The Unspoken Challenge: Addressing Faecal Incontinence

FI Faecal Incontinence Dr Mark Wong Te Ching

Not being able to control your bowels can lead to embarrassing situations. It is also a common condition called faecal incontinence.

In this article, we delve deep into faecal incontinence, its impact, and the urgent need to break the taboos associated with this condition with Dr Mark Wong Te Ching, Colorectal Surgeon at Mark Wong Surgery.

What is Faecal Incontinence?

Faecal incontinence (FI) is the inability to control bowel movements. People with FI cannot control their anal muscles and bowel movements,  resulting in leakage of faeces and/or gas. It’s a sensitive issue, often overshadowed by stigma and embarrassment.

Dr Wong added, “If left untreated or mismanaged, FI can lead to severe skin irritation and depression, causing affected individuals to withdraw from their families and society. “

The Numbers Speak

In Asia, around 7% of adults over 40 experience FI. That’s nearly 320 million people! The majority don’t seek medical attention due to shame.

Why Does Faecal Incontinence Occur?

Several reasons lead to FI:

  • Muscle damage. Childbirth or surgery can weaken the muscles controlling the rectum.
  • Nerve damage. Conditions like diabetes or trauma can affect rectal sensation.
  • Disease. Diarrhoea, constipation, or inflammatory bowel disease can contribute.

Age Matters, but it’s not Everything

Yes, older people are more prone to having FI. However, young adults and children can suffer from this condition too. In Asia, an estimated 3% of the younger population face this issue.

Risk Factors

Dr Wong shared that “The risk factors for women include instrument-assisted delivery (e.g. forceps and vacuum-assistance), large birth weight and a prolonged second stage of labour.  

In men, the risk factors include anal sphincter injuries due to anorectal procedures, e.g. surgery for conditions such as haemorrhoids, anal fissures/fistula or colorectal cancer.”

For men, the risk factors are “anal sphincter injuries due to anorectal procedures e.g. surgery for conditions such as haemorrhoids, anal fissures/fistula or colorectal cancer.  Radiation treatment for conditions like prostate cancer also  contributes significantly to faecal incontinence in males.”

The Asian Perspective

Diet, lifestyle, and rapid urbanisation affect FI prevalence in Asia. Increased processed food consumption and sedentary habits contribute.

Addressing the Challenge

Overcoming the stigma is the first step. Speaking up and seeking medical advice can lead to solutions. Treatment options are aplenty:

  • Dietary changes. Consuming more fibre helps to improve stool consistency, as firmer stools can result in fewer ‘leaks’. 
  • Medications. Drugs can improve stool consistency, including anti-diarrhoeal agents and stool-bulking agents like fibre supplements. 
  • Pelvic floor exercises. Strengthening pelvic muscles makes a difference. It can condition and coordinate anal muscle movements for improved sensation and control. 
  • Surgery. For severe cases, surgical solutions exist. They include Sacral nerve stimulation (SNS),  Percutaneous Tibial Nerve Stimulation (PTNS), Injectable bulking agents, Anal muscle (sphincter) repair and Rectal prolapse surgery (or Rectopexy). 

The Road Ahead

Addressing FI is not just about health. It’s about dignity, quality of life, and societal well-being. Asia has the resources and will. Now, it’s time to act.

Dr Wong stated, “There is an urgent need to educate the community and health care providers about the magnitude of the problem as the number of sufferers is likely to increase with our rapidly ageing population. Furthermore, in most cases,  effective treatment is available, and sufferers need not live  with the malady.”

In Conclusion

FI is more than a medical challenge. It’s a societal issue needing urgent attention in Asia. Therefore, by breaking the silence, seeking help, and implementing solutions, millions can lead better lives.

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