecal incontinence. The treatment of overflow incontinence is removal of the lump by manual evacuation and/or enemas.

A common problem in CES is accidental leakage or seepage of stool of which the patient is unaware. This is usually associated with weakness of the sphincter. Varying stool consistency (dry, hard stools versus liquid faeces) can also aggravate faecal incontinence because of impaired sensation of rectal fullness or an inability to distinguish between faeces or flatus. Finally, a poor diet can cause either diarrhoea (excessively loose stools) or constipation. From time to time, regardless of diet, we all can have bouts of diarrhoea and this is especially distressing for patients with CES.

Dietary advice:
Where stool consistency in general is a problem, patients can adjust their diet and fluid intake in order to have a harder stool. A balanced diet including fresh fruits and vegetables is essential.

Pelvic floor exercises:
Pelvic floor exercises can improve your awareness of the muscles of the pelvis and improve the strength of the anal sphincter. Some physiotherapists and continence advisors specialise in teaching these exercises using computer-aided perineometry.

Pads, pants and anal plugs:
Depending on your needs, protective pads and pants are available for yourself and your bed through the NHS for those living in the UK. In patients with problems of continuous leakage of stools, anal plugs are also available on the NHS and can give you the extra confidence to lead a normal life. Ask your community or continence nurse, doctor or pharmacist for information and availability.

Constipating agents (antidiarrhoeals):
Patients who experience incontinence of faeces associated with loose stool or who have a passive anal seepage of soft stool may benefit from low dose constipating medication. Loperamide or Codeine phosphate reduce faecal incontinence and improve stool consistency. These medications need to be taken prior to eating, and the dose individually titrated. Some patients intentionally stop natural bowel emptying by using constipating agents and are thereby able to plan emptying for a convenient time, when they use suppositories or a mini enema to initiate a bowel motion. Such planning gives an element of control and predictability to bowel function, but the use of constipating agents should always be discussed with your doctor or nurse as there is a risk of developing severe impaction if excessive medication is taken.

Managing intractable faecal incontinence:
Other than pads, very few products have been designed specifically for faecal leakage. In certain cases surgery is necessary to create a stoma.

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