Definition and diagnosis of faecal incontinence in adults
Faecal incontinence is defined as the recurrent uncontrolled passage of faecal material occurring over at least 3 monthsRome Foundation Inc., 2016. Faecal incontinence is considered abnormal once toilet training is complete (generally a developmental age older than 4 years). The cause is often multifactorial, and can include weakness of the pelvic floor–sphincter complex, alteration of visceral sensitivity, impairment of rectal storage capacity, or the presence of liquid stool (which overwhelms continence mechanisms). Commonly, more than one pathology co-exists.
Focused history and examination are important to exclude contributing pathology such as neurological disorders (eg multiple sclerosis), gastrointestinal pathology (eg inflammatory bowel disease, irritable bowel syndrome) and sphincter injury. Exclude underlying constipation with either faecal seepage or overflow diarrhoea.