Management of faecal incontinence in adults

Adults who involuntarily lose solid or liquid stools no longer have to suffer in silence, thanks to new national standards on treating and managing the condition, known as faecal incontinence.

The standards, published by the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care, come into immediate effect.

It is estimated that more than half a million adults in the UK have faecal incontinence, but many are too embarrassed to seek help. High-risk groups include frail older people, women who have recently given birth and those with diarrhoea or a neurological or spinal disease. (Up to 1 in 10 people in the UK will have the condition at some point in their lives.)

'Faecal incontinence has a massive impact on the quality of life of the individual. It may stop them doing the activities they previously did every day such as shopping, going on holiday, or going to church,' explains Marlene Powell, a community-based continence adviser. ‘Many people will even give up their careers, for fear of being caught in an awkward situation,' she adds, citing a secondary school head of department who gave up her job rather than tell her colleagues about the problem.

The new national standards call for healthcare professionals to break what is a ‘healthcare taboo', by asking people at risk whether they have any signs of the condition. Anyone with symptoms should then be fully assessed to determine the underlying causes and, where possible, a cure.
Where it is not possible to find a cure, they should manage the condition as effectively as possible. Options include:

• giving advice on simple dietary changes
• recommending a small dose of loperamide to firm loose stools
• recommending pelvic floor exercises to improve the coordination and strength of the pelvic muscles
• advising the patient to make contact with support groups
• giving advice on skin care
• perhaps ensuring that individuals carry a RADAR key to access public toilets.

Ms Powell adds: 'There is no need for anyone with faecal incontinence to suffer in silence. This guidance aims to give people confidence to know that there are a number of options for curing the problem or managing it – and that they will be able to get their life back to normal.'

The new standards are set out in the guideline ‘Faecal incontinence: the management of faecal incontinence in adults' available at www.nice.org.uk/CG49