A Brief Guide to Bowel Control Problems in Adults

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In depth	Making the case	Bladder control	Bowel control	Primary care	Your baby, your bladder , your bowels
Male pelvic organs	Female pelvic organs	Continence Foundation review	Prevention of incontinence	Project work	Your baby, your bladder , your bowels

Minimum history
- nature (urge or passive) of incontinence
- when started
- how often now
- nature of stool

Minimum examination
- abdomen: PR
- evacuation difficulties
- rectal bleeding
- effect on lifestyle
- past medical, surgical, obstetric and drug history
- proctoscopy/sigmoidoscopy if indicated

Impairment	Possible causes	Usual symptoms	Treatment	Possible Referrals *
Anal sphincter weakness or damage	Childbirth Anal surgery Direct trauma Rectal prolapse Idiopathic weakness	Urgency/urge incontinence (external anal sphincter)	Sphincter exercises if weak Surgical repair if simple disruption	Colorectal surgeon Gastro-enterologist Geriatrician District nurse Neurologist Rehabilitation specialist nurse Continence specialist nurse Colorectal specialist nurse Physiotherapist
Anal sphincter weakness or damage		Passive soiling (internal anal sphincter)	Induce firm stool with diet or medication (No clear surgical options)
Intestinal hurry	Infection Inflammatory bowel disease Irritable bowel syndrome Drug-induced	Frequency, urgency, urge incontinence, loose stool	Treat underlying cause Constipating agents
Impaction with overflow	Immobility Physical or mental frailty Medication Dementia	Passive loss of "spurious diarrhoea" or of solid stool	Disimpact, then keep rectum empty
Neurological disease or damage	Spinal injury Multiple sclerosis	Reflex incontinence or impaction with overflow	Regulate bowel habit Control evacuation with laxatives or evacuants or irrigation

* Urgent referral: recent change of bowel habit; rectal bleeding; pain.

Referral for anorectal physiology studies and anal ultrasound within 1-2 months if conservative measures failing.

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