Sufferers lose self esteem, have a reduced quality of life and only one third of these people actively seek medical advice. Faecal incontinence in the elderly is a major cause of admission to residential care and in this setting is often accompanied by urinary incontinence.
Central control
The central factors that
are important are the requisite intellect to recognise
anorectal signals, intact functioning central pathways and
the necessary mobility to get to the toilet.
People with intellectual impairment or significant neurological disorders such as Parkinson's disease or spinal cord degeneration have a high incidence of bladder and bowel incontinence. Patients confined to wheelchairs or walkers or those who have difficulty bending the hips to sit comfortably can have normal awareness but may have difficulty toileting in time to avoid accidents.
Local control Local rectal factors that are important are
- intact anal sphincters
- a functioning
puborectalis muscle to pull the rectal angle
forward
- the presence of soft tissue anal cushions to bulk up the exit
- a healthy rectal wall
with intact sensation which informs the
individual of rectal content and fullness.
The Anal Sphincters
The anal sphincters are the muscles that close off the lower
end of the bowel. These two muscles wrap in an inner
(Internal Anal Sphincter) and outer (External Anal
Sphincter) circle around the anal outlet.
The puborectalis muscle is continuously tensioned and acts
to pull the lower part of the rectum forward, closing off
the exit angle. When defecation is planned the muscle
relaxes and the anorectal angle widens. Any damage to this
muscle or its innervation will disrupt this sequence.