2 Indications and current treatments
2.1 Faecal incontinence is an inability to control bowel movements, resulting in the involuntary passage of stools. Causes include problems in the rectum, problems with the sphincter muscles (such as damage caused by childbirth), or nerve damage (such as multiple sclerosis, stroke or spina bifida). Faecal incontinence can also occur in conditions such as dementia or severe learning disability.
2.2 Initial management of faecal incontinence includes interventions related to diet, bowel habit and toilet access, and medication (see Faecal incontinence: the management of faecal incontinence in adults, NICE clinical guideline 49). Specialised management options depend on the underlying cause and include pelvic floor muscle training, bowel retraining, specialist dietary assessment and management, biofeedback, electrical stimulation and rectal irrigation. The main surgical treatment is anal sphincter repair. Sacral nerve stimulation is sometimes used for people with faecal incontinence in whom sphincter surgery is deemed inappropriate. If a trial of sacral nerve stimulation is unsuccessful, a neosphincter may be considered (stimulated graciloplasty or an artificial anal sphincter).