Many women, as they get older, experience urinary incontinence, to the extent that most women believe that it is an integral part of the ageing process and freely talk about it. In contrast faecal incontinence is something that is much less openly discussed.
As a consequence, the women who suffer from it tend to do so in silence.
The underlying cause of faecal incontinence is often the same that produces urinary incontinence, mainly because of a failure of the pelvic floor muscles. With faecal incontinence, this would be as a result of a direct injury to the anal sphincter muscles that occurred during childbirth, but it only manifests once again with the ageing process. Obstetric injury to the sphincter complex is a well recognised phenomenon and in the majority of cases it is picked up by the obstetrician or midwife and repaired at the time. However, some are occult (there is no tear of the skin but there has been a tear of the underlying muscle), and it is these that tend to cause a problem later in life.
Faecal incontinence is socially debilitating as it prevents women from interacting for fear of having an accident. Recent advances in our ability to identify obstetric injuries, using a combination of ultrasound and MRI, have improved the management of patients who have a defect in the sphincter muscle. Equally new techniques such as Sacral Nerve Stimulation (in effect a pacemaker) has meant that patients presenting with a generally weak muscle can now be helped in a very straightforward way with dramatic results. The majority of patients can be treated successfully to the extent that it transforms their social life.